Principal Demographics and Geography of Iowa

Iowa is a predominantly rural state with approximately 3.2 million people according to the United States Census Bureau. Ten of Iowa’s 99 counties have a population of 65,000 or more and make up more than half of Iowa’s population, 23 counties have between 20,000 and 64,999 residents, 64 counties have between 5,000-19,999 residents, and two counties have under 5,000 (State Data Center, 2022 population estimates). Based on metropolitan statistical areas (MSA), sixty-one of Iowa’s ninety-nine counties are designated as rural, sixteen are designated as micropolitan, and twenty-two counties are designated as metropolitan. With the state’s predominantly rural population, a lack of transportation is one of Iowa’s most widespread and persistent concerns with regard to access to health services of all types.

 

Iowa has typically had a healthy economy with an unemployment rate of 2.9% (March 2024, Iowa Workforce Development), which is significantly below the US rate of 3.8%. The unemployment rate during the COVID-19 pandemic rose to 8% (June 2020, Iowa Workforce Development). While agriculture and related industries are the main sources of commerce, advanced manufacturing, biosciences, insurance, and financial services also contribute to Iowa’s economy.

 

Although Iowa’s unemployment rate is low, the 2022 American Community Survey reports the percentage of Iowans living below the federal poverty level (FPL) was 11% compared to 9.1% in 2000. Among female headed households, the percent of those living below the FPL level is more than double that of Iowans overall at 23.5% in 2022, compared to 23.4% in 2000. In both metropolitan (14.6%) and micropolitan counties (14.3%), fourteen percent of women ages 18 to 55 live below the FPL. In rural communities, about 12% (12.8%) of women ages 18 to 54 live below the FPL. State-wide, fourteen percent (14.2%) of females ages 18 to 54 live below the FPL. The percent of females ages 18 to 54 without health insurance also varies by MSA. The highest percent of females without health insurance are those living in rural counties (7.5%), followed by females living in micropolitan counties (6.7%). The lowest percent of females ages 18 to 54 without health insurance reside in metropolitan counties (5.6%).  State-wide six percent (6.1%) of females ages 18-54 live below the FPL.

 

In Iowa, the percent of women of reproductive age (WRA) decreased by 0.9% from the year 2000 to 2022. Ninety-one percent (n=91; 91.9%) of Iowa counties reported a decrease in their percent of WRA from 2000-2022. Eight counties reported an increase (7 metropolitan and 1 rural) of their percent of WRA. The percent increase ranged from 3.5% in Sioux County to 150% in Dallas County. During this same time, Iowa has witnessed the closure of over 40 obstetrical (OB) units. Many of these closures were level 1 community facilities with a low volume of annual deliveries (less than 200). There may not be a direct correlation between the OB unit closures and the reduction and shift in the population of WRA. However, HHS continues monitor access to care by levels of rurality.

 

However, state maternal health indicators around health care access and quality have not declined, in spite of the number of closures of L&D units. For example, overall, prenatal care initiation has remained stable over the past 5 years. Staff does note that women living in micropolitan counties compared to those living in metropolitan and urban counties, initiate prenatal care later in their pregnancies. The women of color and those with Medicaid reimbursed births initiate prenatal care later compared to white women and those with private insurance coverage. Accessing perinatal health care in rural areas is complicated by both patient factors and factors related to the delivery care system itself. Ensuring optimal maternal and neonatal outcomes for rural populations poses unique problems and challenges, including providing basic maternity services to these rural areas. A broad spectrum of provider models, including the use of Certified Nurse Midwives, freestanding birth centers, and the use of additional emotional supports such as doula services, will need to be considered as public health research increasingly supports these options to increase maternal health quality and access, particularly in rural areas and for women of color.

 

Statewide, 59 counties in Iowa have a Primary Care Health Professional Shortage Area (HPSA). Each Primary Care HPSA also has a Maternal Care Target Area (MCTA). This was added in 2022 to better identify the need and shortage for obstetric services. The total population living in designated HPSAs statewide as of June 2023 is 1,846,164 which is 60% of the total state population.

