GARNER | Hancock, Winnebago, Worth and Kossuth counties have decided to explore an option they hope improves mental health and disability services for their residents.

Within the past month, the counties’ board of supervisors have individually — and unanimously — voted to draft and submit a letter to County Social Services, or CSS, stating they intend to withdraw from the 22-county service region because they aren’t satisfied with its delivery in their counties.

But it’s likely the first of many steps the four counties, and others wishing to join them, will have to accomplish before such a feat can be realized.

“If you go about it half-a----, that’s what you’re going to get,” said Roger Tjarks, Kossuth County supervisor. “We’ve had some of that in County Social Services, where we tried to do too many things, and we never set a good foundation. ... It’s been a failure, so if we’re going to do it right, let’s do it right from the beginning.”

Tjarks was one of more than 20 supervisors and staff within the CSS service region who met with Jan Heikes of the Iowa Department of Human Services and area legislators on Wednesday in Garner. The meeting was the second for the group in less than a month.

At the first meeting on Sept. 28, a similar-sized crowd voiced concerns about the region’s staffing, funding and delivery of mental health and disability services to Heikes, Bob Lincoln, the region’s CEO, and area legislators.

The second was scheduled to give counties time to determine whether they wished to withdraw from CSS and Heikes time to receive answers to the supervisors’ questions. She brought those answers to the meeting Wednesday.

CSS is one of 14 regions established in 2014 as part of Iowa’s Mental Health and Disability Redesign to “efficiently and effectively” provide mental health services mandated under state law, according to the region’s joint agreement.

With 22 counties spanning North Iowa, it’s the largest region in the state, but all regions operate differently based on the joint agreements the counties approved during the redesign.

Supervisors in Hancock, Kossuth, Winnebago and Worth counties believe that can be improved if a smaller region is established.

But there isn’t “a clear path” in state law that outlines the process for establishing a new region after the redesign, said Sen. Waylon Brown, R-St. Ansgar.

“I met with Director [Jerry] Foxhoven to see what the appetite of DHS is to allow a piece of legislation, and basically what he told me, with some stipulations, they would be willing to take a look at it,” he said. “With a piece of legislation done right, I believe that a pathway can be made.”

The original Mental Health and Disability Services Redesign Regionalization Workgroup recommended the minimum number of residents a service delivery region should have is between 200,000 and 700,000, according to a progress report issued by the Iowa Department of Human Services in December 2016.

“So the real concern is whether counties with smaller populations and with a smaller financial tax base would be able to provide all the services that are required to form a region,” Heikes said. “That’s really the crux of what needs to be looked at.”

But the final mental health and disability services redesign legislation did not require a minimum number of residents be included in the region, but instead required regions to consist of at least three counties.

Because the population requirement isn’t in state law, Heikes said the question is whether a region smaller than the workgroup’s recommendation can provide all the core services, core-plus services and evidence-based practices a region is required to their residents more effectively and efficiently than one that does.

In 2015, the combined population of Hancock, Winnebago, Worth and Kossuth counties was 44,317, which is about one-tenth of the population of the current 22-county region.

“What we can do is we can work to offer the pathway that you need, but I would strongly encourage you guys ... to make sure at the end of the day, you are providing the services in an efficient manner to the people who need them; because at the end of the day, that’s what this is about,” Brown said. “It’s not about whose money is whose. It’s not about where the service is provided. It’s about are the people getting the services when they need them in a timely manner that they need to have them.

“If you can’t do that, I strongly, strongly suggest you take time and look at how the citizens of the counties that you represent will be impacted.”

According to the CSS region’s joint agreement, a county may not withdraw unless written notice is received by CSS from the county board before Nov. 15 for effective withdrawal by June 30 of the following year.

Ron Sweers, Hancock County supervisor and CSS Board member, said it’d likely be two calendar years before the counties were comfortable creating a new region because of the criteria a region must meet.

“Right now, we have services and things work,” said Sis Greiman, Hancock County supervisor. “I think we really have to define everything before we just all of a sudden decide to jump ship.”

The supervisors agreed to continue the discussion with those interested in starting a new region at the next CSS Board meeting at 10 a.m. Oct. 25 at the Hancock County Extension.

And if the counties ultimately decide not to move forward with the establishment of a new region once proper legislation is in place, Tjarks said the discussions will be a “learning tool” for Lincoln and CSS.

Reach Reporter Ashley Stewart at 641-421-0533. Follow her on Twitter at GGastewart.

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