Iowa’s mental health revamp shows little change

Laura Semprini of Iowa City knows what it is like to call behavioral health providers in a desperate attempt to get an appointment during a time of need, just to be told, “Come in three months.” This experience is not uncommon, with the average wait time for behavioral health services in the U. S. being 48 days, according to a November 2024 study by the Health Resources and Services Administration National Center for Health Workforce Analysis. The same study said six in 10 psychiatrists do not accept new patients, making wait times a more significant barrier to accessing care. Semprini now works as a remote peer support coordinator for the Johnson County chapter of the National Alliance of Mental Illness, or NAMI. Although she has been fortunate enough to access behavioral health services when she needed it, Semprini said she understands, as a patient and a provider, there are notable barriers in access to care. In an attempt to streamline services and improve access to behavioral health care across Iowa, a new statewide system was implemented on July 1. After being signed into law by Iowa Gov. Kim Reynolds and passing the Iowa Legislature with bipartisan support in March 2024, the new Behavioral Health Service System reorganized resources across the state. State officials and some mental health advocates said the system will be a more effective way of providing care, while Johnson County officials say the system will be too far removed from the needs of local communities. Semprini worked on the advisory council and governing board for the East Central Region, one of 14 former behavioral health regions across the state. She said much of the old system was working, but there were areas that needed improvement, such as the difficulty in providing substance abuse and behavioral health care together, considering the high rates of the co-occurring diseases. According to a study published by the World Psychiatry Journal and archived in the National Library of Medicine, around 50 percent of individuals with severe mental illness also deal with substance abuse. Marissa Eyanson, director of the division of behavioral health for Iowa Health and Human Services, or Iowa HHS, said the old system was outdated in terms of laws and services designed to provide care to Iowans. She said Iowa HHS conducted a statewide assessment to identify problems with the old system. Eyanson said the previous system was inconsistent in providing care and often led to individuals not receiving help until they were in crisis. She said the new system was developed from a “community-driven, statewide effort,” and has been modernized to fit the current needs of the state to prioritize early intervention. Early intervention initiatives include increased services in locations such as schools or jails places where individuals are likely to gain access to care for the first time, Eyanson said. Johnson County Supervisor Rod Sullivan said funding previously came directly from the county until the funds were combined into regions in 2014, when Johnson County became part of the East Central Region, one of 14 former regions in the state. The old regions each had different entities administering services. Now, the regions combine to form seven districts, and funding is funneled through the Iowa Primary Care Association, or PCA, a singular Administrative Service Organization in an attempt to limit complexities in funding distribution. Iowa PCA said it does not deliver direct clinical care but rather “builds and supports a network,” which reaches across the state to do so. Iowa PCA said it contracts with 124 behavioral health providers across Iowa to deliver care as efficiently and consistently as possible. “Our goal is to ensure Iowans can get connected to care regardless of where they live or what coverage they have,” Abby Ferenzi, senior director of behavioral health services at the Iowa PCA, said in a statement. Semprini said while some providers’ contracts changed as a part of the realignment, NAMI’s contract remained largely the same, though funding for staff training is no longer included. Navigating the behavioral health system Eyanson said a major issue Iowa HHS found was difficulty navigating the old system, leading to hardship in accessing services. “[People] often found there were too many doors but not enough of the right doors,” Eyanson said. She said the addition of system navigators, a “boots on the ground” mechanism to help Iowans maneuver the behavioral health system, has been an immediately impactful change with the new system. Navigators are located throughout the districts and make care more accessible through a less cumbersome process. “We don’t replace local providers we connect and support them, and we strive to make sure rural residents have the same clear pathways to care as urban Iowans,” Ferenzi said in the statement to The Daily Iowan. Iowa PCA has already participated in more than 4, 000 calls to connect Iowans to behavioral health resources across the state from July 1 to late October, the organization said. Eyanson said the previous system had other system navigation tools that were not as accessible, as some had eligibility requirements. Both the “Your Life Iowa” line and the 988 lifeline existed before the transition, but Eyanson said the lines are being emphasized in the new system as another tool for providing immediate assistance to those in need. “What we are trying to do is get people connected sooner,” Eyanson said. “The most common reason folks get sicker with behavioral health-related issues is because they waited to get care, [or] they didn’t know where to