By Steve Woodhouse
A subgroup, comprised of members of the Marion County Board of Supervisors and Public Health Board, is expected to be formed soon to answer questions and provide direction for both boards into the future.
The boards met Tuesday morning in joint session to discuss the future of what services Marion County Public Health (MCPH) will continue to administer in the future. Supervisor Craig Agan, who represents the supervisors on the Public Health Board, has expressed concern that Marion County taxpayers are paying for services provided to those in other counties. This morning's meeting was intended to try to inform and educate both boards regarding concerns with Public Health's operations.
"We're not here to micromanage Public Health," Supervisor Mark Raymie said.
Public Health Board Chair Pati Van Zante indicated that providing health care, overall, is changing across the state. The state is asking Public Health to try to form a medical home model, due to the increasing demand for services. Van Zante also said it is important for all members of the Health Board to stand behind board efforts.
Kim Dorn, Public Health Director, met with Iowa Department of Public Health Administrator Dr. Marianette Miller-Meeks. Dorn shared what she learned from Miller-Meeks, and indicated that, while Miller-Meeks does not support regionalization or centralization of Public Health services, changes do have to be made. Services in some rural areas may not be available, due to a lack of funding or personnel.
Public Health is also trying to understand how it will be further impacted as the "Affordable" Care Act is fully implemented. Public Health hopes to work with community partners to not lose a step during the transition, and to continue to provide services while the availability of grants becomes more scarce.
One program that Marion County administers for four counties (Marion, Lucas, Wayne and Monroe) involves Maternal Health Services. Agan is concerned because 77 percent of Iowa's 99 counties do not administer this program as a County entity. They work through a community action organization.
Dorn indicated that Marion County is a funder of last resort for all programs. She said the program Agan was questioning has always covered all of its expenses.
Agan was concerned about the overhead costs of administering programs. Dorn said these overhead costs would be incurred by the County, regardless of the programs it administers, but if the program was administered outside of Public Health, the programs could be more costly.
Supervisor Jim Kingery suggested that Mid-Iowa Community Action, another agency which has requested space in the former Department of Human Services building in Marion County, could possibly administer some of the social programs operated by Public Health. When the supervisors were asked if asking this organization to perform tasks, already performed by Public Health, would increase overhead, Kingery said he does not believe it would cost more. Agan replied that a hold harmless agreement would be in place to avoid raising costs to Marion County while providing better services to residents in need.
Van Zante added that most counties do not administer state programs because they are too poor to do so. She, too, recognizes that outside funding sources will deplete, and will require change for the future.
"We're going to have to work smarter, as well as harder," Van Zante said. "It's coming, whether we like it or not."
She wants the county to plan ahead. The supervisors and Health Board agree that some questions will need to be answered before they can properly map out a strategy for the future. Raymie suggested a subgroup be formed to try to gather more information, to bring back before the boards, for further discussion.
Public Health also discussed reaching out to better educate the community regarding services available and what Public Health does.