While state officials complete changes to Iowa's mental health system, some who oversee county programs fear they must make drastic cuts during this transition period.
The Legislature approved changes to Iowa's system last May, shifting from a county-based system to a regional approach in which counties pool their money.
The new approach should minimize differences between urban and rural areas, but county officials say until the regional system is fully implemented in 2014, they may be able to reach fewer of the estimated 150,000 Iowa residents with mental health issues.
That's because before the redesign, counties used 50 percent of their budgets to provide the local match for Medicaid. Now that the state provides the local match to Medicaid, local governments see mental health as an area to reduce spending.