 

Overall, Iowa children are in good health. According to the US Census Bureau estimates, 5.8% of Iowa’s total population were under the age of five in 2023. The 2023 Kids Count Profile from the Annie E. Casey Foundation, ranks Iowa 6th in the nation in terms of overall child well-being. The report also shows 3% of Iowa children under the age of 18 were uninsured in 2021, this is 2 percentage points below the overall US. In 2022, 12.3% of families with related children under 17 years old were living below the poverty level. According to the combined 2021-2022 National Survey of Children’s Health, it is estimated that about 139,000 Iowa children and youth have a special health care need. Access to pediatric specialty health care services remains a challenge for children and youth with special health care needs and their families and many families especially those in more rural areas, need to travel to access services.

 

Iowa’s population reports the following demographics: 83.7% White alone, followed by 6.4% who reported they are two or more races, Black or African American alone comprise 4.2%, Asian alone comprise 2.7%, followed by less than 1% single race each among American Indian and Alaska Natives and Native Hawaiian and other Pacific Islanders. Hispanic or Latino individuals comprise 6.9%. Eliminating disparities in systems such as education, employment, health, income, and other social, economic, and environmental factors will improve overall health in Iowa and increase economic growth.

 

Other key demographic data that paint the picture of Iowa includes: in 2022, 28% of families are single parent families. In 2022, the percentage of children in families where the head of household lacks a high school diploma was 8%.

Iowa’s MCAH Population

 

The Family Health Bureau (FHB) Maternal, Child, and Adolescent Health (MCAH) programs promote the health of Iowa’s women, mothers, infants, children, youth and adolescents through public and private collaborative efforts. The FHB contracts with local agencies to serve as the community utility to link individuals and families to care and services in all of Iowa’s 99 counties. Agencies eligible to apply to become MCAH providers include private nonprofit and public entities. Most local agencies provide maternal, child, and adolescent health services; however, a small number of agencies provide only maternal health services or only child and adolescent health services, so some counties have two different agencies that work together to ensure that the MCAH population receive services.

 

Collaborative Service Areas (CSAs)

HHS funds many different activities carried out by local public health, hospitals and community action programs. Several of these areas – WIC, Maternal, Child and Adolescent Health, I-Smile, Title X, and 1st Five – are the focus of an effort to improve health outcomes and enhance program collaboration when providing services.

 

Previously, in some areas of the state multiple WIC agencies serve a single MCAH agency and vice-versa. There were inconsistencies leading to service issues for program participants. Having multiple service providers/agencies also the competition/switching counties between service areas and programs can negatively impact families who struggle to navigate ongoing changes.

 

All of the included programs within the new CSA structure have strong desires to improve health outcomes and have identified that in order to meet the needs of clients the programs must pool resources to achieve the goals.

 

Title V emphasizes the need for evidence-based strategies to address performance measures. WIC emphasizes funding creativity and partnerships. Therefore, the collaboration between these programs, along with the others listed above, will continue to strengthen the evidence-based programming as well as utilizing creativity to achieve the overall goals of the programs.

 

This was a data-driven process that considered which populations were served by area. Data for the past several years includes:

• Population information
• Program utilization information
  • WIC
  • Title V Maternal Health
  • Title V Child and Adolescent Health
  • I-Smile
  • 1st Five
• Medicaid enrollment
• Medicaid births
• Primary care practices

 

General considerations for all CSAs:

• Goal to keep 0-5 year old population estimate at 7,000 or greater
• No more than 12 counties per CSA to assure the ability to reach all counties each month
• Funding must be adequate to effectively serve the CSA population.
• Most service areas will have competition when applying to be a contractor.
• Maps reviewed to develop the CSA map – Iowa’s Public Transit System; Early Childhood Iowa; Mental Health and Disability Service (MHDS) Regions; Iowa Community Action Agencies; Iowa Department of Human Services; HSS Preparedness Program Service Areas

CSAs were implemented in FFY23. The map below shows the current CSA county assignments by agency:

Women/Maternal/Prenatal/Infant Health*:

 

In FFY23, 15 local maternal health agencies provided maternal health services to approximately 4,100 low-income pregnant women. A wide range of health education and support services are available to low-income pregnant women, such as risk assessment, psychosocial screening, oral health screening, delivery planning, and presumptive eligibility. The maternal health agencies also provide care coordination to promote early entry into care.

