Please find below our Region Application along with our Notice of Privacy Practices. All residents of counties in the Rolling Hills Community Services Region are eligible for Information & Referral and Crisis Services regardless of eligibility criteria.
Please send all applications to our Administrative Assistant, Kelsey Allen, at kallen@bvcountyiowa.com, or fax us at (712)749-2707.

General Eligibility:

• The individual is a child under 18 years of age if applying for Children's Behavioral Health services, or the individual is at least 18 years of age if applying for adult mental health/disability services.  An individual who is seventeen years of age and is receiving publicly funded children's services may be considered eligible for adult services through the regional service system during the three-month period preceding the individual's eighteenth birthday in order to provide a smooth transition from children's to adult's services.  
• The individual is a resident of this state if an adult, and if a child, the custodial parent is a resident of the state of Iowa, and the child is physically present in the state.

Diagnostic Eligibility:

• Children - A child must be diagnosed with a serious emotional disturbance (IC 225C.2).
• Adults - The individual must have a diagnosis of Mental Illlness or Intellectual Disability.

Financial Eligibility:

• Children - The child's family has countable household income equal to or less than 500% of the federal poverty level.  Countable household income and family size shall be determined using the modified adjusted gross income methodology.  An eligible child whose family's countable household income is at least 150% and not more than 500% of the federal poverty level shall be subject to a cost share as described in IAC 25.16(3).
• Adults - Gross incomes 150% or below of the current Federal Poverty Guidelines.  Outpatient mental health services may be funded on a sliding fee scale basis.  Individual has resources below $2000 or under $3000 for a multi-person household.

Application Materials

• Rolling Hills Region Application (Word)
• Rolling Hills Region Application (PDF)
• Notice of Privacy Practices
• CSN Multi-Party Release V14