WHAT WILL YOU SAY? Advocate’s Guide to Mental Health ... · Advocate’s Guide to Mental Health &...

Advocate’s Guide to Mental Health & Disability Services Redesign (Summer 2012)

WHAT WILL YOU SAY?

Advocate’s Guide to Mental Health & Disability

Services Redesign



,RZDQV�ZLWK�'LVDELOLWLHV�LQ�$FWLRQ��,'�$FWLRQ��LV�D�QRQ�SUR¿W��QRQSDUWLVDQ�organization that encourages Iowans of all abilities to get involved in their communities and make their voices heard where public policy is discussed. ID Action provides opportunities for involvement, tools to help advocates be effective, and information through newsletters like infoNET.

In early 2012, the Iowa Legislature passed a bill that made big changes in the state’s adult mental health and disability services system. The legislation (Senate File 2315) changed the way the state’s mental health and disability services system is funded and managed, shifting greater responsibility to the state and away from the 99-county system. It also set a new menu of “core services” that must be available to Iowans with disabilities no matter where they live.

Unfortunately, the Legislature stopped short of funding this new system, creating a lot of uncertainty and anxiety among counties, providers, families and those receiving (or waiting for) services. With the passage of the Mental Health and 'LVDELOLW\�6HUYLFHV�5HGHVLJQ�RI��,RZDQV�ZLWK�GLVDELOLWLHV�DUH�OHIW�ZLWK�more questions than answers.

ID Action put together this “Advocate’s Guide to Mental Health and Disability Services” to help advocates understand the changes made by the Iowa Legislature, answer these questions, and identify opportunities for advocacy.

We hope this Guide will help you get started by answering the “who, what, when, where, and why” of redesign!

ADVOCATE’S GUIDE TO MENTAL HEALTH & DISABILITY SERVICES REDESIGN

3


What can I do? 5

2012 redesign local impact worksheet 7

Why Redesign the system? 8

Who will this effect? 9

How does the system change? 11

How are we going to pay for the system? 14

When will the changes happen? 18

What is next? 20

Where can I get more information? 22

Resources 23

�� Final vote on redesign 24�� Core services in SF 2315 25�� “Core Plus” service 26�� Per capita equalization formula chart 27�� 12 steps to successful advocacy 30�� Message worksheet 32�� Know your state senator 33�� Know your state representative 34

4

WHAT’S INSIDE


Many advocates worry about the unintended consequences of the changes made in the 2012 Redesign. They worry that the problems that caused the redesign will still be issues in the new system:

People with disabilities won’t be able to get needed services.

Services won’t be available everywhere in the state.

There won’t be enough money to meet those needs.

There won’t be enough providers to provide those services.

$V�LQ�WKH�SDVW��WKH�VXFFHVV�RI�WKH��5HGHVLJQ�GHSHQGV�RQ�IXQGLQJ�SURYLGHG�E\�WKH�/HJLVODWXUH��/HJLVODWRUV�KDYH�QHYHU�IXOO\�IXQGHG�SDVW�UHGHVLJQV��VR�PDQ\�DGYRFDWHV�wonder if the new system will be any different. Will legislators live up to their promises of funding?

Use this Guide to understand the changes made. It is important that you understand how the system will change, VSHDN�XS�DERXW�\RXU�FRQFHUQV��DQG�KHOS�\RXU�HOHFWHG�RI¿FLDOV�understand what needs to be done to address those concerns.

Figure out how these changes will affect you. You might start by talking to your case manager, providers, county CPC, and county supervisors. Find out their plans for regionalization, and how they plan to deal with funding for services this year, and when the new system takes effect next year. You can use the worksheet at the end of this section to help you.

Talk to legislators and legislative candidates about these changes and how they will affect you. Talk about access, eligibility, and funding in the new system. Explain what these changes mean to you and your family.

Watch your local newspapers for candidate or legislative forums. Go to one near you and submit a question about mental health and disability services redesign. Ask them how (and if) they plan to fully fund the system. Ask them how your services, access and eligibility will be affected if they don’t fully fund it. You can see a forum list at www.infonetiowa.com.

But you can do something about this!

5

WHAT CAN I DO?


7UDFN�DQ\�FKDQJHV�WR�\RXU�VHUYLFHV��DQG�OHW�\RXU�FRXQW\�VXSHUYLVRUV��OHJLVODWRUV��DQG�legislative candidates know so they understand the real impacts of the 2012 Redesign. Tell them if things get better, stay the same, or get worse. Your stories will help them advocate for more funding and changes that will make sure everyone has access to the services they need, wherever they live.

Organize others in your community to do the same. It’s easier (and more effective) to talk as a group than as an individual. So work together. Set up a meeting with other advocates, and invite your county supervisors in to brief you on their plans. Find out what they are going to do, and challenges they are facing. If your county isn’t reaching out to you, then reach out to them.

7DON�WR�WKH�PHPEHUV�RI�WKH�7UDQVLWLRQ�&RPPLWWHH��,QWHULP�&RPPLWWHH��DQG�RWKHU�ZRUN�groups that are working on the redesign of the system. You can call or email them. You can meet with them. You can also attend the meetings and speak during the public input period they have at the end of each morning and afternoon. A complete list of work groups is in the “What’s Next” section of this Guide.

Contact ID Action! We can help you in a number of ways:

Host an ID Action Community Conversation on Redesign. Community Conversations are informal meetings that bring people together locally to learn more about the impacts of the 2012 Redesign and give advocates a chance to ask questions, discuss options, and develop local plans to take action! Contact ID Action for more details or to schedule a Community Conversation in your area (866/432-2846).

Host an ID Action Voter Training. Call us for more details (866/432-2846).

Call us for technical assistance in how to get started organizing others or jump starting your advocacy (866/432-2846 or www.infonetiowa.com or www.idaction.org).

Let others know about INFONET and ID Action - we’d love to add them to our mailing or

emailing lists, or have them follow us on Facebook. It’s free - just have them email us at [email protected] or by calling 866/432-2846. © Lisa Young / 123RF

6

WHAT CAN I DO?


%HIRUH�\RX�WDON�WR�\RXU�OHJLVODWRUV�DQG�OHJLVODWLYH�FDQGLGDWHV��\RX�ZLOO�SUREDEO\�ZDQW�WR�NQRZ�more about how the 2012 Redesign will affect you and your county. Talk to your county supervisors or county CPC about the local impacts. These questions may help you get started.

1. Is my county planning to join a region? If so, which counties are being considered as partners?

2. How will regionalization affect me and the way I get services?

3. Does my county lose money for services this year as we transition to the new system? How much? How does the county plan to make ends meet with less money? What services will be cut? Will there be waiting lists?

4. Will my county lose money when property tax changes go into effect next year? If yes, how much? What changes would need to be made to get by with less money? If no, will the county have extra money? How does the county plan to use this extra money?

5. Does my county currently serve people with developmental disabilities and brain injuries? Will it continue to do so in the new system?

6. What other challenges does my county face in serving Iowans with disabilities? What should I know as an advocate, and what can I do?

7

2012 REDESIGN LOCAL IMPACT WORKSHEET


Iowa’s mental health and disability services system has gone through many “redesigns” in the last twenty years. The reasons for each redesign were really the same:

People with disabilities cannot get the services they need.

Services are not available everywhere in the state.

There isn’t enough money to meet those needs.

There aren’t enough providers to meet the needs.

And the reasons for the failures of all past redesign efforts were also the same: there wasn’t enough money.