go,” Eyanson said. Semprini said Iowa has a shortage of health care providers, and while there are increasing options through telehealth, peer support can also help bridge the gap. She thinks NAMI has been supported by Iowa PCA in prioritizing peer support services. Eyanson said the streamlining of services in the new system should help retain providers across Iowa, fighting the provider shortage nationwide. According to the HRSA, more than 122 million Americans live in an area facing a shortage of mental health professionals. The Association of American Medical Colleges reported Iowa was 44th in the nation in patient-to-physician ratio in 2024. The data represent all physicians, not just behavioral health professionals. “We find that within services and systems that are complex, sometimes people will leave the profession just because they’re done having to deal with the noisiness of that level of administrative effort,” Eyanson said. Existing barriers to behavioral health care Sullivan, the Johnson County supervisor who has 35 years of experience in the behavioral health field, said while access to services is a nationwide problem, it only gets more difficult in rural areas. However, the issue has more to do with proper funding, compared to the system used to deliver services. He said the new system will turn out worse for Iowans, and previous barriers to care will continue within the new system because state funding for services is not increasing. “Iowa does not adequately fund Medicaid,” Sullivan said. “No matter how you provide the service, if they are not funding it adequately, you can’t do what is necessary.” According to a 2025 report from the Kaiser Family Foundation, a nonprofit providing research on health policy, Iowa has the highest rate of mental illness among non-elderly Medicaid recipients, at 51 percent. Medicaid funding is split between the state and federal government. In budget year 2025, $2. 2 billion in state funds and $6. 8 billion in federal funds were appropriated in Iowa for Medicaid. Sullivan no longer sits on a state behavioral health advisory board, as district boards do not have direct interaction with county supervisors. “They are taking the county’s output out of the process and moving it to a state-driven system,” Sullivan said. “Everything state-driven ends up being, in my opinion, worse, because [it is] more removed from the people.” Johnson County Supervisor Lisa Green-Douglass said county-level influence in the system had been decreasing since the realignment was developed and passed into law in March 2024, noting the new governing board, the District 7 Advisory Council, does not include any elected officials. Green-Douglass said having elected officials on the board allows it to be held accountable, “because if they are unhappy with what you are doing, you don’t get reelected.” Semprini works on the new advisory council as both a provider and advisor as a person who has lived experience with mental illness and said even though there are no elected officials on the board, Iowa PCA and Iowa HHS have worked to get input from a wide variety of sources. These sources include patients, law enforcement, and elected officials, on the transition. Sullivan said the new system intends to fix barriers to care throughout Iowa, but he doesn’t think it will be possible without funding increases. “We are going to see less availability [of services],” Sullivan said. “We might see some improvements on some of the very acute stuff, but I would expect things are going to get worse and not better.” Sullivan said he still attends a monthly system of care meeting in Johnson County to discuss access to services, and while he feels like he still has adequate knowledge about the system and services, he no longer has direct input. Redistributing funds Eyanson said while the distribution and organization of state-appropriated funds for the behavioral health system have changed, the dollar amount has not. For fiscal 2026, $236 million has been allocated for the system, a number that has not changed from fiscal 2025. Iowa Rep. Timi Brown-Powers, D-Waterloo, said not only is the behavioral health system not funded enough, but she foresees cuts considering the recent projections that the Iowa revenue is projected to fall $800 million in fiscal 2026, leading to potential complications with the state budget. Eyanson said she does not anticipate any changes in the amount of funding appropriated to Iowa’s behavioral health system, even in light of potential budget difficulties and revenue falls. Brown-Powers said the new behavioral health system looks good “on paper” but will be ineffective without proper funding. Eyanson said the “streamlined administrative effort” prioritized in the new system, particularly through the use of Iowa PCA as an Administrative Service Organization, has saved the state money, which is being reinvested to expand services, such as school-based behavioral health care and system navigation. Eyanson said while the installation of the statewide system was only a few months ago, she has already received feedback in spaces that are improving, including reduced administrative effort from providers. “That means providers get to spend more time being providers,” she said. Eyanson emphasized the goals of Iowa HHS in providing services to all Iowans more efficiently and effectively than before. “It really doesn’t matter where you are, where you sit, who you are ­you should be able to get connected to the services, the resources that you need, and be able to feel confident about how to do it,” Eyanson said.
https://dailyiowan.com/2025/11/18/iowas-mental-health-revamp-shows-little-change/