Community-based Services Evaluation (CBSE) for Iowans with Disabilities and Behavioral Health and Aging Needs

What is this evaluation about?

In early 2022, the Iowa Department of Health and Human Services (HHS) contracted researchers at Mathematica and the Harkin Institute to conduct a systemwide assessment of community-based behavioral health, disability and aging services across the state. The work sought to understand how people access and use these services through Medicaid and other programs.

How did the team focus the evaluation?

The team:

  • Identified guiding principles for the work that suggest community-based services (CBS) in Iowa should be (1) equitable, so consumers can access services aligned to their needs regardless of demographic groups or location, (2) high-quality and person-centered to allow consumers to live where they want and choose their care, (3) proven valuable, like reduced inefficient spending, (4) coordinated and transparent, using a No Wrong Door model and conflict-free case management, and (5) effective and accountable, with roles delineated throughout the system.
  • Analyzed programs and policies within the state about community-based behavioral health, disability and aging services, including Medicaid waivers
  • Hosted discussions with professionals delivering community-based behavioral health, disability and aging services, ranging from Medicaid administrators to frontline staff
  • Analyzed data about Medicaid waiting lists, enrollment and service use
  • Reviewed system redesigns in states like Iowa, to understand the opportunities and challenges of future recommendations
  • Collected of input from invested Iowans across the state through listening sessions, an online feedback form and one-on-one interviews

What did the team accomplish in Year 1?

Three work stream teams accomplished the following:

What did the team find?

This collective effort resulted in findings and recommendations. On January 31, 2023, the team shared an evaluation report: Recommendations for Strengthening Iowa's Community-based Services System, which describes findings and recommendations to improve service delivery throughout the state. To review the findings and recommendations from the evaluation report, check-out Chapters I and II, which include three key recommendations suggesting Iowa HHS:

  1. Implement streamlined screening and improved processes to better align services with people’s needs
  2. Align CBS, including Medicaid HCBS waivers, to the needs of Iowans
  3. Maximize access to Medicaid HCBS and other CBS supports for people with long-term service and support needs

What happens now and how can I get involved?

The team is developing a Transformation Plan to guide the implementation of the recommendations to transform Iowa’s CBS system.

To support system-wide transformation, the team will continue to engage HHS staff, providers and other professionals delivering services, members and caregivers in a variety of ongoing and intermittent feedback opportunities. Please continue to check back on this page for updates.