7KH�¿UVW�JRDO�RI�WKH��5HGHVLJQ�ZDV�WR�H[SDQG�WKH�OLVW�RI�FRUH�VHUYLFHV�DYDLODEOH�WR�,RZDQV�ZLWK�GLVDELOLWLHV��DQG�PDNH�WKHP�DYDLODEOH�HYHU\ZKHUH�LQ�WKH�VWDWH��UHJDUGOHVV�RI�ZKR�SD\V�WKH�bill.

7KH�VHFRQG�JRDO�RI�WKH��5HGHVLJQ�ZDV�WR�DGGUHVV�IXQGLQJ�LQHTXDOLWLHV��ZKLFK�LQ�PDQ\�cases drove local service inequalities.

Like past redesign efforts, the success of the 2012 Redesign depends on whether legislators will be DEOH�WR�¿QG�HQRXJK�PRQH\�WR�SD\�IRU�WKH�QHZ�V\VWHP��DQG�ZKHWKHU�WKRVH�IXQGV�ZLOO�EH�VWDEOH�DQG�reliable from year to year.

8

WHY REDESIGN THE SYSTEM?


Anyone that is a “stakeholder” in the state’s mental health and disability services system may feel the affects of the 2012 Redesign. The changes may be felt more by some or not at all by others, depending on a few things:

1. Access depends on your disability.

Iowans with intellectual disabilities and mental illness are guaranteed access to an expanded list of core services that is the same no matter where they live and no matter who paysthe bill, as long as funding is available.

Iowans with developmental disabilities and Iowans with brain injuries may only receive services after all of the needs of individuals with intellectual disabilities and mental illness are met,and only as funding allows. Twenty counties now serve people with developmental disabilities.Those currently served may continue to receive their current services, but only if the county hasextra money.

2. Access depends on where you live.

The 2012 Redesign includes a new way of funding local services. Some counties will get money from the state to pay for these services, while others will lose money. Even those counties that get state money may not get enough to continue current services, let alone expand their list of “core services.” You can read more about this, and see how your county fares, in the “How arewe going to pay for the system?” section.

3. Access depends on your income.

Iowans with disabilities who earn up to 133% of the federal poverty level will have access to some level of service. An income chart is available on our website at www.infonetiowa.com/TOOLKIT/ISSUESANDPOLICYBRIEFS.aspx.

Iowans who qualify for Medicaid will receive services that are paid for by the state. If the Legislature does not put enough money into Medicaid, waiting lists are likely and the state willhave to roll out its core services much more slowly.

Iowans who do not qualify for Medicaid but fall into this income category will be able to receive locally-funded services through 2014. In 2014, this group of people will become eligible for Medicaid when the federal Affordable Care Act goes into effect. At that time, their services will be shifted over to Medicaid and will no longer be locally funded. Since the Federal governmentplans to pick up 90% of the costs for this expansion, funding may not be as much, if any, of aproblem. However, Governor Branstad has said he will oppose this expansion, which could mean access problems unless more state funding is found.

9

WHO WILL THIS EFFECT?


Iowans with disabilities who earn between 133-150% of the federal poverty level willhave access to locally-funded services. The 2012 Redesign makes Iowans earning under150% of the federal poverty limit eligible for locally-funded mental health and disability services.

Iowans with disabilities who earn between 150-200% of the federal poverty level canDFFHVV�ORFDOO\�IXQGHG�VHUYLFHV��EXW�RQO\�LI�WKHLU�FRXQW\�RU�UHJLRQ�KDV�HQRXJK�PRQH\WR�SD\�IRU�DOO�FRUH�VHUYLFHV��DQG�IRU�DOO�SHRSOH�XS�WR��RI�WKH�IHGHUDO�SRYHUW\�OHYHO.Almost all counties currently serve people that fall into this category, so this could end uplimiting access to services. In addition, a county/region can require copays or use sliding feescales for this group.

4. Access depends on funding.

All past redesigns have failed because they never fully addressed the issue of funding the system. The 2012 Redesign will face the same challenge. Access to serviceswill continue to depend on:

IF the Legislature puts money into the local system as promised;

HOW MUCH money is put into the system; and,

HOW STABLE that funding is to meet ongoing and growing needs.

Until these decisions are made, you can’t really know what the system will look like and whowill be served. If there is enough money, everyone will be served no matter where they live. Ifthere isn’t, the unfairness that Redesign was supposed to address will continue.

7KH��5HGHVLJQ�ZDV�VXSSRVHG�WR�HOLPLQDWH�WKHVH�EDUULHUV��so that regardless of your disability and regardless of where you

OLYH��\RX�ZLOO�UHFHLYH�WKH�VDPH�VHW�RI�VHUYLFHV��

0DQ\�IHHO�WKDW�WKH��5HGHVLJQ�IHOO�VKRUW��DQG�ZLOO�FRQWLQXH to fall short until funding for the system is addressed.

10

WHO WILL THIS EFFECT?


The 2012 Redesign made some very big changes to Iowa’s existing mental health and disability services system:

Core services are expanded and are available to people regardless of where they OLYH�DQG�ZKR�SD\V�WKHLU�ELOO��EXW�RQO\�DV�IXQGLQJ�DOORZV�

Eligibility for services is limited in order to contain costs.

6WDWH�QRZ�SD\V�IRU�DOO�0HGLFDLG�VHUYLFHV��DQG�ORFDO�SURSHUW\�WD[HV�ZLOO�SD\�IRU�DOO�non-Medicaid services and services to people not eligible for Medicaid.

7KH�V\VWHP�ZLOO�PRYH�IURP�D�FRXQW\�PDQDJHG�RQH��WR�RQH�PDQDJHG�E\�UHJLRQV��DQG�legal settlement ends.

,Q�VKRUW��WKH�PDMRU�FKDQJHV�LQ�WKH�V\VWHP�DUH�LQ�ZKR�SD\V�IRU�WKH�VHUYLFHV��ZKR�FDQ�JHW�WKH�VHUYLFHV��DQG�ZKLFK�VHUYLFHV�WKH\�FDQ�JHW��7KH�UHGHVLJQ�GRHVQ¶W�FKDQJH�KRZ�PXFK�PRQH\�LV�LQ�WKH�V\VWHP��KRZ�VHUYLFHV�DUH�GHOLYHUHG��RU�ZKR�SURYLGHV�WKRVH�VHUYLFHV�

&RUH�VHUYLFHV�DUH�GH¿QHG� Core services must be available in all regions and Medicaid waiver programs must also include access to the new menu of core services (but both are only as funding allows. You can see the list of core services in the resource section.

³&RUH�3OXV´�VHUYLFHV�DUH�DOVR�GH¿QHG��7KHVH�DUH�WKH�VHUYLFHV�WKDW�DUH�FRQVLGHUHG�LPSRUWDQW��EXW�QRW�WKH�¿UVW�SULRULW\�LQ�IXQGLQJ�WKH�V\VWHP��$JDLQ��WKHVH�ZRXOG�EH�DGGHG�DV�funding allows. This list is also in the resource section.

'H¿QHV�³FRQÀLFW�IUHH�FDVH�PDQDJHPHQW´�VR�SHRSOH�FDQ�SLFN�WKHLU�FDVH�PDQDJHUV��HYHQ�if they work for the same organization providing the services. Case managers must offer choices beyond what they provide, and must honor these choices.

As many as 50 sub-acute beds may be opened to address the needs of persons with serious and persistent mental illness. Acute beds are expensive, and often people need some step-down level of care like subacute beds (i.e. something more than community-based treatment, but less than hospitalization).

11

HOW DOES THE SYSTEM CHANGE?


Eligibility is limited in order to contain costs. Expanding core services to all populations with disabilities carries a high cost, one that legislators were reluctant to pay. So the 2012 Redesign limits eligibility for services.

