Public Health Service System FAQs

What is the Lead Entity’s responsibility when a local public health agency in their district isn’t carrying out the core services?  Is the Lead Entity responsible for delivering the service or ensuring that another provider does? 

• Yes, the Lead Entity will be responsible for ensuring the services are being provided in all counties within the district served by that Lead Entity.

How will the relationship between lead and local provider entities work? Will there be any shared liability between the lead agency and local providers?

• The Lead Entity will be filling a roll of accountability for service provision across the district, and more importantly convening and collaborating efforts across each district. Iowa HHS is unable to speak to the question of shared liability without greater specificity. Please provide more details in the feedback survey referenced during the April district visits. The survey is available through Friday, May 15, 2026.

What if there is local provider non-compliance with a district? Will the lead entity or the state will be required to monitor, enforce or correct issues, and how will those be handled? Does this differ from contract requirements vs code requirements?

• Iowa HHS is exploring contractual terms to manage expectations of the Lead Entity and local providers. If local providers have recommendations on how best to manage this accountability, you are encouraged to respond to the feedback survey following the April district meetings. This survey is open through Friday, May 15, 2026.

How will Iowans continue to receive the full scope of services and programs they need when local public health agencies already operate with reductions to funding and local budgets?

• This question highlights the importance of district assessment and planning for year one of the lead entity model. The statewide system, due to budget and capacity limits, may not be able to support the needs of every single community. Our challenge, as a statewide system, will be to prioritize the most significant health needs for the entire state and then allow for flexibility of individual communities to identify and support their own unique needs.

Can rural public health services remain robust, sustainable and responsive to community needs under the proposed alignment structure without additional funding and resources?

• Rural models of district-level sharing have demonstrated that high quality, sustainable public health service provision can be accomplished under a shared responsibility structure. Funding challenges will likely persist in the future. Taking action now to establish district-level plans and collaboration provides the best opportunity for local partners to establish a level of sustainability and service provision for their communities.

Will Boards of Supervisors be responsible for covering a local public health agency’s costs if that agency is a lead entity? 

• County tax dollars will not be required to support the lead entity roles. Iowa HHS will establish clear requirements of the lead entity within the RFP and subsequent contract.

With an added layer of governance (the Lead Entity), will non-lead agencies experience a delay in the payment of grant funds?

• Iowa HHS is unable to make projections on this question and would like to hear more about this concern. Please provide more details in the feedback survey referenced during the April district visits. The survey is available through Friday, May 15, 2026.

The current funding to local public health agencies is insufficient to do the necessary work. How will the core services be funded with an additional layer of district administration? 

• These are the difficult discussions and decisions facing public health. We need to be clear about whether we are going to prioritize a defined set of services and do them well, or continue trying to address every need without sufficient investment. Without additional funding, public health cannot fully meet all of the demands affecting the health and well-being of the public.

Can feedback be provided around the alignment funding model?

• The district meetings and the opportunities to provide feedback are the opportunity to discuss the funding model.

What is the total amount of funds for each district?

• Up to $4 Million will be available to support year one lead entity activities in all seven districts, approximately $570,000 per district. Funding for subsequent years will include funds to support basic lead entity operations and local implementation of district plan activities. Funding information will be outlined in the RFP. 

Will all funds be collected by the Lead Entity and the entity will be responsible for distributing the work/monies ? Or will the dollars have to be used by the Lead Entity and subcontracted out to each and every county to do the work within the district?

• Impacted funding will be pooled and contracted through the Lead Entity for distribution to local providers.

How will rural districts be funded? Has Iowa HHS determined a funding formula for each county to plan for county budgets?

• Up to $4 million will be available to support year one Lead Entity activities in all seven districts, approximately $570,000 per district. Funding for subsequent years will include funds to support basic lead entity operations and local implementation of district plan activities. Funding information will be outlined in the RFP.

Will there be a list of activities/services that can or cannot be performed using Iowa HHS funds?

• Yes, Iowa HHS will clearly identify funding eligibility for local Board of Health obligations

What specific areas of improvement and processes will benefit from public health alignment?

Specific areas and processes that will benefit from public health alignment include the following:

• Communicable & infectious disease investigation and outbreak management, which is limited for most individual counties.
• Investigation of environmental exposures and risks, for which minimal to non-existent capacity exists at the local level
• Addressing Iowa’s leading health concerns related to chronic conditions and injury prevention, which account for a significant share of morbidity and mortality and require a more coordinated, upstream prevention approach.

What current redundancies exist throughout the current public health structure?

• The most prominent example of redundancies in the current public health structure was the delivery and payment of home health services. There are likely other redundancies within each district, including activities and services such as health messaging, screening/testing, contracting and others. District assessment and planning will help facilitate conversations between local providers to more clearly define and address redundancies locally.

Will the state mandate or provide any shared software for submitting claims, etc.?

• Iowa HHS is interested in hearing more about what shared software would be most valuable. Please provide more details in the feedback survey referenced during the April district visits. The survey is available through Friday, May 15, 2026.

Would the district plans be updated annually or will the same plans exist for the duration of the grant?

• District plans will be submitted annually throughout the duration of the Public Health Service System State Plan. A timeline of 3-5 years is anticipated but not yet finalized.

What will happen to local boards of health as part of system alignment?

