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Supervisors - Legislative priorPHONE: 563-589-4441 FAX: 563-589-7884 EMAIL: brdofsup@dbqco.org COURTHOUSE DUBUQUE, IOWA 52001-7053 DUBUQUE COUNTY LEGISLATIVE PRIORITIES DONNA L. SMITH ALAN R. MANTERNACH JIM WALLER Presented 2001 The State Budget Crisis We are sympathetic and the reductions that the result of the shortfall in revenue. However, we remind you as impossible situation of having io attempting to provide fiscal year 2002. At the for fiscal year 2002, make in services as a · in the at the same time that we are certified for fiscal year 2003 we Onc program 762 in in 3. Public Health Funding Recently Dubuque County was notified that the Community Services Contract with the Iowa Department of Public Health has been reduced for fiscal year 2002 by $11,829.00. That money will reduce the allocation for public health nursing to $50,414.00 and for Senior Health Services by $3,238.00 for the balance of this fiscal year, necessitating, of course, a reduction in services. Dubuque County already spends $15,000 for public health nursing services to persons in need who do not necessarily meet the criteria for the state's public health nursing program and an additional $80,000 to pay for additional necessary public health nursing services. We assure you that the assumption that Dubuque County will automatically provide additional funding for services when state and federal funding is reduced is a false assumption. Because of federally-imposed restrictions on Medicare and Medicaid funding for home health services, Dubuque County has reached a crisis point in providing those services. The Visiting Nurse Association reports that Finley Home Health Care and Mercy Home Health Care are making referrals to the programs funded through the State of Iowa Single County Grant and County Property tax much sooner because Medicare, Medicaid and private health insurance funding have been exhausted. As a result, fewer clients are being served with the state and local monies. This issue must be addressed statewide. We are asking that a significant funding increase in the year 2002 would achieve a 50% state-county partnership in funding for Public Health Nursing and Home Care Aide programs. We suggest that tobacco money be utilized to provide · these essential health services. 4. Abandoned Wells The Water Well Grants-to-Counties program from the Department of Natural Resources has been decreased from $21,500 to $15,000 per county, at the same time that the DNR is mandating that all abandoned wells be closed. It is estimated that there are 30,000 more abandoned wells in Iowa that need to be closed. Rehabilitation of wells has also been added as an eligible category for the grants. We are asking that the grants be restored to at least the $21,500 figure in order to encourage property owners to close abandoned wells. 5. Environmental Health & Zoning Issues We ask that the legislature insert a definition of a "farm" for zoning purposes. The legislature must determine under what circumstances corporate cormnercial animaI 2 confinement facilities fit within the agricultural exemption for zoning purposes. If appropriate definitions were provided in the Code, counties would gain some control over the citing of commercial confinement facilities. The legislature must also determine definitions counties can util/ze when rural properties are sub-divided and precisely under what circumstances these developments fit within the agricultural exemption State Papers The Dubuque County Board of Supervisors continues to be supportive of the partnership between the University of Iowa Hospitals and Clinics, the State, and counties for the medical care of the indigent. During fiscal year 2002 (the current year), we had utilized 25% of our quota of state papers by November I, leaving the balance of papers for the remaining 8 months of the year. With the increasing number of uninsured or under insured adults, it may be t/me to reevaluate increased availability of state papers for needy people. We anticipate that the elimination of the Medically Needy Program under Medicaid, which is, according to Director Rassmussen, first hi line for elimination, there will be additional demand for State Papers, for General Relief assistance and for Veterans' assistance. We cannot project the immediate effect of the elimination of the Medically Needy Program, but we know that there will be increased costs, at a time that the Dubuque County General Relief Budget is already 20% over budget for fiscal year 2002 because of heating bills from last year's increased fuel cost and bitterly cold winter. Mental Health Parity Iowa does not currently require that health insurance policies cover treatment of inpatient and outpatient mental illness and chemical dependency at the same level and with the same annual and lifetime limits as physical illnesses. The discrepancy in the law is discrkninatory and needs to be corrected. The State should amend the Code to adopt an insurance parity law that requires insurance carriers to use the same co-pays, deductibles and annual and lifetime limits for mental health and chemical dependency treatment as for treatment of other physical illnesses. Substance Abuse Funding Inadequate funding for substance abuse treatment has created a fragmented system with statewide inequities to the access for treatment. 