&RUH�VHUYLFHV�ZLOO�EH�DYDLODEOH�¿UVW�WR�SHRSOH�ZLWK�DQ�LQWHOOHFWXDO�GLVDELOLW\�RU�PHQWDO�illness (and to others only if there is extra money). Review the “Who does this affect” section to read more about this.

Regions may choose to provide services to people earning between 150-200% of the federal poverty level. Again, this is only if funding is available and regions can require this group to pay for a part of their services (co-payments or sliding fee scales). Almost all counties currently provide services to this population.

7KH�6WDWH�ZLOO�QRZ�SD\�IRU�DOO�0HGLFDLG�VHUYLFHV��DQG�FRXQWLHV�ZLOO�QRZ�SD\�IRU�DOO�QRQ�0HGLFDLG�services and services to people who are not eligible for Medicaid. The county where a person lives will now manage and pay for that person’s non-Medicaid services (even if the person goes outside the county to get the services). Iowa is the last state in the country to replace “county of legal settlement” with the “county of residency.”

Counties must form regions to deliver all non-Medicaid services. Regions could choose to pool the money they collect in property taxes, or keep them separate. In order to be approved, regions must:

Include at least three bordering counties;

Show they can provide all core services;

+DYH�DW�OHDVW�RQH�FRPPXQLW\�PHQWDO�KHDOWK�FHQWHU�RU�IHGHUDOO\�TXDOL¿HG�KHDOWK�FHQWHU�LQ�

the region; and,

Have access to inpatient hospital beds in (or close to) the region.

DHS may grant waivers from the three-county region requirement. Counties would be allowed to operate as a single- or two-county region if they can show they can meet all regional requirements on their own.

Counties are given time to voluntarily join a region. Counties that do not join a region voluntarily and do not get a waiver from this requirement will be “assigned” a region by DHS.

Regions will decide how they want to operate. Regions can decide how they manage their money (joint regional or separate county accounts). They will decide how to work with providers to make sure core services are available, and make decisions about how to track performance and share information. The State will hold regions accountable for results; each region will have to sign a contract with DHS that shows those expectations.

12



$�UHJLRQDO�JRYHUQLQJ�ERDUG�ZLOO�PDNH�GHFLVLRQV�DERXW�WKH�V\VWHP��EXW�RQO\�county supervisors (or someone they designate) are allowed to vote. Legislators wanted to make sure that the people making decisions about funding for local servicesZRXOG�KDYH�WR�DQVZHU�WR�YRWHUV��)RU�WKDW�UHDVRQ�OHJLVODWRUV�ZHUH�YHU\�VSHFL¿F�DERXW�who could be on these decision making boards, and who could vote.

ƕ�Regions must have a regional governing board made up of at least one county supervisor from each county in the region (who can vote), one service provider (who cannot vote) and one person who uses services or a family member (who cannot vote).

ƕ�Regions must have advisory committees to get input from service providers and people using the services (or their family members). These committees appoint the nonvoting members on the governing board. Regions can choose to have one single board with representation of both groups, two separate boards, or boards in each county. How regions set these boards up, and how members are appointed, is left to each region.

A regional administrator will be hired by the governing board to manage services in the region. Iowa law currently requires counties to hire a person to be a “Central Point of Coordination” or “CPC” to manage county funded MH/DS services. In the new system, there will be a regional administrator who manages a network of “coordinators of disability services” located throughout the region (where they are located is a decision of the governing board). Current CPCs may become the new coordinators of disability services.

13



There are two questions that the 2012 Redesign did not answer:

Where will we get the money to pay for the new system?

Will there be enough to meet the need?

:LWKRXW�NQRZLQJ�WKH�DQVZHUV�WR�WKHVH�WZR�TXHVWLRQV��ZH�FDQ¶W�VD\�IRU�VXUH�KRZ�WKH�V\VWHP�ZLOO�EH�IXQGHG��DQG�LI�LW�ZLOO�EH�HQRXJK�WR�FRYHU�WKH�QHHGV�RI�DOO�,RZDQV�ZLWK�disabilities. We do know that without adequate funding at all levels, access will continue to depend on what type of disability a person has, and where they live.

7KH��5HGHVLJQ�OD\V�RXW�D�SODQ�WR�SD\�IRU�WKH�V\VWHP��EXW�OHJLVODWRUV�DUH�QRW�VXUH�LW�LV�going to work. $�³)LVFDO�9LDELOLW\�&RPPLWWHH´�ZLOO�PHHW�WKLV�\HDU�WR�VHH�LI�WKH�SODQ�ZRUNV��¿QG�out how much it will cost, and develop other options to fund the system.

This is how the Legislature plans to pay for the new system:

The State keeps $170 million that had been going to counties, and got an extra $40 million to cover the shortfall. The state will then pay for all Medicaid services. If there isn’t enough money, they could start or expand waiting lists, or ask the Legislature for extra money (called a “supplemental” appropriation).

Counties will continue to raise money through property taxes to pay for non-Medicaid services, but they are only allowed to raise up to $47.28 per person living in the county. The Legislature called this a “per capita equalization formula,” but for some counties, this means taxes will be cut and the county will have to cut spending on services. For others, the state will make up the difference. Some advocates say there is very little “equal” in the “equalization formula.” This is how it will work:

�� Counties will be able to raise $47.28 per person (per capita) living in the county. Right now, counties are allowed to raise a total of $125 million from property taxes – that’s an average of $47.28 per person. But the amount per person actually raised in counties varies from $97.39 per person in Audubon County to $14.56 per person in Plymouth County. The new plan tries to “equalize” this so each county raises the same amount per person as every other county.

�� 44 counties raise more than $47.28 per person and would need to cut their property taxes. They would not get money from the state to make up this $10.8 million cut. Nearly 1 million Iowans live in these counties. The following counties fall into this category:

14

HOW ARE WE GOING TO PAY FOR THE SYSTEM?


Adams, Allamakee, Audubon, Bremer, Buchanan, Carroll, Cass, Cedar, Cerro Gordo, Clayton, Clinton, Crawford, Davis, Delaware, Dubuque, Emmett, Fremont, Greene, Guthrie, Hamilton, Hancock, Hardin, Harrison, Humboldt, Jasper, Kossuth, Lee, Louisa, Lucas, Mahaska, Marshall, Mitchell, Muscatine, Palo Alto, Pocahontas, Pottawattamie, Ringgold, Sac, Shelby, Union, Wapello, Webster, Winneshiek, and Worth

�� The 55 counties that raise less than $47.28 per person would get state money to bring them up to that level. 7KDW¶V�DERXW��PLOOLRQ�LQ�WKH�¿UVW�\HDU��7KLV�LV�ZKDW�WKH��Legislature is calling “property tax equalization.” There are 2.1 million Iowans living in these areas. The following counties fall into this category:

Adair, Appanoose, Benton, Black Hawk, Boone, Buena Vista, Butler, Calhoun, Cherokee, Chickasaw, Clarke, Clay, Dallas, Decatur, Des Moines, Dickinson, Fayette, Floyd, Franklin, Grundy, Howard, Henry, Ida, Iowa, Jackson, Jefferson, Johnson, Jones, Keokuk, Linn, Lyon, Madison, Marion, Mills, Monona, Monroe, Montgomery, O’Brien, Osceola, Page, Plymouth, Polk, Poweshiek, Scott, Sioux, Story,Tama, Taylor, Van Buren, Warren, Washington, Wayne, Winnebago, Wright and Woodbury

�� Not all of the 55 counties getting money from the state will get enough to keep services at current levels. ,Q�DGGLWLRQ��WKH�5HGHVLJQ�GLGQ¶W�DGG�DQ�LQÀDWLRQ�IDFWRU�WR�WKLV��equalization formula, so there is no automatic increase to keep up with increased costs and demand.