• The role of a local Board of Health (LBOH) is not impacted under this model. The Board of Health remains in Iowa Code and continues to have jurisdiction over public health matters in the county, maintaining autonomy for the local public health agency.
• HHS' model is about using the HHS district map to structure statewide funding/programs in a way that encourages and supports local coordination and collaboration in addressing state-wide priorities defined in the future Public Health Service System state plan.
• If there is any change for LBOH, it will be to understand the needs of their population within the district and across the geographical area and to use this information in guiding the local public health agency under this new district funding model. 

What is the Lead Entity’s responsibility to local Boards of Health throughout their district?

• Iowa HHS welcomes feedback on this topic. Counties are encouraged to provide responses to the survey questions presented during the April district visits. The survey is available through Friday, May 15, 2026.

Maintaining autonomy is extremely important to communities. Will alignment reduce the autonomy at the local level?

• Iowa HHS is working to find a balance between setting an overall direction for the public health system to address leading health priorities, while providing local flexibility to determine how best to organize and provide the priority services. While autonomy to use state funds in any way a local provider determines will be narrowed, the autonomy to determine how best to deliver services will remain. In addition, local providers will have full discretion to identify and support other locally identified needs that fall outside of statewide priorities.

How does a district model enable a ”well-coordinated system with clear access points for Iowans?”

• Iowa HHS is focusing on the broad HHS system, not just public health. In addition to public health, HHS is designing a system that more clearly links Public Health, Behavioral Health, Early Childhood & Family Services, Aging & Disability Services, and Community Access & Eligibility. This system design, through each system's "Lead Entity," should facilitate more clearly defined access points into each system, within each district.

How does Iowa HHS view collaboration at the local level? Public health agencies across the state, particularly in rural areas, are creating and maintaining collaborative relationships both within and outside our communities on a daily basis.  

• The transition to the Shared Responsibility Model with lead entities is intended to support existing successes in local collaboration, expand those successes across all 99 counties, and strengthen connections beyond public health to include other HHS service systems.

Has Iowa HHS obtained feedback from current, established program districts in terms of successes and challenges?  What are the “wins”? How will challenges be addressed in the PH System Alignment process?  

• Yes, Iowa HHS has visited with existing collaborative partnerships, hosted the April townhalls, and continues to receive feedback about the "wins", challenges, and concerns. Challenges are a routine part of the public health system and often best addressed by local collaboration. The Year 1 assessment and planning phase will be instrumental in identifying and developing a plan to navigate current and future challenges.

A five-year project period is a lot to consider taking on – What support will Iowa HHS provide, other than funding, to make this five-year project period successful?

• Iowa HHS is preparing a technical assistance and support plan that will be comprehensive. Your feedback is welcomed. Please respond to the feedback survey distributed following the April district visits. The survey is open until Friday, May 15, 2026.

How does Iowa HHS view collaboration at the local level? Public health agencies across the state, particularly in rural areas, are creating and maintaining collaborative relationships both within and outside our communities on a daily basis.  

• The transition to the Shared Responsibility Model with lead entities is intended to support existing successes in local collaboration, expand those successes across all 99 counties, and strengthen connections beyond public health to include other HHS service systems.

Has Iowa HHS obtained feedback from current, established program districts in terms of successes and challenges?  What are the “wins”? How will challenges be addressed in the PH System Alignment process?  

• Yes, Iowa HHS has visited with existing collaborative partnerships, hosted the April townhalls, and continues to receive feedback about the "wins", challenges, and concerns. Challenges are a routine part of the public health system and often best addressed by local collaboration. The Year 1 assessment and planning phase will be instrumental in identifying and developing a plan to navigate current and future challenges.

Can you describe the expectations for lead entities for the five core services?

• Iowa HHS will include this information in the RFP, and sooner if available.

Will there be a list of activities/services that can or cannot be performed using Iowa HHS funds?

• Yes, Iowa HHS will clearly identify funding eligibility for local Board of Health obligations.

What are the services local public health agencies will be required to provide utilizing Iowa HHS funds?

• Iowa HHS will clearly define these requirements as part of the RFP. These changes in funding eligibility will not take affect before July 1, 2027.

Is the map that has been created for the behavioral health services funding appropriate as a model for public health funded districts?

• The Iowa HHS map is primarily for administrative purposes and should not be viewed as a restrictive boundary for organizing and delivering HHS-funded public health services. Forcing the use of the map boundaries would highlight the limits of applying "one map for everything". Specific funding for the provision of HHS core public health services has yet to be determined, but funding formulas will take into account population as well as unique needs throughout the state.

Will the opportunity to become a Lead Entity be restricted to only public health agencies?

• Iowa HHS intends to limit eligible RFP applicants to designated local public health agencies. If a Lead Entity is not identified for a specific district, HHS will broaden the applicant pool for a subsequent Lead Entity funding opportunity.

Can the timeline for public health alignment be extended?

• There is no plan to extend the timeline. The year-long period of assessment and planning by districts will be essential to further inform prioritization for how Iowa HHS funding is used.

What are the services local public health agencies will be required to provide utilizing Iowa HHS funds?

• Iowa HHS will clearly define these requirements as part of the RFP. These changes in funding eligibility will not take affect before July 1, 2027.

Can staff provide both lead entity services as well as local public health services in a county? Or are they required to be lead entity FTEs?

• Iowa HHS is open to a shared FTE concept that covers both lead entity responsibilities as well as Local Public Health services within the district/county.

What role will the regional epidemiologists have in alignment?

• Iowa HHS anticipates regional epidemiologists maintain a similar role and want to use this model for other technical assistance and support needs that HHS should provide.