Supervisors pursue joining NWIACC

Posted August 22, 2018 at 10:54 pm

By Julie Ann Madden

In less than 60 days, Plymouth County Supervisors have gone from proposing Northwest Iowa Care Connections (NWIACC) join Plymouth and Sioux Counties’ Sioux Rivers Regional Mental Health & Disabilities Services to being invited to join them.

At their Aug. 7 meeting, Supervisor Chairman Don Kass said he, Supervisor Mark Loutsch, and Sioux County Sioux Rivers’ representatives met with NWIACC reps on June 27 in Primghar.

“We have to explore options as to how Mental Health services will be done and who will pay for those in Plymouth County beyond July 31, 2019,” said Kass. “We had a very positive and constructive discussion with them, and we actually invited them to join (us).”

Then he read NWIACC’s answer, which came in a letter from NWIACC Governance Board Chairman William Leopold: “…decided to retain our region’s autonomy and decline your offer…and extend an invite to join NWIACC…” They requested a Letter of Intent response by Aug. 20 for their Aug. 28 meeting.

NWIACC is comprised of Clay, Dickinson, Lyon, O’Brien, Osceola, and Palo Alto counties.

Currently, Sioux Rivers is comprised of Plymouth, Sioux and Woodbury counties. But, Woodbury is leaving July 2019 to join Rolling Hills, which includes Buena Vista, Calhoun, Carroll, Cherokee, Crawford, Ida and Sac counties.

With Iowa’s recent legislation, regions must consist of three or more counties by July 2019. Otherwise, Iowa Department of Human Services Director Jerry Foxhoven will assign regions with fewer than three counties to another region.

That July 2019 date also affects the number of regions allowed in the state, explained Kass. The number at that time will be the maximum number of regions allowed in the state.

Kass stressed it’s important to keep Mental Health service options open by keeping Sioux Rivers viable as long as possible to keep local control of these services, and at the same time to become a three-county or more region to prevent Foxhoven making the decision for Plymouth County residents’ care.

Supervisors were hesitant to commit to joining NWIACC because they want more details about what NWIACC provides and how those are paid.

“(NWIACC and Sioux Rivers’ 28E Agreements which govern Mental Health regions) are similar but there are significant differences in services we provide,” said Kass.

“I’m not sure services are really far apart but they are delivered differently,” said Sharon Nieman, Plymouth County’s Service Coordinator of Mental Health Services through Sioux Rivers. “It needs to be explored on an even chart to crosswalk over the services — to make sure we are well aware of any services that would change to our Plymouth County residents.”

“Their structure for staffing patterns is a little bit different than what we are but the population of those six counties (is more comparable),” she said. “They cover a lot of land mass but population-wise they are a little less than us. (Their staffing pattern is) something we’d have to discuss — along with any other changes within the 28E Agreement.”

In Sioux Rivers each county had its own service coordinator but NWIACC has one full-time service coordinator and one quarter-time service coordinator.

Also, Sioux Rivers has two representatives from each county on its Governance Board but NWIACC has only one.

“It’s not a huge difference,” said Nieman, “but there are differences — good or bad.”

The NWIACC board’s “level of cooperation is much higher than what we’ve experienced with Woodbury,” said Kass.

“I’m guessing they are like-minded counties — not a large metropolitan area,” said Supervisor Craig Anderson. “A huge metropolitan area changes the direction of Mental Health.”

“Their administrative costs are a lot higher than ours even with only one service coordinator,” said Loutsch. “Ours is part-time and paid differently.”

However, “Plymouth County wouldn’t be subsidizing the rest of the region like we were with Woodbury County,” said Kass, noting Woodbury County accessed 73 percent of the services but only paid 63 percent of the region’s costs. “We’ll be in a better, more equitable cost position than we were with Woodbury County.”

“Where we go, this is not our only choice,” said Loutsch. “We don’t have to follow Sioux County. We can also go east (to Rolling Hills region).”

“But the situation wouldn’t be as fiscally advantageous to Plymouth County because we would also be subsidizing the rest of Rolling Hills,” said Kass.

“The (Mental Health tax) levy would go up significantly,” said Nieman.

“It would be fairly stable with NWIACC,” said Kass, and Loutsch agreed.

Nieman noted there were counties “east of NWIACC” that are disgruntled with their current region and also talking with NWIACC.

“Then it’s how big will NWIACC become,” said Nieman. “We need to look at because it changes the dynamics…it could change the lay of the land.”

“There’s value in keeping our options open,” said Kass, favoring keeping Sioux Rivers intact until July 2019 because of the three regions’ “geographical sprawl” and how it could be reconfigured. “(Joining NWIACC) is the best way of controlling our own destiny and taking advantage of our financial position. We’d be better off with NWIACC than with Rolling Hills.”

Another advantage is before regionalization, those counties worked together, said Kass.

“This (decision) doesn’t end Sioux Rivers,” said Kass. “This is simply a Letter of Intent. This is in no way binding. It simply states our intent. Sioux Rivers is still a region until June 30, 2019.”

Nieman told the supervisors the county’s current 28E Agreement requires they state their intent by Nov. 15 as to what the county’s plan for Mental Health services is and what region they will join.

Sioux County supervisors had passed their “Letter of Intent” the day before. Several supervisors preferred staying with Sioux County, too.

“(This Letter of Intent) is for more discussion,” said Nieman. “They still have concerns and questions just like the rest of us do. It’s for more discussion because we don’t want to preempt the dissolving of the region without knowing all the factors.”

Anderson made a motion to authorize Kass to sign the draft Letter of Intent Kass presented. However, other supervisors weren’t supportive of the wording and the motion died for lack of a second.

Finally, they changed the wording to state, “Plymouth County intends to pursue your invitation to join NWIACC,” changed the email address, and added the July 2019 date.

Supervisor John Meis made the motion to authorize Kass signing it with the changes, and Loutsch seconded it. The roll-call vote was unanimous, 5-0.

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