�� The Legislature “promised” to put $30 million into the system next year. We know that at least 25% of our legislators won’t be returning (retirements), and others still need to get re-elected. No one knows for sure if there will be money, and how much. The answers to these questions will determine what services are available, and who will get them.

Bills that counties say they do not owe - “disputed bills” - are written off by the state. These are bills that counties say are not their responsibility and have refused to pay. This doesn’t help counties pay for services, but it does address a source of confusion when looking DW�FRXQW\�¿QDQFLDO�LQIRUPDWLRQ��7KHUH�LV�DQ�estimated $12 million in disputed bills statewide.

Counties that received “risk pool” funds this year are allowed to keep them for another year. Only four counties got this money to avoid waiting lists and service cuts, and some couldn’t spend it all because of timing. Counties were to spend the money by November, or give it back to the state. This gives them until June 30, 2013 to spend it. This should help these four counties maintain services during the transition. ©Vedran Vukoja/ 123RF

15



How “Equalization” Works in Two Counties

Scott County is allowed to raise $3.3 million from its local property tax to pay for non-Medicaid services. That’s about $20 per person living in that county. Beginning July 1, 2013, Scott County would be able to spend $7.8 million ($47.28/person). The state would pay the difference between the current levy ($3.3 million) and the budgeted amount ($7.8 million). They get an extra $4.5 million – which is about what they need to keep services at current levels.

Jasper County is allowed to raise $3.1 million from its local property tax to pay for non-Medicaid services. That’s $85 per person living in that county. Since they are above the $47.28/person cap, they would have to lower their levy and collect only $1.7 million beginning -XO\��7KH\�ZLOO�KDYH�WR�¿QG�D�ZD\V�WR�FXW�FRVWV�DQG�PDNH�XS�WKLV��PLOOLRQ�GLIIHUHQFH��which is nearly half of the county’s current budget. That could mean cutting services (which of course is the opposite of the 2012 Redesign’s goals of equalizing services and expanding core services statewide).

The new “per capita equalization formula” goes into effect July 1, 2013. But counties will stop getting state funding beginning July 1, 2012. Counties will have to operate for one year without state funds that had been used for locally-delivered serviced

So what did the Legislature do to help counties get through this year without cutting services?

Set up a Transition Fund to help counties get through this “transition year” - but didn’t put any money into it!

�� Counties say they need at least $20 million in one-time funds to avoid cuts this year.

�� Legislators found $20 million in one-time federal funds that could be used by counties to maintain services for this year.

�� Legislators decided to wait to spend these funds until they come back in January 2013. They promised counties that they would give them the $20 million in January 2013 “if there is a need.”

�� Many counties wonder how they will get through six months of the year without money – and wonder why lawmakers didn’t go ahead and spend the money this year. That has created a lot of speculation (if they didn’t spend it this year, will they next year? Why wait?).

16



�� Even though there is no money in the Transition Fund, counties are directed to apply for the funds. DHS will collect these requests, determine how much is needed to get through the transition period without cuts, and forward the amount needed to the Legislature for discussion when they return in January 2013.

�� The Transition Fund rules state that the fund is to support current services (those in FRXQW\�PDQDJHPHQW�SODQV�DV�RI�-XQH��WR�WDUJHWHG�SRSXODWLRQV��GH¿QHG�DV�people with intellectual disabilities and mental illness). Counties could apply for funds to pay for continued services to people with developmental disabilities and brain injuries, EXW�OHJLVODWRUV�ZLOO�PDNH�WKH�¿QDO�GHFLVLRQ�RQ�ZKRVH�VHUYLFHV�ZLOO�EH�PDLQWDLQHG�ZKHQ�they return in January 2013.

Directed DHS to appoint a Transition Committee of stakeholders to address transition year problems. This group will work with DHS and counties to make sure the transition from a county-based system to a regionally-based system is smooth. But for counties that began having problems this July, recommendations may be too late to avoid cuts in services. You can see who is on this committee, meeting schedules, and other information online at www.dhs.state.ia.us/Partners/Partners_Providers/MentalHealthRedesign/TransitionCommittee.html.

$SSRLQWHG�D�³0HQWDO�+HDOWK�DQG�'LVDELOLW\�6HUYLFHV�5HGHVLJQ�)LVFDO�9LDELOLW\�&RPPLWWHH´�WR�¿QG�out if the plan for funding the system will actually work. This group of legislators will work out details on the continuation of the property tax levy, per capita equalization payments, funding for the system, and how to address growth and population shifts. Legislators talked about a 3% annual growth added to the $47.28 cap so counties could begin to provide all of the core services listed, and start making headway on “core plus” services like jail diversion. But this LQFUHDVH�ZDV�QRW�D�SDUW�RI�WKH�¿QDO�DJUHHPHQW��7KLV�FRPPLWWHH¶V�UHFRPPHQGDWLRQV�ZLOO�EH�UHYLHZHG�E\�WKH�/HJLVODWXUH�LQ��<RX�FDQ�¿QG�RXW�ZKR�LV�RQ�WKLV�FRPPLWWHH��PHHWLQJ�schedules, and other information online at www.legis.iowa.gov/Schedules/committee.aspx? GA=84&CID=849.

Continued the Mental Health and Disability Services Legislative Interim Committee and directed this group to oversee redesign as it goes into effect, and recommend changes to make sure the system works as intended. They may recommend changes.

17



),6&$/�<($5��-XO\��WR�-XQH��State pays for all Medicaid services after July 1, 2012.

State forgives all bills for services provided before July 1, 2011 that counties say they do not owe (“disputed bills”).

&RXQWLHV�LQ�WURXEOH�¿QDQFLDOO\�WKLV�\HDU�PXVW�VHQG�LQ�DSSOLFDWLRQV�IRU�WUDQVLWLRQ�IXQGV�E\�November 1, 2012 (even though there is no money in the Transition Fund).

Counties have until April 1, 2013 to voluntarily join a region. Counties wanting to form a one-county or two-county region have until May 1, 2013 to apply for a waiver. DHS will work with counties not yet in a region for three months (April 1 - July 1, 2013) to help address barriers and join a region. After that time, counties will be assigned regions, with all counties to be in a region by December 31, 2013.

Workgroups meet (read more about these in the “What’s Next” section of this Guide). Reports are due in December 2012.

Most of the changes made in the 2012 Redesign will not happen immediately, and many depend on funding. Here are a few key dates.

July 1, 2012: State pays for Medicaid services; bills disputed by counties are written off; and DHS begins providing technical assistance to counties forming regions. Sometime after this date, all counties will use the same functional assessments to determine service needs.

April 1, 2013: Counties may voluntarily join a region.

May 1, 2013: Counties wanting to be a single county region or a two county region must request waivers.

July 1, 2013: Counties not in a region will be assigned a region by DHS.

July 1, 2013: Core services and new limits on eligibility go into effect. Property tax changes and the new “per capita equalization” formula go into effect July 1, 2013. Legal settlement ends.

December 31, 2013: All counties in a region (unless waived).

July 1, 2014: Regions are to be fully operational.

18

WHEN WILL THE CHANGE HAPPEN?


DHS selects and requires use of standardized functional assessments for people with intellectual disabilities, mental illness and brain injury (sometime before July 1, 2013). These functional assessments would be used statewide, so everyone would be using the same tools to determine need for services.

Mental Health Institutes are required to be capable of providing services to people with co-occurring disabilities by July 1, 2013.