3 First, the State must appropriate monies to pay for the actual cost ofdetoxificafion, and then. in a separate fund, the State must appropriate monies to pay for the number of comm~mity-based treatment and follow-up services. 9. Mental Health Issues A. Growth in Mtt/MR/DD Fund The best possible solution to the Iowa dilemma for services for the Mentally Ill, Mentally Retarded and Developmentally Disabled is for the State to assume responsibility for this entire system. One way that this could perhaps be done is for the state to assume the system and abolish the concept of legal settlement so that clients could more freely move and be placed in appropriate settings closer to home. Perhaps the State could assume that responsibility sooner ifcotmfies would agree to pay to the state an mount based on current expenditures, which would decrease each year for a period of years, at the end of which the county responsibility would be completely gone. On April 9, 2001, the Dubuque County Board of Supervisors wrote to you and the Governor, following the adoption of our fiscal year 2002 budget, attaching a memorandum from the Iowa State Association of Counties, informing all of ns that the Governor had reduced his recommended appropriation for the MH/DD Growth Factor from $26.5 million to $18 million, on the assumption that the new Adult Rehabilitative Option under Medicaid and the county balances would offset this decrease. We had already been informed of a reduction in block grant funding from the Federal level for fiscal year 2002, for which we were able to budget. To date, only a few consumers have been enrolled in the Adult Rehabilitative Option, and we are informed that it would be premature to budget for these funds for fiscal year2003. We are also informed that the Administrative Rules are not yet complete for the Adult Rehabilitative Option, and that reimbursement is limited to services that meet definitions developed by the State. In other words, a consumer may qualify for these funds for 2 hours of a day, while the County pays for services for the other 6 hours. Beginning in January, counties will be preparing budgets, which are due in Des Moines to the Department of Management by March 15, 2002. We need your help in order to arrive at a level of appropriations for this fund early in the session. We have already been informed that the Department of Human Services must reduce spending in Medicaid, beginning with the Medically Needy Program. We 4 have no way of knowing how further reductions in Medicaid will affect this fund before we can certify a budget. There is a proposal from the Department of Human Services and the Central Point of Coordination Restructuring Task Fome to abolish the legal settlement concept and substitute residency for it. This proposal is based on a principle of eqn/table service access, and ideals that require funding to follow consumers wherever they choose to live. Un/ess that goal is established first, legal settlement cannot be abolished, because counties like Dubuque, which offer a rich array of services, will be magnets for disabled persons from other counties. B. State Payment Program During any given fiscal year, Dubuque County has approximately 115 active "State Cases". Payment for these services have been reduced by 4.3% and providers have been notified. Because Dubuque County will be negotiating through the County Rate Information System, based at the Iowa State Association of Counties, for rates during subSequent fiscal years, we do not yet know the effect of those reductions on future per diems paid for services by Dubuque County. At the State level, Director Rassmnssen has stated that further staff reductions would be made in workers who manage the MHfDD State Payment Program. In Dubuque County this means that the DHS service worker who has previously been assigned to these 110 consumers annually will be reassigned to other duties, leaving the Dubuque County MH/DD Department to determine legal settlement and refer cases. If Dubuque County were to adequately budget for assessment and service coordination for the state cases, it is projected that an additional two or three full t/me employees would have to be hired by Dubuque County. A larger problem with these State Cases is case management for individuals who have no legal settlement in any Iowa County. The restructuring at the Department of Human Services has already directly affected the way the Dubuque County MH/DD Department operates; adult service workers have been essentially abolished, so there is no social worker for disabled people, so the County is contacted for these issues and must refer cases to Medicaid Case Management, at the County's expense: Managed Mental Health Care Concerns about the State's managed mental health and substance abuse provider continue with providers of service. We are concerned that services for "state cases" managed by the provider