Community-Based Services Evaluation

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Evaluation Overview

Iowa HHS, Mathematica, and the Harkin Institute approached the Community-Based Services Evaluation by:  

  1. Identifying guiding principles for the work, which suggest community-based services (CBS) in Iowa should be:
    1. Equitable, so consumers can access services in line with their needs, regardless of demographic group or location.
    2. High-quality and person-centered, enabling consumers to live where they want and choose their care.
    3. Proven valuable—for example, by reducing inefficient spending.
    4. Coordinated and transparent, using a “No Wrong Door” model and conflict-free case management.
    5. Effective and accountable, with roles clearly defined throughout the system.
  2. Analyzing programs and policies in the state about community-based behavioral health, disability and aging services, including Medicaid waivers.
  3. Hosting discussions with professionals delivering community-based behavioral health, disability and aging services, ranging from Medicaid administrators to front-line staff.
  4. Analyzing data about Medicaid waiting lists, enrollment and service use.
  5. Reviewing system redesigns in states like Iowa to understand the opportunities and challenges of future recommendations.
  6. Collecting input from Invested Iowans across the state through listening sessions, an online feedback form and one-on-one interviews.  
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What did the team achieve? 

Three work stream teams achieved the following results:  

Iowa CBS evaluation by the numbers infographic

Infographic labeled "Box I.1. Iowa CBS evaluation by the numbers". The infographic has boxes reading: 
-45 interviews with key informants, including DHHS 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
-68 counties of the 99 in Iowa represented across our community engagement activities
-15 experts on a Community Advisory Committee offering sustained input to our evaluation activities, findings, and recommendations
-300+ policy and program documents reviewed from Iowa and other states

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What did the evaluation find? 

This team effort resulted in the Final Evaluation Report, Recommendations for Strengthening Iowa’s Community-Based Services System, which describes findings and recommends next steps to improve service delivery throughout the state. For a summary of the findings and recommendations, see Chapters I and II of the report, which describe three key recommendations for Iowa HHS:  

  • Implement streamlined screening and improved processes to better align services with people’s needs.
  • Align CBS, including Medicaid home- and community-based services (HCBS) waivers, to the needs of Iowans.
  • Maximize access to Medicaid HCBS and other CBS supports for people who need long-term services and supports. 
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