 

Child and Adolescent Health*:

 

In FFY23, 14 local child health agencies provided child health services to approximately 78,867 children, ages 0 to 22 years. Through dental care coordination services, the child health programs help families obtain access to dental education and referral through Iowa’s I-Smile™ program. Child health agencies may also provide gap filling services, such as immunizations; developmental, nutrition and psychosocial screenings; and laboratory tests including blood lead testing. Child health agencies also provide informing and care coordination services for the Medicaid population.

 

*Service Area maps with local agency information are included in the Attachments.

 

 

Children and Youth with Special Health Care Needs:

 

University of Iowa Health Care Stead Family Department of Pediatrics, Division of Child and Community Health (Child and Community Health) administers Iowa’s Title V program for Children and Youth with Special Health Care Needs (CYSHCN), overseeing systems building, enabling, and direct services. Child and Community Health has administrative offices in Iowa City, a network of 12 Child Health Specialty Clinics (CHSC) Regional Centers, 3 satellite locations, and additional family support services across Iowa, employing around 80 public health professionals, clinical providers, and family navigators. Through the Regional Centers, University of Iowa Health Care Division Child and Community Health provides direct clinical care (in-person and via telehealth), care coordination, and family to family support to CYSHCN ages 0–21 and their families. In calendar year 2023, the program provided services and supports to over 7,200 (7212) Iowa CYSHCN and their families.

 

 Child Health Specialty Clinics Regional Center Locations:

 

 

The University of Iowa Health Care Division of Child and Community Health vision is to ensure a systems-oriented approach to care for Iowa’s children and youth with special health care needs and their families, using the Blueprint for Change Framework, guided by the Standards for Systems of Care for CYSHCN 2.0. The mission is to improve the health, development, and well-being of children and youth with special health care needs in partnership with families, service providers, communities, and policymakers. The current priorities for Iowa’s CYSHCN program are 1) access to care, 2) transition to adulthood, and 3) family support. In addition to administering the MCH Title V program for CYSHCN, the University of Iowa Health Care Division of Child and Community Health provides services and supports to Iowa CYSHCN and their families through a number of programs including the Iowa Regional Autism Assistance Program, the Iowa Pediatric Mental Health Care Collaborative, and provides Early ACCESS services as is part of Iowa’s Early Intervention program.

 

Workforce development, including increasing cultural diversity among the CYSHCN workforce, is a need within Iowa’s System of Care for CYSHCN. The capacity of the CYSHCN workforce is dependent on geographic location with shortages most acute in rural areas of the state. The Iowa CYSHCN program proudly supports family-centered services and advocates for family-professional partnerships at the local, state, and national levels, and has continued to expand the use of telehealth to connect families with specialists and to train new family advocates through the Iowa Family Leadership Training Institute.

 

Access to pediatric specialty care is a challenge for families in Iowa, especially for those with complex medical needs and those living in more rural areas of the state. Most pediatric specialty services are concentrated in only a few of Iowa’s 99 counties. According to the 2021-2022 National Survey of Children’s Health, over one-third (34%) of children with complex health needs had difficulty or were prevented from receiving specialty health care in the past year. Iowa ranked in the bottom 20% of states with number of general pediatricians ever certified, aged 70 and under per 100,000 children (American Board of Pediatrics Workforce Data Book, 2017/2018). Iowa has a shortage of developmental specialists to assess, diagnose, and treat CYSHCN including those with Autism Spectrum Disorder and Serious Emotional Disorders. 

 

Iowa currently has seven Home and Community Based Services (HCBS) Waivers that provide funding for services and supports so that individuals who would otherwise require care in a medical institution can live in their own homes and communities. Five of these waivers apply to Iowa CYSHCN: the Health and Disability Waiver, the Intellectual Disability Waiver, the Brain Injury Waiver, the Physical Disability Waiver, and the Children’s Mental Health Waiver. Waivers that CYSHCN are eligible for cover about 21,000 Iowans and many of the waivers have long wait lists. University of Iowa Health Care Division of Child and Community Health provides consultation, technical assistance, planning, and care coordination for approximately 715 individuals under the age of 21 with complex and special health care needs who are applying for the Health and Disability (HD) Waiver, are on the waiting list for the HD Waiver, or currently enrolled with the HD Waiver.

