Opponents of Medicaid expansion have mischaracterized the effect its implementation would have on Iowa counties. In pointing out the fact that more Iowans with a need for mental health services would be covered and funded with federal dollars, it is being stated that counties will experience a "windfall." This ignores the costs associated with the expansion of services required of the regions under Mental Health and Disability Services (MH/DS) redesign. The shift to a regional service management system was predicated on using the funds freed up by Medicaid expansion.
In addition, the argument implies that counties would continue to levy at the current rate, even if those funds are not needed to fund regional services. Additional funds will be used to address the rising cost, to reduce or eliminate waiting lists and to provide the new services required by MH/DS redesign.
If there is an excess of resources once these needs are met, history has shown that boards of supervisors will reduce the mental health levy rate in their counties and provide property tax relief to their constituents. This is a much more appropriate outcome than scooping property tax funds to support a statewide health insurance program.
The Iowa State Association of Counties is a private, nonprofit corporation whose members are county officials from the 99 counties in Iowa. ISAC’s mission is to promote effective and responsible county government for the people of Iowa.