DHS must estimate how much it would cost to make persons with developmental disabilities and brain injuries eligible for core services, and make recommendations on ways to pay for it (including options for private insurance coverage). Recommendations due December 14, 2012.

),6&$/�<($5��-XO\��WR�-XQH��

County property taxes are changed to allow for counties to raise up to $47.28 per person starting July 1, 2013.

Legal settlement is repealed beginning July 1, 2013. The county where a person lives will be responsible for paying for that person’s services.

Eligibility limitations go into effect July 1, 2013. Counties are required to serve people with intellectual disabilities and mental illness (and are only allowed to serve those with other developmental disabilities if they have extra money).

Counties/regions must begin paying for the new menu of core services on July 1, 2013.

New regional service system management plans must be completed by April 1, 2014 (and are updated annually each April 1). These plans replace the current county management plans, which describe the services they will pay for, the people they will serve, and the budget for doing it.

),6&$/�<($5��-XO\��WR�-XQH��

Regions begin operating on or before July 1, 2014.

A complete and detailed timeline is online atwww.infonetiowa.com/TOOLKIT/ISSUESANDPOLICYBRIEFS.aspx

19

WHEN WILL THE CHANGE HAPPEN?


7KH��5HGHVLJQ�LV�WKH�¿UVW�VWHS�LQ�ZKDW�ZLOO�EH�D�ORQJ�SURFHVV��7KH�/HJLVODWXUH�H[SHFWV�WR�PDNH�changes next year, and they know they still have to deal with the very big job of paying for the system.

Here are the things that will happen in the next year:

Counties will use functional assessments to decide if a person can access services.

Counties will start forming regions.

DHS will draft rules (which show how a state agency plans to make the changes required by legislators).

Nine work groups will meet to answer the questions that were not addressed in the 2012 Redesign.

Here are the things the 2013 Legislature may need to look at:

Funding for the system (transition year, next year, and ongoing).

Eligibility limitations (Do they really want to scale back who is eligible, like people with developmental disabilities and people with brain injuries?).

5HJLRQDO�DGPLQLVWUDWLRQ�ÀH[LELOLW\��:HUH�WKH\�WRR�VSHFL¿F"�$UH�WKHUH�EDUULHUV�WKDW�QHHG�WR�EH�addressed for regions to work well?).

Ongoing inequities in property taxes, per capita equalization fund, and what to do about those 44 counties that have to cut spending.

Here is what each of the nine work groups will address:

The Mental Health and Disability Services Study Committee is made up of 12 legislators. They will look at issues brought up by the Transition Committee and other work groups that may require legislative changes. They will also look at the recommendations of the Fiscal 9LDELOLW\�&RPPLWWHH��<RX�FDQ�¿QG�RXW�PRUH�LQIRUPDWLRQ�DERXW�WKLV�FRPPLWWHH�DW�www.legis.iowa.gov/Schedules/committee.aspx?GA=84&CID=541.

The Mental Health and Disability Services Redesign Fiscal Viability Study Committee is also made up of legislators. It will look at the impacts of the “per capita equalization formula,” changes in county property taxes, system funding needs, and whether the formula and ¿QDQFLQJ�SDVVHG�E\�WKH�/HJLVODWXUH�ZLOO�DFWXDOO\�ZRUN��<RX�FDQ�¿QG�RXW�PRUH�LQIRUPDWLRQ�DERXW�this committee at www.legis.iowa.gov/Schedules/committee.aspx? GA=84&CID=849.

The Transition Committee will work on issues that come up moving from the old to the new system. There are two CPCs and two county supervisors on this committee, which will consult

20

WHAT IS NEXT?


with DHS on rules for the new system, review data to determine if changes are needed, and address barriers to regionalization. They will also review problems counties have in making HQGV�PHHW�¿QDQFLDOO\�LQ�WKLV�WUDQVLWLRQ�\HDU��<RX�FDQ�¿QG�WKH�PHPEHUVKLS�OLVW��PHHWLQJ�schedules, and other information online at www.dhs.state.ia.us/Partners/Partners_Providers/MentalHealthRedesign/TransitionCommittee.html.

The Workforce Work Group ZLOO�EH�OHG�E\�WKH�,RZD�'HSDUWPHQW�RI�3XEOLF�+HDOWK�DQG�¿QG�ways to make sure there is an adequate and well-trained workforce available to deliver UHTXLUHG�FRUH�VHUYLFHV��7KH�JURXS�ZLOO�DOVR�UHYLHZ�WUDLQLQJ�DQG�FHUWL¿FDWLRQ�LVVXHV�

The Children’s Work Group will continue meeting to recommend a streamlined service system for children with disabilities, with a focus on bringing kids placed out of state back to ,RZD��<RX�FDQ�¿QG�WKH�PHPEHUVKLS�OLVW��PHHWLQJ�VFKHGXOHV��DQG�RWKHU�LQIRUPDWLRQ�RQOLQH�DWwww.dhs.state.ia.us/Partners/Partners_Providers/MentalHealthRedesign/ChildrensMentalHealth.html.

The Judicial Work Group�ZLOO�DOVR�FRQWLQXH�LWV�ZRUN�WR�UH¿QH�UHFRPPHQGDWLRQV�IRU�MDLO�diversion, an independent (and statewide) patient advocate program, uniform involuntary FRPPLWPHQW�SURFHGXUHV��DQG�PHQWDO�KHDOWK�FRXUWV��<RX�FDQ�¿QG�WKH�PHPEHUVKLS�OLVW��PHHWLQJ�schedules, and other information online at www.dhs.state.ia.us/Partners/Partners_Providers/MentalHealthRedesign/Judicial-DHS.html.

The Outcomes & Performance Measures Work Group will identify outcomes that will be used in performance--based contracts with counties and regions. The outcomes are to address expectations in accessing services, readmission rates, employment, administrative FRVWV�DQG�SURFHGXUHV��GDWD�UHSRUWLQJ��HWF��<RX�FDQ�¿QG�WKH�PHPEHUVKLS�OLVW��PHHWLQJ�schedules, and other information online at www.dhs.state.ia.us/Partners/Partners_Providers/MentalHealthRedesign/Outcomes.html.

The Service System Data and Statistical Information Integration Work Group will work on an integrated data reporting system, so all regional/county and state information can be gathered and used by policy makers to improve the system, and determine funding needs. <RX�FDQ�¿QG�WKH�PHPEHUVKLS�OLVW��PHHWLQJ�VFKHGXOHV��DQG�RWKHU�LQIRUPDWLRQ�RQOLQH�DW�www.dhs.state.ia.us/Partners/Partners_Providers/MentalHealthRedesign/ Service%20Sys-tem%20Data%20and%20Statistical%20Information.html.

The Regulatory Requirements Work Group will look at ways to streamline provider regulations and requirements – getting rid of what providers call “unnecessary regulations.”

21

WHAT IS NEXT?


The “Resources” section provides more detail on a number of subjects, including a list of how each county fares in the new system, a list of how each legislator voted on the 2012 Redesign bill, tips on contacting your legislators or talking to candidates, message development worksheets, and more.

Here are a few links to resources to get you started:

<RX�FDQ�NHHS�XS�WR�GDWH�RQ�WKH�SURJUHVV�RI�UHGHVLJQ�DQG�¿QG�RXW�ZKHQ�WKHUH�DUH�opportunities to provide input on the infoNET website - www.infonetiowa.com.

<RX�FDQ�¿QG�LQIRUPDWLRQ�RQ�WKH�YDULRXV�ZRUN�JURXSV�RQOLQH�DW�www.dhs.state.ia.us/Partners/MHDSRedesign.html.