 

Over the past 2 years, HHS has been evaluating and redesigning Iowa Medicaid waiver programs. It is anticipated that when the process is complete, there will be two waiver programs, one for Children and Youth populations, and another for Adult and Aging populations. Eligibility for waiver services will be based on level of care needed, and specific disability categories.

 

Medicaid In Iowa

 

In 2016, CMS announced that it approved the launch of IA Health Link (Iowa’s Medicaid Modernization initiative). The goals of Medicaid Modernization included improved quality and access, greater accountability for outcomes, and creating a more predictable and sustainable Medicaid budget. Medicaid agencies contract with managed care organizations (MCOs) to provide and pay for health care services.

 

The Iowa Department of Health and Human Services currently contracts with the following three MCOs for Iowa’s Medicaid Modernization initiative to provide and pay for health care services to the vast majority of Medicaid members:

• Wellpoint Iowa, Inc. (formally Amerigroup Iowa, Inc.)
• Iowa Total Care
• Molina Healthcare of Iowa, Inc.

 

Iowa’s Title V program has had a collaborative relationship with Iowa Medicaid Enterprise (IME) for more than 30 years. Medicaid’s work with the Title V Maternal, Child, & Adolescent Health program began with a systems change initiative to decrease barriers and assure that pregnant women and children have access to services to which they were entitled. The relationship offered a comprehensive system of care that included outreach, informing newly eligible families of EPSDT services, and care coordination services. Although linkage with established medical and dental homes is a program priority, local Title V contract agencies are also able to bill Medicaid for direct care maternal and EPSDT services through specific provider packages established by Iowa Medicaid. Title V agencies provide EPSDT gap-filling services under Iowa Medicaid’s Screening Center provider status, and Title V agencies provide Maternal Health gap-filling services under Medicaid’s Maternal Health Center provider status.

 

The working relationship between Iowa Medicaid and Family Health Bureau programs is solidified each year through a contractual arrangement which is called the Omnibus Agreement. The current Omnibus Agreement is based upon a collaborative agreement with attachments that address administrative services; EPSDT/MH/OH/1st Five programs; Hawki Outreach; the Healthy Families Line; and a Medicaid match project.

 

Title V contractors continue to share challenges with billing for direct health care services to the MCOs. Title V staff assist with conversations with the Medicaid Division when the contractors are unable to resolve issues independently. 

 

Iowa Health and Wellness Plan

 

The Iowa Health and Wellness Plan, Iowa’s version of Medicaid expansion, was enacted through bi-partisan legislation to provide comprehensive health care coverage to low income adults. The plan offers coverage to adults age 19-64 with an income up to 133 percent of the Federal Poverty Level (approximately $20,030 for an individual

Approximately $27,186 for a family of two (or higher depending on family size). The plan began on January 1, 2014, and currently serves approximately 197,000 Iowans. The Iowa Health and Wellness Plan includes dental services under the Dental Wellness Plan (DWP). Effective July 1, 2017, adult Medicaid members age 19 and older were combined into a single, improved Dental Wellness Program administered by Delta Dental of Iowa and MCNA Dental.

 

Data Integration

 

The FHB continues to integrate program data including care coordination, referral management, risk assessment, practice management, billing, and client and population level reporting. The data systems consolidated/integrated to the new system, Iowa Connected (formerly signifycommunity).

 

Development of the new Iowa Connected system was necessary when Signify presented a letter of termination to FHB on September 19th, 2022. In that letter, Signify notified of its intent to sunset the Signify Case Management system on December 31, 2022. At that point numerous discussions took place as to how HHS could replace the entire Case Management system in just over 3 months. Various HHS internal teams along with vendor partners such as AWS and SSG (Strategic Solutions Group) quickly gathered and collaborated on possible resolutions to an overbearing challenge mandated by extremely limited time constraints. Although Signify granted two support extensions (through June 30, 2023) time constraints remained one of the most significant project risks. The new Iowa Connected data system launched June 19, 2023 with minimal issues. Several enhancements have been implemented in the system since launch to make the system more user-friendly and to reduce data entry burden for users.

