The Crawford County Board of Supervisors on Tuesday voted 5-0 to deny Woodbury County entry into the Rolling Hills Community Services mental healthcare region.
Dawn Mentzer, Rolling Hills CEO, visited the supervisors meeting on Tuesday to present a resolution of the Rolling Hills Governance Board that recommended approval of Woodbury County’s request to join Rolling Hills effective July 1, 2019.
Rolling Hills currently comprises seven Iowa counties, including Crawford, Buena Vista, Calhoun, Cherokee, Sac, Ida and Carroll.
A majority of the Rolling Hills counties would have to vote in favor of adding Woodbury for the resolution to pass. So far, Cherokee and Buena Vista counties have voted to add Woodbury.
Woodbury County is scheduled to exit Sioux Rivers Regional Mental Health and Disability Services on July 1 due to problems working with Sioux and Plymouth counties in that services region.
Mentzer said adding Woodbury County would double the population within Rolling Hills, which she said was important to some of the members of the Rolling Hills board.
Due to legislation approved in 2017, mental health regions will have to build access centers, mobile crisis units and community-based crisis stabilization services, she said.
Adding a high-population county would help provide the new, and expensive, services.
Mentzer said that Rolling Hills would require Woodbury to provide a set amount of resources to come in on a level playing field with the counties already in the region.
Woodbury County would have to contribute $1 million to Rolling Hills on July 1, 2019, and would also have to provide their first quarterly per capita payment at that time.
“If they don’t have the financials in the spring of next year, then the deal is off the table,” Mentzer said.
She noted that Supervisor Cecil Blum, who is the board’s mental health advisory board representative, has been consistently opposed to Woodbury County’s entry into Rolling Hills.
She said his concerns were valid about not wanting to have to subsidize Woodbury County if that county did not have enough money to contribute.
Supervisor Dave Muhlbauer asked Mentzer what Woodbury County would bring to Rolling Hills other than additional population.
Mentzer said she believes Iowa will end up with a smaller number of mental healthcare regions in the near future.
The state currently has 14 regions.
“I think the writing is on the wall that we are probably going to be down to six or seven regions in three to five years,” she said.
Mentzer said the Rolling Hills board believes adding Woodbury would be more advantageous than having to add six or seven other counties in the future to include the necessary population.
Muhlbauer asked if the Iowa Department of Human Services (DHS) would dictate the makeup of regions in the future.
Mentzer said DHS doesn’t currently have the authority to take such action.
A study of the fiscal viability of the current healthcare regions is scheduled to take place this fall.
“A lot of regions are going to be in trouble,” she said.
A complicating factor is the new state requirement that mental healthcare regions spend down their balances to 25 percent of their yearly budgets by 2020 if their counties have a total population under 100,000; regions with a total population over 100,000 must spend down to 20 percent.
Rolling Hills currently has a reserve balance of $3.2 million, which does not include the mental healthcare balances of the region’s individual counties.
“We have to expend a ton of money over the next couple of years to create those (new) services,” she said. “If we take Woodbury, we’d have to be at 20 percent because we’d be over the 100,000 threshold.”
Mentzer said she believes the Iowa Legislature will recommend the change to a smaller number of regions to gain economies of scale by sharing resources.
Supervisor Steve Ulmer said Woodbury’s size would be an advantage for adding the county to Rolling Hills.
“But they also bring a boatload of problems,” Blum said.
Muhlbauer said his concern would be that the county would lose local services.
“Our region is financially solid,” Blum said. “Some are struggling. We’re not.”
Mentzer said Woodbury has pending financial issues that were of concern.
Woodbury provided $1.2 million in services above the county’s maximum levy.
“They have some significant budget reductions they are going to be facing,” she said.
Blum said he believes that if Woodbury stays within Sioux Rivers region an additional year, the other counties will play hardball with Woodbury, which could complicate the situation.
“They (Woodbury County) might not make the criteria next year, anyway,” Muhlbauer said.
Menzter said Woodbury would have to agree to the stipulations given by Rolling Hills.
Woodbury would have to make payments to Rolling Hills from their mental health funds; the county couldn’t use money from their general fund accounts to cover a shortage, Ulmer pointed out.
Carroll County has always been a firm no on the question of adding Woodbury, Blum said.
Carroll, Calhoun, Sac and Ida counties have not yet voted on the resolution.