Iowa HHS director says agency will work to make health care more accessible • Iowa Capital Dispatch - Iowa Capital Dispatch

Iowa Health and Human Services Director Kelly Garcia said Friday that the state agency plans to focus on making health care more accessible across the state through changes to Iowa’s public health providers, like the new system for behavioral health.

Garcia answered questions from reporters on “Iowa Press” about the state’s new Behavioral Health Services System (BHSS) signed into law by Gov. Kim Reynolds earlier in May. This system replaces the current Mental Health and Disabilities Services (MHDS) system made up of 13 regions and combines it with the state’s substance abuse treatment system — made up of 19 regions — into a new public health care system of seven districts.

The BHSS system will go into effect in 2025. While Garcia praised the system as currently set up, she said there was significant work left to be done in the year before implementation. She said  much of the next year will be spent assessing and refining the program to ensure that the new system is accessible to Iowans as possible. In the past, she said, there have been issues with people in certain regions not being able to obtain needed services based on their location.


Unlike the previous public mental health care system, she said, the BHSS will allow for more accountability measures through the state. It will mean that when Iowans are having problems, the state does not need to “wait for a cataclysmic event to decide whether the system is working or not,” she said.

“What we want here is for Iowans to have equal access no matter where they live and what their needs are,” Garcia said. “We shouldn’t have county or region barriers to that system. … The timeline kicks off a year worth of transition. And so come July of next year, we will have a newly redesigned system. Will that be final? No. We will be in a mode of continuous improvement and deep evaluation to ensure that all Iowans have access to services.”

While the new BHSS system is being implemented, lawmakers did not provide additional funding for it. When asked by moderator O. Kay Henderson about $2o million in unspent funding that could have been used for mental health services, Garcia said the department is planning to use the next year to determine funding needs.

The determination includes looking at different ways that behavioral health services can be provided and paid for using Medicaid and other sources in the next year, making sure that the state is paying for “evidence-based practices” and drawing down federal matches for funding when applicable, she said.

“I get asked all the time, ‘Do we need more money in the system?’ And the answer is, ‘I don’t know, I can’t tell you quite yet,'” Garcia said. “What we see there, Kay, is unspent balances and some duplication of funding as well. And so, we’re teasing through that now that we’ll be able to see it at a deeper level, and then that measurement comes into play, because we may need more money in the system, but today I can’t see all of it.”

Disability care moved to separate HHS division

In addition to the consolidation of mental health and substance use services, the law also moves disability services, currently provided by MHDS, to the Iowa Department of Health and Human Services’ division of disability and aging services.

Garcia said this change will help provide a “brightly lit path” for individuals with disabilities and their families to understand the care and public resources available to them — in addition to moving toward more care being provided close to home for high-needs individuals.

Garcia said that in talking with people with significant health needs, she and HHS staff have repeatedly heard that many want to stay with their families and community. Many of the department’s changes are a means to allow people to stay at home and close to loved ones while still accessing needed care, she said.

She said the state’s Home- and Community-Based Services program allows Iowans who meet the “required Medicaid-covered level of care” typically provided in nursing and care facilities or hospitals to receive services at home through a Medicaid waiver system. Providers of needed assistance are paid under the Medicaid system from a fee-for-service payment.

The HHS director said in-home and community health care services are beneficial to Iowans with disabilities and specialized needs — but that the process for getting these provisions can be complicated, and “in fact, not really meeting the needs of Iowans today.” She said the department is having conversations with people using the program, advocates and health care providers on how to best ensure people are accessing needed services.

Federal nursing home staffing rule comes amid existing shortages

One of the motivating factors for Iowans seeking alternatives to traditional nursing homes are the reports of inadequate care and understaffing at the state’s long-term care facilities following the COVID-19 pandemic.

Legislation aimed at addressing these issues through measures like a proposed cap on allowable charges for temporary staffing agency workers at Iowa nursing homes did not pass this session. However, this year’s Health and Human Services budget did include a provision establishing joint training sessions between nursing home staff and state inspectors about common complaints.

There has recently been federal action to address nursing home shortages, with President Joe Biden’s administration setting new rules for nursing home staffing standards at facilities that receive taxpayer money through Medicare and Medicaid. Officials representing Iowa care providers have said a majority of Iowa nursing homes will struggle to meet the new standards while facing workforce shortages.

One measure proposed to help health care providers meet the new requirements is raising the state’s Medicaid reimbursement rates, providing more state funds for covered services. Garcia said HHS will be conducting its regular reimbursement rate review in the 2024 legislative session.

She also said the biggest focus of the HHS department in the discussion of nursing homes is “quality care,” not necessarily keeping all current facilities open and in business.

“We know that is what individuals expect and what family members want for their loved ones, and so, we have a variety of different initiatives through the Medicaid program that really hone in and focus on that,” Garcia said. “We do see significant changes in the need for nursing facilities — bed capacity that is lower than makes a sustainable business operation. And so, we work with the Association of Health Care Providers, we work with individual nursing facilities on those transition plans as desires of what Iowans want shift. Most Iowans are saying they want to stay at home. And so, when we think about that rebalancing of home and community-based services along with institutional settings, it’s not an either this or this, it is a network. We have to have a full continuum and all parts have to be strong.”

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