Iowa is not immune from the health care challenges occurring nationally. Rising costs and a shortage of healthcare providers makes access to services more challenging in some areas of our state, especially rural communities. Health care the way it exists today may not be sustainable in some areas. But with change comes the opportunity to create a more integrated, coordinated system based on the needs of the state and local communities, promoting the health and wellness of every Iowan.
In 2018, Governor Reynolds signed two historic bills into law expanding mental health services for Iowans and advancing suicide prevention. In 2019, the Governor successfully established Iowa’s first Children’s Mental Health System with overwhelming support from the legislature. After decades of talking about what should be done to improve mental health, solutions are now in place so core services are available statewide to address the needs of Iowa’s adults, children and families. This year, to support a strong, sustainable mental health system for generations to come, the Governor proposes the following:
- $80 million in state appropriations invested in the mental health system to create more stability for regions and counties.
- State investment will be coupled with county mental health levy cap reductions to reduce property tax burdens.
- State and regional partnership in furthering the mental health system access and quality will be a more efficient and predictable use of taxpayer dollars.
Fifty of Iowa’s 99 counties provide obstetric (OB) services, and the number of hospitals with OB doctors on staff has decreased over the last several years. Since 2000, 34 hospitals have closed OB services due to declining population and inability to recruit and retain physicians willing or able to provide OB care. In order to improve access to maternal care for expectant mothers and their babies across our state, the Governor proposes the following:
- $400,000 for a Family Medicine OB/GYN Fellowship program that will offer four physician fellows a year of specialized OB/GYN training following the three-year family medicine residency.
- Expand access to telementoring technology to enable specialty conferences between OB/GYNs and family medicine physicians.
- Improve access to preventative care and contraception by passing legislation introduced in 2019 that would allow eligible individuals to receive a self-administered hormonal contraceptive prescription from a pharmacist without proof of a prior prescription from a primary care provider.
In the last several years, technology has enhanced our lives in many ways, and health care is no exception. As the use of telehealth has increased, it has proven to be a useful tool to get care to people at the right time and in the most convenient place. Telehealth also presents a unique opportunity to expand access to care that is limited in some areas, including mental health services. As such, the Governor proposes the following:
- $5 million state appropriation for the further expansion of telehealth providers and sites of service in the Medicaid program.
- Allow schools to be recognized as a site of service so telehealth services can be provided to students during the school day.
Substance Abuse Treatment
A lack of funding for substance abuse treatment programs and facilities means that a growing number of Iowans are unable to get the help they need to overcome an addiction. Substance abuse providers have not had a Medicaid rate increase in years and, as a result, waitlists continue to grow and programs have closed. The Governor proposes the following Medicaid rate increases so that Iowans suffering from substance use issues have access to the care they need and deserve:
- $2.8 million state appropriation increase for residential substance use treatment Medicaid services.
- $3.4 million state appropriation increase for outpatient substance use treatment Medicaid services.
The Governor acknowledges the importance of home and community-based care for aging and disabled individuals, and the difference these services make in maintaining health and quality of life. In an effort to improve funding levels for service providers for the state’s Home and Community-Based Services and Habilitation Medicaid programs, the Governor proposes:
- Across the board increase in funding equivalent to $3.3 million in state appropriations.
Centers of Excellence Pilot Program
Health care is changing, and Iowa must adapt. Declining populations in some communities are resulting in lower volumes of patients, and local hospitals and health systems are struggling to sustain all the services they have historically provided. We must identify new ways to provide quality, sustainable care that meets the needs of our communities. As such, the Governor is proposing a Centers of Excellence pilot program to encourage innovation and collaboration among regional health care providers with the purpose of transforming care delivery for the better:
- $500,000 state appropriation will be supplemented by community investments for this matching grant program.
- Grants will be awarded to two proposals that demonstrate regional collaboration to assess targeted medical needs of local residents, and establish partnerships between rural hospitals and health systems to leverage resources and develop a business model for long-term sustainability.