House File 2643, the latest budget for the Department of Health and Human Services which passed the Iowa House of Representatives 51-41 in a late Saturday-night session, would split County Social Services into two regions.

With 22 counties, the mental health region is twice the size of Central Iowa Community Services, the next largest Mental Health and Disability Services region in the state. Iowa has 14 regions.

“It could be a great opportunity for our area and a great opportunity for local providers,” Webster County Supervisor Mark Campbell said.

Specifically, it would allow the region to gain badly-needed inpatient beds, subacute care and full-access centers.

The budget bill went to the governor’s desk after state Rep. Ann Meyer’s original bill that would allow new mental health regions to be formed, introduced in February, failed to get to the floor for a vote.

“Consternation” from committee and subcommittee members, among others, was focused on the possibility that new regions could be non-contiguous, she said. Much of that concern was derived from “windshield time” with long drives for services.

“But for a lot of services, people (in CSS) were already in the car driving for an hour or two,” said Meyer, R-Fort Dodge.

Currently, a county can leave for another region, but is not able to form a new region of its own. New legislation awaiting Reynolds’ signature would allow a new region to be formed with a population of 50,000 and at least one city with a population of 24,000.

New rules would also allow a departing county to take its reserve funds with it. Under current rules, if Webster County wanted to leave for another mental health region, it would lose $1.6 million in reserves that are used to tide it over from year to year before taxes are paid.

Perhaps just as importantly, it would allow the state legislature to audit a region.

Many of Webster County’s frustrations with CSS have boiled over publicly on more than one occasion, with county supervisors often expressing exasperation over an inability to get county-specific statistics showing how many residents are being served and the cost per resident.

At $1.4 million annually, Webster County is the third-largest funder of the 22-county system. Black Hawk County, home to the Waterloo-Cedar Falls metro, is the largest.

Requests were often met with responses indicating the region was unable to break their statistics down into county-specific numbers. In their last October encounter with CSS’ CEO Bob Lincoln, supervisors grilled the head on the region’s lack of transparency.

“How many times do we have to ask for (the numbers)?” asked Supervisor Keith Dencklau in October, noting his requests over five years. “I’ve gotten an excuse every year, and you’re standing there giving me another excuse. I can’t levy for this stuff if I don’t have any numbers or any facts.”

“It’s unproductive for us to generate numbers for member counties,” Lincoln responded, in part, before moving on with his presentation on CSS expansions.

After being told that contracts were in place for a mental health access center, which Meyer said was “dangled” in front of the county to prevent it from leaving the region sooner, Campbell said that CSS was unable to produce copies of the contracts.

“If everybody was getting equal services, it would be workable,” Campbell said.

In February, supervisors submitted a Freedom of Information Act request to CSS to get the information they needed — an act usually reserved for journalists petitioning government entities for access to documents or information. The request was acknowledged, but Webster County is still without the numbers it needs.

Lincoln resigned from CSS early this week, after the legislation including the ability to audit regions passed.

“We wanted to know where our citizens’ tax dollars were going and, by tracking this data, opportunities for improvement,” said Supervisor Niki Conrad.

Knowing whether money is being used for acute care or substance abuse treatment, for example, can inform decisions.

Meyer noted that “a lot” of Webster County funding was going to Waterloo without benefiting the western quadrant of the region.

In the new legislative scheme, counties east of* and including Cerro Gordo County would continue to be called CSS. Worth, Winnebago and Kossuth counties have already planned to join Northwest Iowa Care Connection to their west.

Webster County could potentially join Central Iowa Community Services, Rolling Hills Community Services or Northwest Iowa Care Connection, if it decides not to form its own region. The viability of joining Northwest Iowa Care Connection would depend on where Pocahontas County decides to go.

Meyer said the legislation will finally allow regions to work out the “kinks” in the Mental Health and Disability Service Region model about 10 years after it was created, with no major changes since.

“I feel like if you put something into law and it’s brand new, somewhere down the line we’ll see issues and need to work out the kinks,” she said. “That’s what this is doing.”

She is hopeful Gov. Kim Reynolds will sign the bill soon.

“There’s no indication she’s not going to sign it,” she said after speaking with the governor’s staff Wednesday.

*A previous version of this story incorrectly indicated that counties west of and including Cerro Gordo would retain the County Social Services name.