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Out-of-staters stretch mental health budget

Clinton Herald - 1/21/2021

Jan. 21—CLINTON — The Eastern Iowa Mental Health Region is hoping for a solution to the number of out of state individuals utilizing region mental health services.

Out-of-state clients impact the mental health budget by coming into the Region and using Region services, Eastern Iowa Mental Health Region CEO Lori Elam said.

The situations impacts the general assistance and sheriff's office budgets as well, she said.

"Many of them end up under a mental health commitment, and so, then we are paying hospital, attorney, sheriff, that type of thing," Elam said.

"Because many of them don't have insurance. The general assistance piece of it, they're seeking rent. We can't help with rent assistance if they don't have a job to pay for their rent going forward," Elam said.

"We offer bus tickets, so if they want to go back home, we're happy to send them back home. Or we're helping with utilities," said Elam

Elam doesn't want to sound "cold and cold hearted and cruel," she said, but taxpayer dollars are for people who live in Iowa. The problem is not just people from from Illinois, Elam said, but from all over the country.

Elam requested that state legislators consider changing the residency definition in Iowa Code. If the Region could get some tweaking to the language in Iowa Code, they could have the ability to say they are not going to pay someone's rent or pay for something related to mental health services if they do not meet residency requirements, Elam said.

This would allow the Region to protect taxpayer dollars, Elam said. The Region is trying to stretch mental health funds as far as they can. This problem is not among border counties only, but all around the state, Elam stated.

Iowa House Rep. Mary Wolfe asked what would happen to out of state individuals who do not meet the residency requirements if Iowa Code were adjusted as requested by the Region.

Wolfe said she realizes there is no easy answer. "I just wonder ... the cost to the state of leaving these people untreated, especially the ones in crisis," she said.

"I mean they're going to end up in our jails, and our jails will be treating them, or our prisons, even worse. But yeah, I totally get it, and maybe we can all think outside the box and think of something," Wolfe said.

Elam said that under the proposal, the Region could decide not to provide services if the individual is not a resident of Iowa. Saying no to someone is hard, she said, but the Region cannot pay for everyone.

It is unfair to taxpayers to use funds for someone traveling across the state who is not a state resident, Elam said.

"Those are really tough decisions that we deal with every day," Elam said. "Unfortunately, somebody could get really, really sick and end up under a mental health commitment and be in the hospital. And then we have to decide, do we pay the hospital even though they're not an Iowa citizen or a Scott County citizen or an Eastern Iowa citizen?

"We don't want to leave our hospitals in the lurch and not be paid for services rendered," Elam said. "So we would probably pay them, but time after time and time and time again, then we start looking at our budget numbers and trying to figure out how do we make this work. We can't keep stretching them thinner and thinner."

Eastern Iowa Mental Health Region Board Chairman and Scott County Representative Ken Beck said this change would give the Region the option to offer services to out of state residents. The region currently does not have the option to turn individuals away, he said.

The state used to have a payment program through which the Region could send in bills for out-of-state residents to get reimbursed by the state. The state payment program essentially went away, Elam said.

"I believe there still is a small portion of a state payment program, but I'm not real sure how it's even accessed, if it is at all," Elam said. "So there used to be something for this but it has long gone since."


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