 

Public Health Accreditation Board

 

The legacy Iowa Department of Public Health achieved accreditation from the Public Health Accreditation Board (PHAB) in November 2018. This award marked an important milestone in the department’s journey towards adopting a culture of quality. Benefits of the accreditation process included: learning that occurred through the use of cross-department teams, increased focus on the importance of reviewing and updating documents, an opportunity to hone in on both opportunities and gaps, and having quality improvement, health equity, performance management, workforce development and other topics embedded in the work of the department. MCAH program staff were active participants in the site visit process by providing their expertise in site visit interviews. Title V program staff continue to participate in the department’s next steps now that accreditation has been achieved and reaccreditation is on the horizon. The department continues to further develop areas of strength and build on opportunities in order to further the quality culture, maintain accredited status and pursue reaccreditation.

 

Iowa HHS is currently preparing to apply for reaccreditation in late 2024. In addition to working on reaccreditation, Iowa HHS is available to provide technical assistance to local and Tribal agencies on their accreditation journeys. It is recommended that Iowa’s local health departments use the PHAB standards even if not currently seeking accreditation. Use of the PHAB standards will bring more consistency to public health service delivery across our state. Meeting standards and achieved accredited status signifies the role public health plays in assuring a healthy Iowa.

 

Healthy People 2030 Champion

 

The Iowa Department of Health and Human Services was designated as a Healthy People 2030 Champion by the US Department of Health and Human Service Office of Disease Prevention and Health Promotions. This designation recognizes HSS’s commitment to achieve Healthy People’s overarching goals and objectives.

HHS programs may use the Healthy People 2030 Champion designation when writing grant applications or for other publications to show HSS's close alignment to the Healthy People 2030 goals of health equity and well-being. 

 

To achieve this designation, HSS met the following eligibility requirements:

• Have a demonstrated interest in, understanding of, and experience with disease prevention, health promotion, social determinants of health, health disparities, health equity, or well-being
• Have an organizational mission that's aligned with the Healthy People 2030 framework or objectives
• Sign a Partnership Agreement and Trademark License with ODPHP that includes details about how the organization supports the Healthy People 2030 vision

 

Strengths and Challenges Impacting the MCH Population

 

Challenges

 

Rural

The rural nature of Iowa presents unique challenges for clients to access services throughout the state. Local Title V MCAH agencies work to ensure needed health services are provided in the rural counties. This is accomplished through building partnerships with health providers and community resources. Likewise, University of Iowa Health Care Division of Child and Community Health provides services for families of CYSHCN in rural areas. FHB staff is currently utilizing contractor agencies to develop Family Engagement and Health Equity advisory groups at the local level to ensure involvement of rural populations in the development and implementation of Title V activities in all 99 counties.

An initiative in Iowa to incentivize providers to practice in underserved areas is the Primary Care Recruitment and Retention Endeavor (PRIMECARRE) which was authorized by the Iowa Legislature in 1994 to strengthen the primary health care infrastructure in Iowa. PRIMECARRE allocations currently support the Iowa Loan Repayment Program, with matching federal and state funds. This initiative offers two-year grants to primary care medical, dental, and mental health practitioners for use in repayment of educational loans. This program requires a two-year practice commitment in a public or non-profit site located in a health professional shortage area (HPSA). While Title V is not directly working on PRIMECARRE, Title V staff communicate regularly with PRIMECARRE staff to address shortages in primary care, OB and dental providers that impact the MCH program.

Health Equity

The Health Equity Advisory Committee (HEAC) began as a way to focus health equity in Iowa’s 2020 Title V Needs Assessment. Initially the committee was used to guide programmatic health equity work, such as the Child and Adolescent Health Request for Proposal (RFP) and subsequent Request for Application (RFA). However, there has been a struggle with continued engagement among this group. The HEAC has lost members throughout the year, and often only two or three members attend meetings, out of a possible 24. Staff have decided to put a pause on the state level committee. In the CAH RFP/RFA are requirements for health equity and family engagement groups. When local groups are fully established representatives from each CSA area will be asked to serve on a state level group or join the Maternal and Child Health Advisory Council.