have equal access to services, in accordance with the county management plan of the county in which the individual needing services lives. Dubuque County is particularly sensitive to the "state case" issue because of our location, and because of the county's continued responsibility to pay for commitment costs for "state case" clients from Wisconsin and Illinois who are not actually committed to a state institution. We are a catchment area for these services because Mercy Medical Center provides them to consumers from a large We suggest that the contractor's'responsibility be expanded to include all of the commitment costs for both mental health and substance abuse, eliminating this problem for counties located in catchment areas. Long Term Nursing Care for Geriatric MH/DD Clients (ICF/PMI) There are no monies available to develop specialized intermediate care facilities to care for elderly and/or physically ill persons who have been diagnosed with mental illness and cannot be managed in the traditional nursing home setting. The legislature must direct the Medicaid program to develop a per diem rate for residents based on the type of care provided, and appropriate funds to cover 100% of the non-federal share of the cost. This need grows consistently as people brought back to our communities through the MI-UDD system age and require nursing care, and as the aging population grows. Through the 109-bed geriatric unit at Sunnycrest Manor, Dubuque County has provided care for some of these clients when they meet the county's criteria; however, the county cannot care for all of this population at that facility for several reasons. One of them is cost; this population requires enormous amounts of stafftime which the regular Title XIX reimbursement does not pay for. Another is that the facility is not licensed as a PM][ and to do so would endanger the Medicaid money that we do receive for geriatric clients, through the prohibition on ut/llzln§ Medicaid for a "large public mental institution." The only beds currently providing the appropriate level of care are at Clarinda MHI, which has been certified to receive a higher level of Medicaid reimbursement. However, there is a long waiting list there, and persons who are admitted to the program must leave their own communities. Dual Diagnosis Approximately 70 per cent of persons with chronic mental illness experience a occurring problem with substance abuse. Treatment for dually diagnosed individuals is a critical need. The DHS program available for these consumer is in Mt. Pleasant, where beds are limited and costs are prohibitive; is critical that the State and its managed care contractors approach the needs of the dually diagnosed population in an integrated manner. Services to the Department of Corrections Counties are being requested to fund MH/DD services to persons who are under the jurisdiction of the Department of Corrections. This has happened to Dubuque County in two ways: (1) Requests for residential placement for persons who have disabilities and/or have disabilities at the County's expense. (2) Requests for vocational and/or counseling services for persons brought to our county under the "interstate compact" to complete requirements of probation. It continues to be our position that persons under the jurisdiction of the Department of Correctional Services are the responsibility of the State of Iowa. There is nationwide concern that a substantial percentage of the people in the corrections system have mental illness, substance abuse diagnoses and that there is no treatment available for those people. We continue to be concerned that people having diagnoses of mental illness or substance abuse remain the responsibility of the Department of Correctional Services and encourage sufficient state funding to provide the services needed by persons supervised by the department.. Civil Court-Ordered Services In the 1980's the State of Iowa began transitioning the funding and supervision of court services from counties to the state. This process was never completed and it is time to do so. As you study the issue of the employment status of Judicial Advocates, who are currently actively seeking employment status either through the state or the counties, consider that the counties meet non of the federal qualifications for "employer" for these advocates. We do not h/re, fire, train or supervise these people; we should not be their employer for ethical reasons because the county's interests in any case may be different from the Advocate's. Advocates should either be paid in the same manner as Court-Appointed Attorneys, or should be employees of the State of Iowa. We also ask that court-ordered sheriff's transportation and other fees be paid by the State, as well as court-appointed attorneys in the commitment process, and any court-ordered diagnostic evaluation. H. Brain Injury Funding for persons with a brain injury is very limited and many of these individuals need services that they are unable to obtain. Counties do not have resources available to add a new population group to our management plans. Therefore, we support the establishment of a state/federal funding stream to provide services for persons with brain injury. 