<RX�FDQ�¿QG�LQIRUPDWLRQ�DERXW�WKH�LQWHULP�OHJLVODWLYH�VWXG\�JURXSV�RQOLQH�DW�www.legis.iowa.gov/Schedules/Interim.aspx.

You can get on e-mail lists related to redesign by contacting Joanna Schroeder at DHS ([email protected]).

“Like” the infoNET Facebook page to keep updated on breaking news - www.facebook.com/pages/infoNET/311412648681.

List of current legislators and their contact information can be found at www.legis.iowa.gov/Legislators/senate.aspx (Senators) and www.legis.iowa.gov/Legislators/house.aspx (Representatives).

/LVW�RI�FDQGLGDWHV�IRU�OHJLVODWLYH�RI¿FH�DQG�WKHLU�FRQWDFW�LQIRUPDWLRQ�FDQ�EH�IRXQG�DW�www.infonetiowa.com/Portals/7/Winnerlist.pdf.

<RX�FDQ�¿QG�\RXU��OHJLVODWLYH�GLVWULFW�DWZZZ�OHJLV�LRZD�JRY�5HVRXUFHV�5HGLVW�UHGLVWULFWLQJ�DVS[��,I�\RX�QHHG�WR�¿QG�RXW�ZKR�FXUUHQWO\�UHSUHVHQWV�\RX��JR�WR�ZZZ�OHJLV�LRZD�JRY�/HJLVODWRUV�¿QG�DVS[V��

<RX�FDQ�FRQWDFW�WKH�*RYHUQRU¶V�RI¿FH�DW�JRYHUQRU�LRZD�JRY�FRQWDFW��

22

WHERE CAN I GET MORE INFORMATION?


Resources


FINAL VOTE ON 2012 REDESIGN

6HH�KRZ�\RXU�OHJLVODWRUV�YRWHG�RQ�WKH�¿QDO�5HGHVLJQ�%LOO��6)��

66 REPRESENTATIVES & 30 SENATORS VOTED YES:

REPRESENTATIVES: Alons, Brandenburg, Baltimore, Baudler, Berry, Byrnes, Chambers, Cownie, Deyoe, Dolecheck, Drake, Forristall, Fry, Garrett, Grassley, Hagenow, Hager, Hanusa, Heaton, Hein, Helland, Horbach, Huseman, Jacoby, Kajtazovic, Kaufmann, Kelley, Klein, Koester, Kressig, Lensing, Lofgren, Lukan, Lykam, Mascher, Massie, L. Miller, Moore, Paulsen, Paustian, Pearson, Quirk, S. Olson, Raecker, Rasmussen, Rayhons, Rogers, Running-Marquardt, Sands, Schulte, Schultz, Shaw, J. Smith, Soderberg, Sweeney, Thede, Thomas, Tjepkes, Upmeyer, Van Engelenhoven, Vander Linden, Wagner, Watts, Winckler, Windschitl, Worthan

SENATORS: Bacon, Beall, Black, Bolkcom, Bowman, Courtney, Danielson, Dearden, Dotzler, Dvorsky, Fraise, Gronstal, Hancock, Hatch, Hogg, Horn, Jochum, Johnson, Kibbie, Mathis, McCoy, Quirmbach, Ragan, Rielly, Schoenjahn, Seng, Seymour, Ward, Wilhelm, Zaun

31 REPRESENTATIVES & 16 SENATORS VOTED NO:

REPRESENTATIVES: Abdul-Samad, Arnold, Cohoon, De Boef, Gaines, Gaskill, Hall, Hanson, Heddens, Hunter, Isenhart, Jorgensen, Kearns, McCarthy, H. Miller, Muhlbauer, Murphy, Oldson, R. Olson, T. Olson, Petersen, Pettengill, M. Smith, Steckman, J. Taylor, T. Taylor, Wenthe, Wessel- Kroeschell, Willems, Wittneben, Wolfe

SENATORS: Anderson, Bartz, Bertrand, Boettger, Dix, Ernst, Feenstra, Greiner, Hahn, Hamerlinck, Kapucian, Kettering, Smith, Sodders, Sorenson, Whitver

24

FINAL VOTE ON 2012 REDESIGN


MENTAL HEALTH/DISABILITY SERVICES REFORM BILL

7UHDWPHQW�GHVLJQHG�WR�DPHOLRUDWH�D�SHUVRQ¶V�FRQGLWLRQ��LQFOXGLQJ��EXW�QRW�OLPLWHG�WR�� o Assessment and evaluation. o Mental health outpatient therapy. o Medication prescribing and management. o Mental health inpatient treatment.

�%DVLF�FULVLV�UHVSRQVH��LQFOXGLQJ��EXW�QRW�OLPLWHG�WR�� o 24- hour access to crisis response. o Evaluation. o Personal emergency response system.

6XSSRUW�IRU�FRPPXQLW\�OLYLQJ��LQFOXGLQJ��EXW�QRW�OLPLWHG�WR�� o Home health aide.� R�+RPH�DQG�YHKLFOH�PRGL¿FDWLRQV� o Respite. o Supportive community living.

6XSSRUW�IRU�HPSOR\PHQW��LQFOXGLQJ��EXW�QRW�OLPLWHG�WR�� o Day habilitation. o Job development. o Supported employment. o Prevocational services.

5HFRYHU\�VHUYLFHV��LQFOXGLQJ��EXW�QRW�OLPLWHG�WR�� o Family support. o Peer support.

Service coordination including (but not limited to): o Coordinating physical health and primary care. o Case management. o Health homes.

25

CORE SERVICES IN SF 2315


Regions must make sure that the following “core plus” services are available when funding is provided:

&RPSUHKHQVLYH�IDFLOLW\�DQG�FRPPXQLW\�EDVHG�FULVLV�VHUYLFHV��LQFOXGLQJ�EXW�QRW�limited to):

o 24-hour crisis hotline. o Mobile response. o 23-hour crisis observation and holding. o Crisis stabilization facility and community based services. o Crisis residential services.

Sub-acute services provided in facility and community-based settings.

-XVWLFH�V\VWHP�LQYROYHG�VHUYLFHV��LQFOXGLQJ�EXW�QRW�OLPLWHG�WR�� o Jail diversion. o Crisis intervention training. o Civil commitment prescreening.

$GYDQFHV�LQ�WKH�XVH�RI�HYLGHQFH�EDVHG�WUHDWPHQW��LQFOXGLQJ�EXW�QR�OLPLWHG�WR�� o Positive behavior support. o Assertive community treatment. o Peer self-help drop-in center.

26

“CORE PLUS” SERVICES


How to Use the Following“Per Capita Equalization Formula Charts”

The following two pages detail how the proposed Per Capita Equalization Formula will affect each of the state’s 99 counties. This formula replaces the current property tax that counties use to pay for mental health and disability services.

County: The name of the county.

Current Max Levy Dollar: The amount of property taxes collected in the county now to pay for mental health and disability services.

Population: Number of people living in the county.

Current Max Amount Levied Per Capita: This is how much your county currently spends per person (per capita).

Max Amount Levied at $47.28 Per Capita: This is how much your county will be allowed to spend at $47.28 per person.

New Rate at $47.28 Per Capita: This is the new property tax rate for the county – how much the county will have to tax in order to collect $47.28 per person.

Current Rate: This is the current property tax rate for the county.

Increase/Decrease in Dollars Levied: Shows whether the county gets more (or less) money in the 2012 Redesign.

7R�¿QG�RXW�KRZ�\RXU�FRXQW\�IDUHV��1. Find your county.