 

While it has been a challenge, staff have been trying to find opportunities to make the HEAC more of a fixture in guiding the state’s Title V work. Title V would like to begin by shifting the power to the committee, have them guide the direction of the work, and ensure the members have a larger voice in programmatic decision making at the state level. This would allow staff and other programs within FHB to better engage and partner with the HEAC. Staff coordinators are currently looking for ways to structure the advisory committee so the group is truly able to give their insights and knowledge to guide Title V and other MCH-related programs. The HEAC has the beginnings of the framework necessary to achieve this but need to bolster state staff skills and knowledge to be able to successfully implement it. In 2022, Iowa (both MCH and CYSHCN staff) joined the Accelerating Equity Learning Community through the MCH Workforce Development Center. This opportunity has helped focus our efforts, and identify opportunities for growth. Participants in the cohort have been working to shift the culture of health equity within the Title V program by focusing on building health equity skills among Title V staff, not just knowledge. This will also ideally lead to increased support for Title V contractors as they work on their own health equity and community engagement efforts; in a way that does not put undue burden on the committee. Another goal is to shift from knowledge to skills based health equity training to help increase the confidence of Title V staff to assess and offer support to contractors wherever they are in their health equity and community engagement journey.

 

The Iowa Title V CYSHCN program continues to focus on building capacity for leading systems-level health equity initiatives. Strategic planning for these efforts are led by an internal Health Equity Committee, and the program is committed to providing care to CYSHCN and their families that is culturally and linguistically appropriate, and building capacity to thoughtfully engage diverse families across the state. The CYSHCN program is also working to learn new ways to measure and evaluate the impact of the health equity initiatives.

 

Strengths

 

Health Insurance Coverage

In 2022, America’s Health Rankings reported that 95.5% of the population in Iowa had some form of medical insurance.  Since 2010, children eligible for Hawki and Medicaid have been able to obtain immediate, temporary Medicaid coverage through the Presumptive Eligibility for Children program. All Title V agencies are able to assist families in applying for Medicaid and presumptive eligibility. Iowa’s Hawki program also has a dental-only option to increase access to oral health services for families that have medical coverage but lack dental coverage.

 

Iowa women with medical insurance was reported to be 94% from America’s Health Rankings. Iowa is currently one of the most inclusive states in the US in terms of Medicaid income eligibility for pregnant women. Iowa women that make 375% of the Federal Poverty Limit (FPL) or below are eligible for Medicaid assistance during pregnancy and for 60 days postpartum. In 2024, the Iowa Legislature passed a bill to expand postpartum Medicaid coverage to 12 months postpartum.  This change resulted in a decrease in the income limit for pregnant and postpartum women to quality for Medicaid coverage, reducing it to 215% of the FPL.  All Title V funded local Maternal Health Agencies assist clients in applying for presumptive eligibility, helping women obtain Medicaid coverage early in pregnancy regardless of legal status. Future Title V efforts will focus on providing expanded care to pregnant women beyond the traditional 60 day period. 

 

Maternal Mortality

Iowa’s maternal death ratio has followed an upward trend over the past 10 years (2013 – 2022). According to the Iowa Department of Health and Human Services (Iowa HHS) Bureau of Health Statistics (BHS) - Vital Statistics, the Iowa maternal death ratio/100,000 live births has ranged from a low of 8.3 maternal deaths/100,000 live birth in 2020 to a high of 48.9 maternal deaths/100,000 live births in 2021. Iowa’s Maternal Mortality Review Committee (MMRC) met several times during the reporting period and will be publishing a report on 2019-2021 maternal deaths in the fall of 2024.  Due to small numbers of maternal deaths, multiple years must be combined to ensure data validity. 

 

Iowa HHS launched a new section of the statewide mental health and substance use disorder website, YourLifeIowa that is dedicated to Maternal Mental Health and includes resources and information about perinatal depression including warning signs.  The YourLifeIowa website includes a 24/7 call center with texting and chat options and includes updated crisis resources. 