10. State Court Administrator's Office and Juvenile Court Services As the situation currently stands, counties are paying a pro-rata share for space occupied by State Court Administration in the Black Hawk County Courthouse. We also provide space in our Courthouse, where space is scarce. We ask that you amend Iowa Code Section 602.1303(1)(b) to provide only that counties provide offices for the district court. We also ask that the mandate that counties provide space for Juvenile Court Services be transferred to the state, which employs the Juvenile Court Services staff. It is chaotic for us to be negotiating to rent space for an office that is staffed by state employees, and where we have absolutely no control over the numbers of people and therefore the numbers of offices that are necessary. 11. Funding of State Mandates County budgets are increasingly burdened with the cost of current and new state mandates. In order to avoid forcing additional spending onto the property tax, any service mandated by the state must have adequate state funds to pay for it. The mandate issue is complex. It relates to much of what we do, and in both direct and indirect ways. For example, Dubuque County has had to employ more prosecutors and needs more jail space because more people are being charged and sentenced, although we know that the legislature did not specifically intend to cause jail overcrowding when the legislation was passed. Particularly at this time of State budget cuts, it is essential to remember that mandates will effect property taxes, and we note that limitation of property taxes is also on your agenda~ It makes no sense to us that costs would be shifted to us at the same time that you discuss limiting our ability to raise additional funds. Unfunded mandates force additional spending onto the property tax; any service mandated by state legislation should have adequate state funds to support it. A recent example of this practice occurred this fall when the Department of Management proposed eliminating a position. The proposal was made that because the individual worked with counties on county budgets, that the counties would "chip in" to pay for the position. From the County's General Fund! The County Engineer was also informed by the Department of Transportation that staffwho conduct the Needs Study to determine the percentage of Farm to Mark and Road Use Tax Funds that will be appropriated to individual counties would be elim/nated by the Department. The IDOT asked whether County Engineers were willing to take the study over. A copy of the letter from that State Department is attached. 12. Funding for County Jails The cost of building and operating county jails continues to consume an ever- increasing share of the budget for most counties. One way to fight this is for the State to guarantee the necessary fund to fulfill its statutory duty to reimburse counties for holding state prisoners in county jails. The State of Iowa is required by statute to reimburse counties for the cost of holding parole violators in county jails, and to reimburse counties for work release violators and some OWI violators. The current $900,000 appropriation falls short of the millions necessary for full reimbursement. The state should pay counties for the entire cost of housing all prisoners under the jurisdiction of he Department of Corrections held in county jails or other county-paid facilities. ISAC bas learned that in some states, Medicaid coverage is continued for adults and children in jail or detention during the pre-trial phase. If a person has already been determined eligible for Medicaid prior to being detained in jail or detention, it makes sense for these people to continue eligibility. 13. Juvenile Detention Juveniles who are currently being placed in detention facilities may have needs that exceed the ability of detention or shelter facilities to meet. There is a backlog of youth waiting for placement in residential programs wh/le youth needing secure facilities may be placed in un-secured shelter facilities or in juvenile detention facilities at costs exceeding $200 per day. The state also continues to allow shelter facilities to charge counties for costs that exceed the maximum paid by the state for shelter care. The disparity between the shelter care per diem state-capped rate and allowable rates has grown to $32.07 per day, which is a cost shift to counties. We ask that the state pay the entire rote for the cost of shelter, increase the availability of residential placements for juveniles, provide necessary programs for them, based on their individual needs. 14. Tax Credits and Exemptions Property tax credits and exemptions are mandated by state law and administered by county governments on behalf of local taxing jurisdictions. Currently, military service property tax exemption is funded by the state only to a certain tax credit limit of $6.92 per $1,000 in property value. This only covers about 21% of the total actual claims submitted for tax exemption, creating a shortfall of $9.7 million in state funding of this exemption that local taxing entities subsidize. Local property taxpayers are financing the unfunded portion of the tax exemption with property tax, although the mandate comes fi:om the state. The Dubuque County Treasurer received half of the homestead credit reimbursement last week, reduced by over $67,000. 