"Before, the state used to give us a lump sum of money and we used property tax dollars to pay for everybody eligible [whose county of residence] was Wapello County," said county supervisor Steve Siegel.
But starting last month, anyone who is on Medicaid is now a state case, not a county case, which means the county has fewer patients. The Medicaid expansion takes effect in January, which will reduce the county's client list, Siegel said.
Fewer county cases mean Wapello County will also see less revenue.
"They lowered our max levy for mental health by a third starting this current year," he said. "But there will be further limitations. For every one of our clients that switches over to Medicaid starting in January, 80 percent of those savings will be reduced from our maximum levy. It's unclear whether we'll be in better shape or worse."
On average every month, River Hills receives 25 to 30 people from the county.
River Hills will only provide necessary, emergency procedures for county referrals. For example, River Hills would charge a flat fee plus 15 percent of the cost of a simple dental procedure, such as a filling or pulling a tooth. But for more complex, restorative procedures, such as a root canal or crown, River Hills would charge the county a flat fee plus 50 percent of the procedure's cost.
The changes will affect different counties in different ways. O'Brien County is now unable to pay for mental health services, according to the Des Moines Register, after Gov. Terry Branstad vetoed the $13 million that was supposed to help counties transition to the redesign.
"They have no money for mental health for the rest of this fiscal year," Siegel said. "There will be others joining that list, but we won't be one of those, at this time anyway."