��,I�\RXU�FRXQW\�LV�RQ�WKH�¿UVW�FKDUW��WKH\�ZLOO�JHW�PRUH�PRQH\��,I�\RXU��FRXQW\�LV�RQ�WKH�VHFRQG�FKDUW��\RXU�FRXQW\�ZLOO�ORVH�PRQH\�

3. Look at the last column “Increase/Decrease.” This shows how much more (or less) the county will have to pay for non-Medicaid services.

27

PER CAPITA EQUIALIZATION FORMAL CHART


Per Capita Levy Rate Distribution

5/15/2012 Page 1 of 2 LSA:average levy per capita2 .xlsx

CountyCurrent Max Levy Dollar Population

Current Max Amount

Levied Per Capita

Max Amount Levied at $47.28

Per Capita Current Rate

Increase(+)/ Decrease(-) in

Dollars Levied

Adair 309,066$ 7,682 40.23$ 363,205$ 0.68354 54,139$ Appanoose 607,651 12,887 47.15 609,297 1.59755 1,646 Benton 908,642 26,076 34.85 1,232,873 0.77920 324,231 Black Hawk 5,779,837 131,090 44.09 6,197,935 1.29838 418,098 Boone 878,976 26,306 33.41 1,243,748 0.76703 364,772 Buena Vista 669,512 20,260 33.05 957,893 0.71595 288,381 Butler 389,899 14,867 26.23 702,912 0.55973 313,013 Calhoun 431,560 9,670 44.63 457,198 0.72715 25,638 Cherokee 477,158 12,072 39.53 570,764 0.70043 93,606 Chickasaw 572,250 12,439 46.00 588,116 0.86029 15,866 Clarke 430,559 9,286 46.37 439,042 1.25114 8,483 Clay 402,866 16,667 24.17 788,016 0.45561 385,150 Dallas 1,524,538 66,135 23.05 3,126,863 0.43428 1,602,325 Decatur 321,858 8,457 38.06 399,847 1.25563 77,989 Des Moines 1,751,030 40,325 43.42 1,906,566 1.35882 155,536 Dickinson 412,509 16,667 24.75 788,016 0.20928 375,507 Fayette 773,024 20,880 37.02 987,206 0.93065 214,182 Floyd 610,064 16,303 37.42 770,806 0.87515 160,742 Franklin 358,934 10,680 33.61 504,950 0.55555 146,016 Grundy 530,188 12,453 42.58 588,778 0.80263 58,590 Howard 364,201 9,566 38.07 452,280 0.80197 88,079 Henry 846,381 20,145 42.01 952,456 1.20731 106,075 Ida 300,889 7,089 42.44 335,168 0.71660 34,279 Iowa 729,235 16,355 44.59 773,264 0.99081 44,029 Jackson 787,145 19,848 39.66 938,413 1.03811 151,268 Jefferson 607,300 16,843 36.06 796,337 0.93625 189,037 Johnson 3,138,395 130,882 23.98 6,188,101 0.55747 3,049,706 Jones 883,021 20,638 42.79 975,765 1.08440 92,744 Keokuk 490,075 10,511 46.62 496,960 0.97221 6,885 Linn 8,195,141 211,226 38.80 9,986,765 0.92468 1,791,624 Lyon 248,113 11,581 21.42 547,550 0.39903 299,437 Madison 534,189 15,679 34.07 741,303 0.76993 207,114 Marion 1,089,896 33,309 32.72 1,574,850 0.93506 484,954 Mills 609,781 15,059 40.49 711,990 0.82169 102,209 Monona 375,993 9,243 40.68 437,009 0.74293 61,016 Monroe 340,278 7,970 42.69 376,822 0.89683 36,544 Montgomery 369,740 10,740 34.43 507,787 0.75864 138,047 O'Brien 570,532 14,398 39.63 680,737 0.91856 110,205 Osceola 195,225 6,462 30.21 305,523 0.51982 110,298 Page 652,027 15,932 40.93 753,265 1.15375 101,238 Plymouth 363,771 24,986 14.56 1,181,338 0.30500 817,567 Polk 14,439,175 430,640 33.53 20,360,659 0.77651 5,921,484 Poweshiek 444,227 18,914 23.49 894,254 0.46320 450,027 Scott 3,308,032 165,224 20.02 7,811,791 0.46749 4,503,759 Sioux 1,027,388 33,704 30.48 1,593,525 0.82781 566,137 Story 3,066,575 89,542 34.25 4,233,546 0.90372 1,166,971 Tama 568,799 17,767 32.01 840,024 0.70729 271,225 Taylor 140,346 6,317 22.22 298,668 0.48037 158,322 Van Buren 314,328 7,570 41.52 357,910 1.19785 43,582 Warren 1,084,011 46,225 23.45 2,185,518 0.67388 1,101,507 Washington 781,141 21,704 35.99 1,026,165 0.88135 245,024 Wayne 254,099 6,403 39.68 302,734 0.97100 48,635 Winnebago 433,910 10,866 39.93 513,744 0.90610 79,834 Wright 554,967 13,229 41.95 625,467 0.77868 70,500 Woodbury 3,564,086 102,172 34.88 4,830,692 1.06055 1,266,606Sub Total 69,812,533$ 2,089,941 33.40$ 98,812,410$ 28,999,877$

In FY 2014, these counties will have their rates subsidized by the State. Total Cost $28,999,877

LSA:average levy per capita2 .xlsx

28

PER CAPITA LEVY RATE DISTRIBUTION


Per Capita Levy Rate Distribution

5/15/2012 Page 2 of 2 LSA:average levy per capita2 .xlsx

CountyCurrent Max Levy Dollar Population

Current Max Amount

Levied Per Capita

Max Amount Levied at $47.28

Per Capita Current Rate

Increase(+)/ Decrease(-) in

Dollars Levied

Adams 191,282 4,029 47.48 190,491 0.75741 -791 Allamakee 786,775 14,330 54.90 677,522 1.20782 -109,253 Audubon 595,900 6,119 97.39 289,306 1.81940 -306,594 Bremer 1,294,995 24,276 53.34 1,147,769 1.33525 -147,226 Buchanan 1,292,163 20,958 61.65 990,894 1.52177 -301,269 Carroll 1,800,630 20,816 86.50 984,180 1.85067 -816,450 Cass 789,047 13,956 56.54 659,840 1.19469 -129,207 Cedar 968,646 18,499 52.36 874,633 1.04285 -94,013 Cerro Gordo 2,284,794 44,151 51.75 2,087,459 1.09147 -197,335 Clayton 868,795 18,129 47.92 857,139 1.10971 -11,656 Clinton 2,883,428 49,116 58.71 2,322,204 1.43996 -561,224 Crawford 1,012,457 17,096 59.22 808,299 1.37666 -204,158 Davis 426,870 8,753 48.77 413,842 1.63823 -13,028 Delaware 926,948 17,764 52.18 839,882 1.03815 -87,066 Dubuque 5,165,648 93,653 55.16 4,427,914 1.42090 -737,734 Emmet 820,900 10,302 79.68 487,079 1.75318 -333,821 Fremont 462,193 7,441 62.11 351,810 1.06647 -110,383 Greene 627,158 9,336 67.18 441,406 1.10794 -185,752 Guthrie 614,141 10,954 56.07 517,905 0.99031 -96,236 Hamilton 860,241 15,673 54.89 741,019 1.06958 -119,222 Hancock 629,221 11,341 55.48 536,202 0.81296 -93,019 Hardin 898,104 17,534 51.22 829,008 1.12001 -69,096 Harrison 920,559 14,928 61.67 705,796 1.32546 -214,763 Humboldt 473,531 9,815 48.25 464,053 0.85420 -9,478 Jasper 3,120,466 36,842 84.70 1,741,890 2.37693 -1,378,576 Kossuth 1,140,780 15,543 73.40 734,873 1.05801 -405,907 Lee 2,164,720 35,862 60.36 1,695,555 2.04617 -469,165 Louisa 601,189 11,387 52.80 538,377 1.01955 -62,812 Lucas 441,861 8,898 49.66 420,697 1.63091 -21,164 Mahaska 1,227,887 22,381 54.86 1,058,174 1.34008 -169,713 Marshall 2,115,400 40,648 52.04 1,921,837 1.49988 -193,563 Mitchell 610,215 10,776 56.63 509,489 1.13942 -100,726 Muscatine 2,055,392 42,745 48.08 2,020,984 1.26465 -34,408 Palo Alto 688,176 9,421 73.05 445,425 1.16941 -242,751 Pocahontas 440,242 7,310 60.22 345,617 0.82238 -94,625 Pottawattamie 4,745,180 93,158 50.94 4,404,510 1.15419 -340,670 Ringgold 342,082 5,131 66.67 242,594 1.30170 -99,488 Sac 579,215 10,350 55.96 489,348 0.96284 -89,867 Shelby 885,694 12,167 72.79 575,256 1.37590 -310,438 Union 751,659 12,534 59.97 592,608 1.83771 -159,051 Wapello 2,447,733 35,625 68.71 1,684,350 2.34379 -763,383 Webster 2,146,797 38,013 56.48 1,797,255 1.47156 -349,542 Winneshiek 1,428,756 21,056 67.86 995,528 1.52465 -433,228 Worth 441,512 7,598 58.11 359,233 0.85186 -82,279Sub Total 55,969,382$ 956,414 58.52$ 45,219,254$ -10,750,128$