15. Tax sale property Each year, the County Treasurer delivers to the Board of Supervisors a list of properties which have been deeded to the County. We then prepare a Request for Proposal to s~ll this property. Some of it is sold. Other parcels, however, are pieces of bluff, lots which are too small, too steep, or too narrow. Infrequently, a derelict building is located on one of these lots. Ail of this is a liability to the County, particularly resulting from the terrain of Dubuque County. When the property is sold, proceeds are shared with all taxing districts. 10 16. We suggest that when these properties become delinquent and are ready to become the property cfa public entity, properties within a city become the propefaf of, and liability of, that city. The County would then assume the liability and responsibility for the properties in the rural areas. When and if the property is sold, proceeds would continue to be shared with all taxing districts applicable. Tax Increment Financing Tax Increment Financing Districts under Iowa Code Chapter 403 should be changed so that the taxing authority establishing the TIF district can only create an urban renewal area with the approval of each a~fected taxing jurisdiction of the city or county and school that share the TIF base. TIF districts should be limited to a certain number of years, specifically pertaining to TIF's designated for eliminating urban slum or blight. All TIF districts must also be required to prepare a fiscal impact statement prior to approval. If any one of the taxing entities does not approve of the TI~ District, than an individual taxing entity or combination of taxing entities may elect to create a district that applies only to their portion of the tax levy. Two cities in Dubuque County have created such districts for residential purposes; one of the two created a district which includes almost the entire city, thereby reducing the amount of money available for county services, although those servmes must remain available to those citizans. Therefore, there is an additional property tax burden on farmers, who are already facing extreme economic difficulties. 17. Southwest Arterial We are discouraged by the news that the Southwest Arterial has not been included in the Iowa Department of Transportat/on's five-year plan. Because the Southwest Arterial is such a vital link in Dubuque County's transportation system, we believe that the project must receive a high priority from the Iowa Department of Transportation Commission. We are asking for your assistance in making sure that this vital !ink is included in ][DOT's five-year plan. encl. (2) 11 PHONE: 319589-4441 FAX: $19..589-4478 COURTHOUSE DUBUQUE, IOWA 52001-7053 DONNA L. SMITH ALAN R. MANTERNACH JIM WALLER April 9, 2001 The Honorable Tom Vilsack Governor, State of Iowa Statehouse Des Moines IA 50319 Dear Tom: It is with great disappointment that we read that you have propesed a revised fiscal year 2002 budget showing that counties will lose $18 million in the growth fund for mental,he~}th and developmental disabilities. In 1995, the leg/siature established propc~rty tax relie~/n/l~e fo~rn'0f state monies prov/ded to counties for expenditures in the Mental Health/Developmental Disabilities Fund. The growth funds were established to address service cost inflation, new consumers and ~ and efficiency. It is our understanding that the teg/slature has ~ new proposal will take another ~ r's incentive funds; your for a total of $429,903. On February 20, 2001, we were notified by Services that Dubuque County would not receive $5,035.75 in block ~xpect from that fund in fiscal year 2002 was in doubt becanse ~ is ontemplatmg hm~tmg prOperty mx. H~ ~e .e reduclxm~qfprop~ taxes hta brae when the State ~s also cuttmg momes ong/~dly meant to accompEsk that goat, ~ · , ~·,. ~; ' ~ The argument~ for tak~g t~ ~ne~'~ ~imfies a~e that the proposed new-rehabii~tio/~,ger~es ~vill be available and,~ilt ~ave property, tax, momes, tha~ program ~s notyetunder way: '~ andin~ ha~anc~ent will not work ~ the:,*,~fDD,,func~p~ '~ because bitt/ngs from StateInsfitUti f0 i the State are ff{C[Ue,ntty lat~ lending balance~ enable counties to pay fo~ f~rst quart~ pm~ld~rsY /~,':~ "~ These act~uns a[ep~g ¢ounUe~ m an untenable altuat~om Please restore ~heMbt/DD funct~ and allO~v loc2d officials to make decision~ abo/ii taxati6~ Tuat is what we are el~cte4 i(~'~t0: ' ~ ' ' Sincerely, ~ .j,;/ jh Memorandum STATE ASSOCIATION zo~ E CourtAve, SuiteA, Des Moines, IA 50309-4901 OF COUNTIES p.. 515-244-7181- fax 515-244-6397-e-mail mail~iowacounties, om THE GOVERNOR'S REVISED BUDGET, A CUT IN MENTAL HEALTH DOLLARS Governor Vilsack's revised fiscal year 2002 budget was released yesterday showing budget cuts and revenue adjustments totaling $285 million. Of those cuts, counties will take a significant