Alison Hauser

Three employees from Webster County’s mental health system will be laid off due to changes brought about in Iowa’s Medicaid system.

The Webster County Board of Supervisors approved the reduction at its regular meeting Tuesday.

“This was through County Social Services with the restructure,” said Supervisor Bob Thode, who sits on the County Social Services board for Webster County. “Unfortunately, we had to cut back on our employees.”

County Social Services is the 22-county mental health region which includes Webster County. It was created as part of a statewide regionalization effort in 2012 with the intention of bringing better services to patients in all counties.

CSS is now directly integrated with Webster County’s Community Services office, which once handled mental health issues independently. Community Services Administrator Alison Hauser also serves several roles for CSS.

Changes to Medicaid which took effect Jan. 1, 2016, were a key factor in changing how case management works. Iowa switched management of its Medicaid system to three managed care organizations which now oversee payments.

Two of those three MCOs began doing case management internally when the switch occurred, Hauser said. The third used CSS for case management initially, but has since changed.

“Amerihealth had originally subcontracted with us when they took over when managed care came in. And last year in February they identified they were taking case management internal,” Hauser said. “Our last cases transferred internal this month.

“We had a reorganization amongst our region to four quadrants, and as a result of that three direct staff out of Webster County were laid off.”

Patients will now have case managers provided directly by the MCOs, not by the region.

CSS still maintains two case managers which oversee a slightly larger area — 27 counties — taking what are known as HIPPP clients, or Health Insurance Premium Payment Program.

This is a program for people who have insurance but who also receive Medicaid funding — mostly children whose parents have insurance, Hauser said. For these clients it’s cheaper for the state to pay their premium than it would be to pay the MCOs.

That reorganization gave Hauser responsibility for the western quadrant.

“I also, like I said, am case manager administrator for our County Social Services Integrated Care Management,” she said.

Back in 2015, CSS was trying to position itself to offer targeted case management for the area under the new MCO system, although it eventually wasn’t made a subcontractor.

There has been some friction within the organization. Hancock, Winnebago, Worth and Kossuth counties’ boards of supervisors have all voted to show their intent to leave the region because they aren’t satisfied with its delivery in their counties, according to a published account in the Mason City Globe Gazette.