Grand Total 125,781,915$ 3,046,355 144,031,664$ 18,249,749$

These counties will be required to reduce their property taxes by $10,750,128

LSA:average levy per capita2 .xlsx

29

PER CAPITA LEVY RATE DISTRIBUTION


Step 1: Identify Your Cause.What do you want? Focus on the solution, not the complaint!Ask for it all, but be willing to compromise.See the big picture.'H¿QH�WKH�SUREOHP��:KDW�GR�\RX�ZDQW�¿[HG"Is there more than one solution?

Step 2: Do Your Homework.Know the issue – and put it into human terms.Gather facts and expert information.List the pros and cons of your solution.Form a response to the cons.Track legislation and learn the legislative process.

Step 3: Know Your Legislators.Visit the legislative website (www.legis.state.ia.us) or local library for help.Contact your county auditor, or your state/local election commissioner.Social media (most legislators have an online presence - Facebook, Twitter, website).

Step 4: Rally the Troops.Who else supports your cause (legislators, businesses, organizations)Enlist their support.Decide on common themes – so your messages resonate.Help your legislator understand why your position is important to his/her constituents.Fight where the legislator lives through grassroots at home.Be prepared to give the legislator information s/he can use.

Step 5: Build Support for Your Cause.Use the media.Strength in numbers – work as a group.Consider rallies and other public events to get out your message.

Step 6: Determine Who Can Help You.&LW\�&RXQFLO�0D\RU�&RXQW\�RI¿FLDOVBusinesses/Civic OrganizationsChild WelfareLegislatorsLobbyistsMedia/News EditorsGrasstops vs. Grassroots

30

12 STEPS TO SUCCESSFUL ADVOCACY


Step 7: Communicate.Attend city council meetings.Make appointments with the person you selected in Step 6.Make telephone calls.Visit your State Capitol – and Lobby!Write letters or email.Invite your legislator to a community event or go to a fundraiser.

Step 8: What to Write/Say.State the problem.State the solution.Put the issue into context with a personal story.Ask for help.Say thank you!Follow up.

Step 9: Keep It Short & Simple.Be courteous and respectful.Be brief, concise, and to the point.Be informative and truthful.Be positive – always make your case without being critical of others.

Step 10: Support Those Who Support You.Join organizations sympathetic to your cause.Support candidates who support you.Remember – there are no permanent friends or permanent enemies.Do not take traditional friends for granted.1HYHU�ZULWH�RII�D�OHJLVODWRU�MXVW�EHFDXVH�RI�SDUW\�DI¿OLDWLRQ�Don’t make legislative enemies – you might need them in the future.

Step 11: Remember – It’s Not Personal.Listen to your opponents with the same respect and attention you want.Try to understand their position.Keep channels of communication open.Seek compromise and be diplomatic.

Step 12: Don’t Give Up – or Give In.Remember Rome wasn’t built in a day.Be persistent and consistent.Aim for consensus rather than victory. Be willing to settle for making progress.6WD\�FRPPLWWHG�±�\RX�KDYH�D�FRPSHOOLQJ��HQHUJL]LQJ�UHDVRQ�WR�NHHS�¿JKWLQJ�XQWLO�\RXaccomplish your goal.

31

12 STEPS TO SUCCESSFUL ADVOCACY


Advocacy Tips)ROORZ�WKHVH�WLSV�ZKHQ�WDONLQJ�RU�ZULWLQJ�WR�\RXU�HOHFWHG�RI¿FLDOV��

1. Be Polite. Treat policy makers with respect, even if they don’t agree with you.

2. Be Persistent but Patient. Policy change takes time. Don’t give up.

3. Practice and Prepare. Practice talking to your legislator - it really does help. Think about what you want to say before you meet with, write or call them.

4. Be Clear. Stick to a simple and clear message and keep with it. Get to the point quickly and don’t forget to let them know what you want them to do.

5. Be Personal. These real life examples mean a lot to legislators. It helps them look at issues differently - and put a human face on them.

6. Be Honest. Never lie. You want to be a reliable source of information to your policy makers.

Your Issue/Story (in 50 words or less):

What do you want them to do: (in 50 words or less):

Three key points to make:

1.

2.

3.

32

MESSAGE WORKSHEET


Add any other information about your State Senator that you want to remember, including any personal connections you have. For example, you attended the same high school, you live in the same town,

\RX�JR�WKH�VDPH�FKXUFK��HWF��<RX�FDQ�¿QG�WKLV�LQIRUPDWLRQ�RQOLQH�DW�ZZZ�LQIRQHWLRZD�FRP

Notes/Other Information

Name of my State Senator: Political Party:

Democrat RepublicanContact Information:

Phone Number Email Address

My Senator’s “Other Job” is (teacher, farmer, etc.):

Committee Positions:My Senator is on the following committees:

My Senator is Chair, Vice Chair or Ranking Member on the following committees:

My Senator holds the following leadership positions (i.e. Majority or Minority Leaders, Assistant Majority or Minority Leader):

33

KNOW YOUR STATE SENATOR


Add any other information about your State Senator that you want to remember, including any personal connections you have. For example, you attended the same high school, you live in the same town,

\RX�JR�WKH�VDPH�FKXUFK��HWF��<RX�FDQ�¿QG�WKLV�LQIRUPDWLRQ�RQOLQH�DW�ZZZ�LQIRQHWLRZD�FRP

Notes/Other Information

Name of my State Representative: Political Party:

Democrat RepublicanContact Information:

Phone Number Email Address

My Representative’s “Other Job” is (teacher, farmer, etc.):

Committee Positions:My Representative is on the following committees:

My Representative is Chair, Vice Chair or Ranking Member on the following committees:

My Representative holds the following leadership positions (i.e. Speaker of the House, Majority or Minority Leaders, Assistant Majority or Minority Leader):

34

KNOW YOUR STATE REPRESENTATIVE


Date post:	15-Aug-2020
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

WHAT WILL YOU SAY? Advocate’s Guide to Mental Health ... · Advocate’s Guide to Mental Health &...

Documents