 

The Iowa AIM program implemented the OB Hemorrhage Patient Safety Bundle (PSB) in 2022/2023, and the Severe Hypertension PSB in 2023/2024.  The Obstetric Hemorrhage PSB included all 56 obstetrical hospitals, making Iowa one of the first states to achieve HRSA’s ambitious goal for 100% of hospitals in the United States (US) to participate in the AIM program. This collaborative was conducted from October 2022 to July 2023 and the full population impact of the work is still being evaluated, however, initial evaluations show that SMM from hemorrhage has declined from historic rates.  Improvements in key process measures have also been noted midway through the Severe Hypertension PSB

 

I-Smile™

In 2006, child health contractors received funding to begin administering the I-Smile™ program in Iowa communities. Each contractor is required to maintain a dental hygienist as their I-Smile™ coordinator and is responsible for developing their own community-based strategies. These include: developing local partnerships to increase awareness about oral health; working with dental offices to encourage acceptance of referrals of underserved families needing dental care; promoting oral health through participation in community events and presentations at meetings; training medical providers how to apply fluoride and do oral screenings to build the safety net; and assuring care coordination and gap-filling preventive services (e.g., fluoride applications) are provided for at-risk families.

 

Each year, Medicaid paid claims are reviewed to measure program impact. Using 2005, data (the year before I-Smile™ began) as the baseline, data have shown annual improvements for Medicaid-enrolled children (ages 0-12) receiving through this program care. In 2023:

• Over three and a half times more children received gap-filling preventive care from a dental hygienist or nurse through I-Smile™ in a public health setting compared to 2005 (28,782 in 2023; 7,865 in 2005)
• 95% more Medicaid-enrolled children in Iowa were seen by a dentist than in 2005
• 62% of children ages 3-12 years old were seen by dentist, and when including those seen in a FQHC dental clinic, the rate rises to 73% (duplicated)

 

Iowa Department of Health and Human Services’ Current Guiding Principles

 

Data Driven: HHS makes informed, data-driven, and evidence-based decisions to drive quality and improve results.

 

Accountability: HHS uses public resources responsibly to improve lives through the programs and services the department provides.

 

Integrity: HHS generates trust through honest, respectful, and reliable work that all staff can be proud of.

 

Equity: HHS actively identifies and removes barriers to access and inclusion so that the department can provide all individuals an opportunity to succeed.

 

Communication: HHS communicates in a thoughtful and coordinated way to ensure individuals are well informed about the department’s work.

 

Collaboration: HHS facilitates meaningful partnerships that focus on the voices of the individuals and communities that are being served.

 

Iowa HHS Strategic Plan and Operational Plan

 

In January 2024, Iowa HHS released the agency’s new strategic plan, guiding the work of the newly formed health and human service agency. The new strategic plan allows the agency to focus on core operations that guide the way HHS supports Iowans. 

 

The new plan has three strategic priorities:

1. Elevate Organizational Health: Advance and accomplish Iowa HHS initiatives by leveraging responsive leadership, an engaged and motivated team, effective internal communication, innovation and positive work culture.
2. Advance Operational Excellence: Optimize Iowa HHS efficiency, resilience, and effectiveness through the integration of aligned technology and updated policies and processes, with focus on team collaboration and coordination.
3. Help Iowa Thrive. Provide equitable access to health and human services resources helping individuals, families, children and communities thrive.

 

Divisions and bureaus within Iowa HHS will have the opportunity to contribute to the “Strategic Plan in Action,” which outlines pathways and measurement to achieving our strategic priorities. 

