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'It's a crisis': Democrat Rita Hart hears how privatized Medicaid has affected mental health care

The Hawk Eye - 8/16/2018

Aug. 16--MOUNT PLEASANT -- State Sen. Rita Hart learned up close Wednesday how Iowa's privatization of Medicaid services has affected local mental health care providers over the last two years.

Hart, of Wheatland, was selected in June by gubernatorial candidate Fred Hubbell to serve as his running mate in the campaign to unseat Republican Gov. Kim Reynolds in November.

Hart visited Hillcrest Family Services in Mount Pleasant to hear from some of its staff the challenges they face trying to provide mental health care services in small towns and rural communities.

The organization is based in Dubuque, but also serves southeast Iowa in Mount Pleasant, Wapello and Washington.

Of all the difficulties raised during the hour-long discussion, from conflicting standards between the Managed Care Organizations, administrative burdens and a lack of understanding about how to best serve the mentally ill, Hart heard from all sides that the biggest problem with the MCOs was their failure to reimburse providers for health care services they give patients.

"I think that probably the safest statement we can make is that providers would just be happy to recoup costs," said Sarah Berndt, coordinator of disability services for Henry County. "Nobody's looking to make a ton of money, they just want to make back what it cost them to do the service that they're doing. I don't think that's too much to ask any system."

At Hillcrest, division director Chris Betsworth said a significant portion of his time was spent justifying its services to United Healthcare and Amerigroup, the two MCOs operating in Iowa.

"It all comes down to spending more and more time justifying what we're doing even when it's already been well documented and justified," said Betsworth, who acknowledged Hillcrest has lost hundreds of thousands of dollars since former Gov. Terry Branstad switched from state-run Medicaid to private insurance companies.

Hart, a former educator and farmer who has been in the Legislature since 2013, said she and Hubbell were "committed to turning the Medicaid privatization back under state control."

"We're going to have to do that in a thoughtful, careful manner," she said, deriding the short timetable Iowa had to adjust after Branstad unilaterally moved the state to managed care.

Mary Lane, lead therapist at Hillcrest in Mount Pleasant, discussed how the state better needed to address how mental health disorders and substance abuse worked hand-in-hand.

"Trying to integrate both has been very difficult from my experience," said Lane. "It's very difficult to get funding for those who are struggling with substance abuse and mental health."

In the past, Lane said, agencies like Hillcrest would be reimbursed by Iowa Medicaid for at least 21 days of treatment for its patients. But when the MCOs came in they "slashed" the number of reimbursable days to between seven and 14.

"We're having to send these individuals out, or, certainly, take that loss as an agency," Lane said. "That's been very difficult because substance use is everywhere. Once we send them out onto the street, where are they going to go? They're likely going to relapse."

Berndt and Betsworth agreed grouping mental health care providers into geographical regions across the state has helped fund some new initiatives through taxpayer dollars, such as crisis telehealth services between Hillcrest and Great River Medical Center in West Burlington and the emergency department at Henry County Heath Center in Mount Pleasant.

"We try very, very hard to be a positive path of entrance into the system so we're not stigmatizing people," Berndt said. "We're trying to give them a lot of venues to come into the system."


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