Community-Based Services Evaluation

Evaluation Overview

How the Community-Based Services Evaluation Was Conducted

Iowa Department of Health and Human Services, Mathematica, and The Harkin Institute evaluated Iowa's community-based services by:

Establishing key goals to ensure services are:

• Equitable – people can access the services they need regardless of where they live or their background.
• High-quality and person-centered – people can choose where they live and how they receive care.
• Valuable – services improve outcomes and make efficient use of resources.
• Coordinated and transparent – people can access support through a "No Wrong Door" approach and receive conflict-free case management.
• Effective and accountable – responsibilities are clearly defined across the system.
• Reviewing Iowa's community-based behavioral health, disability, aging, and Medicaid waiver programs and policies.
• Gathering feedback from professionals across the system, including Medicaid leaders, service providers, and frontline staff.
• Analyzing data on Medicaid waiting lists, enrollment, and service utilization.
• Examining how other states have redesigned similar systems to identify potential opportunities and challenges for Iowa.
• Listening to Iowans through community listening sessions, online feedback, and individual interviews to understand their experiences and needs.

What did the team achieve? 

Three work stream teams achieved the following results:  

• 45 interviews with key informants (including HHS administrators, case managers, and frontline providers.
• 8.5 million claims records for Medicaid members receiving HCBS in 2018 and 2019.
• 46 conversations with consumers, family members, caregivers, and providers through listening sessions and interviews.
• 379 responses to an online feedback form 
• 300+ policy and program documents received from Iowa and other states. 

What did the evaluation find? 

The evaluation resulted in the Final Evaluation Report, Recommendations for Strengthening Iowa's Community-Based Services System (2.44 MB) .pdf , which outlines key findings and steps to improve services across Iowa.

The report recommends that Iowa HHS focus on three main areas:

1. Improve screening and service coordination so people are connected to the services that best meet their needs.
2. Align community-based services, including Medicaid HCBS waivers, with the needs of Iowans to ensure support is responsive and effective.
3. Expand access to Medicaid HCBS and other community-based services for people who need long-term services and supports.

For a summary of the findings and recommendations, see Chapters I and II of the report.