 

The Iowa HHS Strategic Plan and Strategic Plan in Action documents can be found here: https://hhs.iowa.gov/about/performance-and-reports/strategic-plan

 

Wellness and Preventive Health Division Strategic Planning

The Wellness & Preventive Health (WPH) Subdivision of Iowa HHS contains the agency’s maternal and child health work, including maternal and reproductive health, oral health, child and adolescent health, WIC, and healthy eating and physical activity work. This section of teams and bureaus was created in the fall of 2022 and continues to form its identity and fully understanding its scope and space within Iowa HHS. WPH staff conducted an accelerated strategic planning process utilizing existing plans from across programs within WPH. The majority of the teams in WPH have recently published strategic plans or are currently using work plans from their grants. In lieu of starting from scratch and creating a new WPH strategic plan, the WPH leadership pulled together the existing plans into a clear, coherent strategy. Steps taken in this accelerated process include:

• A robust review of action plans, work plans, strategic plans, and other goals, objectives, and strategies being used across the WPH section by WPH leadership.
• The review of existing plans among WPH teams, lead by team leaders, to check for accuracy, appropriateness, and alignment with existing strategy.
• The coding and sorting of all WPH goals into four themes by WPH leadership.
• The review of teams’ plans by other teams within WPH to check for areas of existing collaboration and opportunities for new partnerships across teams.
• A check across all teams for upcoming external trends and opportunities for inclusion in the strategic plan.

 

University of Iowa Health Care Division of Child and Community Health Strategic Plan

University of Iowa Health Care Division of Child and Community Health developed a five-year strategic plan in 2017, which was updated in 2021. Funding through the Title V program serves as foundational support for all CYSHCN activities. The strategic plan includes the following goals:

• Care Coordination and Clinical Services
  • Title V funding supports the Regional Center structure and allows resources to be combined so services can be provided through a community-based approach, even in the most rural areas of the state.

 

• Family Professional Partnerships
  • Title V funding is combined with other state and federal funding sources to build a robust system of family-centered care and shared decision making at all levels.

 

• Advocacy and Policy
  • Strengthened by the designation as Iowa’s Title V program for CYSHCN, University of Iowa Health Care Division of Child and Community Health provides a leadership role in pediatric advocacy and policy efforts at the local, state, and national levels.

 

• Health Equity
  • The promotion of health equity and honoring diversity among Iowa children and youth with special health care needs and their families is a primary goal in the University of Iowa Health Care Division of Child and Community Health strategic plan. Leadership support is funded through the Title V CYSHCN program.

 

 

Other State Statutes and Regulations that Impact Title V Programs:

 

Iowa Administrative Code Chapter 641.76 Summary
 

The Maternal, Child, and Adolescent Health (MCAH) programs are operated by the HSS as the designated state agency pursuant to an agreement with the federal government. The majority of the funding available is from the Maternal and Child Health Block Grant, administered by the United States Department of Health and Human Services. The purpose of the program is to promote the health of mothers and children by providing preventive, well child care services to low-income children and prenatal and postpartum care for low-income women.

 

Chapter 641.76 explains how Maternal and Child Health programs will be administered in the state, the relationship between HSS and University of Iowa Health Care Child Health Specialty Clinics (CHSC), what services can be provided, who is eligible to provide the services, the eligibility requirements of the clients and the purpose of the MCAH Advisory Council. For more information on Iowa Administrative Code Chapter 76 follow this link: https://www.legis.iowa.gov/docs/iac/chapter/641.76.pdf

 

Other sections of Iowa Code that impact Title V:

To review previous code references follow this link: http://search.legis.state.ia.us/nxt/gateway.dll/ic?f=templates&fn=default.htm

Red Tape Review

Governor Kim Reynolds signed Executive Order 10 on Tuesday, January 10, 2023, putting a moratorium on administrative rulemaking and instituting a comprehensive review, or red tape review, of all existing administrative rules.

The order directs that each rule chapter effective on January 1, 2023 be reviewed by the department according to a schedule established by the Administrative Rules Coordinator (ARC). Upon completion of this review, the department will submit a rule report to the ARC detailing a list of rules to repeal and a list of rules HHS proposes to re-promulgate. For those HHS will re-promulgate, a new rulemaking is to be initiated.

The Executive Order directs a comprehensive evaluation and rigorous cost benefit analysis of all existing and proposed rules to evaluate their public benefits, whether the benefits justify the cost, and whether there are less restrictive alternatives to achieve their intended goal. Each new rule chapter finalized by the department must reduce the overall regulatory burden, or remain neutral, as compared to the previous rule chapter.

Iowa HHS expects the review of all administrative rules to be completed by the end of 2024.