loss in the MH/DD growth factor. The Governor originally recommended approximately $26.5 million dollars to be distributed to counties meeting established criteria. The revised budget shows an $18 million reduction. In essence, the new proposal will grant only $6 million for mental health growth and only $2 million for counties needing to access the risk pool. The executive branch sites several reasons for the reduction including that the decrease will be offset by both the new rehabilitation services available under Medicaid and the "over $95 million available in county balances." The revised budget further suggests that the reduction would be offset by "projected implementation of mental health parity that would allow the private sector to share the costs." The premises used to establish the Governor's new growth factor recommendation are inaccurate. First, the rehabilitation services (ARO) have not been implemented and to date counties are unable to access matching Medicaid dollars. Second, the $95 million in the county fund does not take into consideration the 25-35 percent carryover that counties need to "run" the mental health fund. Nor does that figure take into consideration funds that have already been reserved or encumbered by the counties. Last, the first funnel ensured that there would be no mental health parity this year thus not shifting any of the burden to the private sector. It is imperative that you are aware of what will happen to your mental health fund if the growth factor is reduced by $18 million. The Iowa State Association of Counties will be pulling together a group of county representatives to respond to this revised proposal by the Governor. If you have any questions please call the ISAC office at (515) 244-7181. Iowa Department of Transportation '~!~,~ 800 Linooln Way, Ames, ~A 50010 515-239-1661 Fax: 515-239-1120 August17,2001 Ref. No. 733 To: From: ICEA Executive Board Royce Fichtner, Marshall County Engineer Mark Nahra, Delaware County Engineer Tom Rohe, PIymouth County Engineer John Easter, ISAC Director of intergovernmental Affairs Mike Wentzien, Iowa County Supervisors Association Lobbyist Dennis Tice, Director"~k.-~ Planning and Programming Division Subject: Proposal to Eliminate the Quadrennial Need Study As a result of restructuring and staffing reductions here at the Department, we have been evaluating our tasks and responsibilities to identify changes that will allow us to function more efficiently and effectively. One item we have identified is the elimination of the Code of Iowa requirement to conduct a Quadrennial Need Study. As required by Section 307A.2(14) of the Code of Iowa, the Quadrennial Need Study is conducted to investigate present deficiencies and future twenty-year maintenance and constrUction needs of the roads and the ability of each applicable authority to meet the needs for the planning, construction, repair and maintenance of roads within their jurisdiction. Although the study is required to evaluate all public roads in the State, the main function is to distribute seoondary and farm-to-market road use tax funds to the counties. Over the years, the need study has been scrutinized as a tool for distributing secondary and farm-to-market road use tax funds. Currently, 70% of the secondary and farm-to- market fund distributions are based on each county's relative share of needs. The remaining 30% is distributed based on each county's relative share of land area. A major concern among counties is the often-significant changes in needs for individual counties from need study to need study. In fact, several research projects have been completed in recent years to evaluate the need study and in one case to develop an alternative method for distributing the secondary and farm-to-market funds. There are other concerns with the need study as well. First, the Transportation Commission has expressed concern regarding the fact that the need study analysis does not include any economic considerations or any measures to prioritize the needs. This is a concern that was also expressed in the January 1989 legislatively mandated study of the needs and finances of towa's roads. Second, the need study requires thousands of person-hours to complete. In Iight of the Department restructuring and concerns with the study itself, the Department is proposing to eliminate the need study. I:I~]~NIgN~,LLNnO0 SEtNO[' CI ^IBO bl Proposal to Eliminate the Quadrennial Need Study August 17, 2001 Page 2 Because the elimination of the need study will have the greatest impact on county governments, we have set up a meeting to discuss t. his issue with you and seek your input. The meeting is scheduled for Wednesday, August 29, 2001 at 10:00 am. The meeting will be held in the Office of Systems Planning Conference Room that is located on the first floor of the Northeast Wing of the DOT complex in Ames. For your review, we have enclosed a copy of the proposed Code of Iowa c_hanges under consideration by the Department for the upcoming legislative session. If you have any questions or would like additional information please call Stu Anderson at 515-239-1312. Enclosure