An Open letter re: Iowa Senate File 479, for a Children’s Mental Health System

Dear Senator Edler (the Floor Manager for this bill) and the Iowa Senate,

I am a parent of a child with serious mental illness and have served on the Children’s Mental Health and Wellness Work groups / Committees from 2015-2018 as well as the Iowa Mental Health Planning and Advisory Committee from 2014-2018. I want to thank you for your work on SF479, for the building of a Children’s Mental Health System.

As you know the House passed HF 690 today, the counterpart to SF479. In listening to the floor debate, I was disappointed that a significant issues was not adequately addressed and hope it will be when the Senate discusses the bill: the financial eligibility requirement. Twice the bill states that this system will not have financial eligibility requirements, but it appears to do just that:

On page 2: the system will serve “all children in this state who need the services, regardless of the place of residence or economic circumstances of those children.” (lines 23-25)

On pages 9-10:  “A region shall work with children’s behavioral health service providers to ensure that services in the required behavioral health core service domains in subsection 4 are available to children who are residents of the region, regardless of any potential payment source for the services.” (lines 34 -3)

However, on page 9 it gives an eligibility requirement that the child’s family makes less than 500% of the Federal Poverty Level (lines 17-18). In other words, children of these families are NOT eligible for services. Further, there is a cost sharing measure that puts a sliding scale on co-pays for families that make 150% up to 500% of FPL. My question is why is there a cut off of services for families at 500%? During the House discussion, it was implied that the regions would cover these children, but that is not what the bill actually says.

The false assumptions here seems to be that:

  1. Mental illness is a poverty issue. (It is not. Mental illness is a health issue that affects all economic groups.)
  2. Children’s mental health services are available for those who have the money to pay. (Many are not. For instance, Behavioral Health Intervention Supports are only available to children who receive Medicaid Title 19.), and
  3. That families who make 500% of FPL can afford core services for their child. (Private insurance often does not cover prescribed mental health care in our state. This leads to another issue: how the failure to enforce mental health parity laws is unduly costing tax payers in our state, as Medicaid ends up picking up the slack.)

    Please consider taking off the eligibility requirement of less than 500% of FPL. All children who need services should have access to services. Unless we do so, it is dishonest and inconsistent to say “regardless of economic situation”. We would not say that only children of families that make less that 500% of FPL should have access to chemotherapy or insulin.

    Finally, while I realize that this is a first step and that much more work is to be done, I am also disappointed in the lack of attention this bill gives to children with complex needs. PMICS (long term care) and therapeutic schools and classrooms are not included. It took far too long to finally address complex needs for adults in Iowa, it is disappointing that we are following the same path with children. It is much more expensive (and cruel) to feed these kids into the juvenile justice system, which is what we do when we fail to meet their level of need. Any comprehensive system must have a full array of services.

    That said, let me point out what the bill gets right: Data collection and sharing that data with the public on service outcomes and performance; providing much needed (and currently lacking) mobile crisis services for youth, putting core services into code, and having a parent on the state board and regional advisory boards.

    These, along with the budget item to get rid of all waiting lists for the children’s mental health Medicaid waiver, are important steps to helping Iowa kids and our state’s future. Please add to these positives a robust funding plan to make this system sustainable into the future. Thank you for your continued work on behalf of all of Iowa’s kids.

    Tammy Nyden

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