Iowa to implement new children’s mental health care system under terms of legal settlement

DES MOINES — Iowa’s health agency pledged to ensure the delivery of home and community-based services to the state’s most vulnerable children with mental and behavioral health care needs under the terms of a settlement agreement approved recently by a federal judge.

The settlement resolves a lawsuit filed two years ago by three Iowa children, who were represented by three advocacy groups, including Disability Rights Iowa.

The lawsuit claimed the State of Iowa for decades had “disregarded the lack of mental and behavioral health services” and had failed to provide “intensive home and community-based services” to Medicaid-eligible children as required by federal law.

The settlement agreement requires the Iowa Department of Health and Human Services to provide mental and behavioral health care services to Medicaid-eligible children in Iowa, including intensive care coordination, intensive in-home and community therapeutic services, and mobile crisis intervention and stabilization services.

The settlement also requires a new screening and assessment process to ensure eligible Iowa children under the age of 21 with serious emotional and behavioral health conditions are receiving the required services.

Judge Stephen Locher, of U.S. District Court in the Southern District of Iowa, granted preliminary approval to the settlement agreement on Jan. 24, and the groups involved issued a joint news release this week announcing the settlement. A final settlement approval hearing has been scheduled for May 7 in Des Moines.

Disability Rights Iowa, Children’s Rights, and the National Health Law Program, along with the Chicago-based law firm Ropes and Gray represented the plaintiff children, who were not named.

Those groups worked on the settlement agreement with the Iowa Department of Health and Human Services, under Director Kelly Garcia and Iowa Gov. Kim Reynolds. They agreed to an interim settlement agreement in October 2023 that created the framework for the two sides to negotiate the final agreement that was delivered on Jan. 15.

“Disability Rights Iowa commends the significant work that has been done by all parties to develop this settlement agreement,” Catherine Johnson, Disability Rights Iowa executive director, said in the joint news release. “The partnership between our agency, Children’s Rights, the National Health Law Program, Ropes and Gray, and Gov. Reynolds and her administration enabled this move towards addressing the needs of children with mental health conditions in Iowa.”

Disability Rights Iowa is a legal nonprofit organization that advocates for the rights of Iowans with disabilities.

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“For decades, the lack of services available has put the effected children at a greater risk for institutionalization, which takes them away from their families or caregivers who are best able to love and care for them,” Johnson said in the joint release. “We are pleased to be a part of this monumental change in addressing the pitfalls of the current system and finding solutions to improve the mental and physical well-being and safety of Iowa’s youth.”

The settlement agreement also includes a series of 13 goals and 10 principles to which the Iowa Department of Health and Human Services must adhere as it implements the agreement. Those goals and principles include directives like identifying the array of home and community-based services to provide and the eligible population to receive them, improving collaboration and coordination between state agencies and providers, establishing consistent statewide screening and assessment procedures, and ensuring that the services delivered are child-centered and family-driven, individualized, outcome-based and more.

The Iowa Department of Health and Human Services has named its new children’s mental and behavioral health care system the Iowa Responsive Excellent Care for Healthy youth initiative, or Iowa REACH. The system’s goal, the agency said, is to provide community-based services across the state.

“The agreement and our REACH strategy signify a major step in the right direction for Iowa youth and their families,” Garcia said in the joint news release. “We’ve spent several years seeking input from stakeholders, individuals and families directly affected and believe REACH is a comprehensive approach focused on providing core services and path forward to meet the unique mental and behavioral needs of Iowa’s children.

“Iowa HHS is fully committed to implementing new strategies and evaluating current outcomes to ensure we are meeting the needs that our children and youth deserve and families expect.”

The settlement also contains reporting requirements. The state must track and report quarterly certain data, including the number of Iowa children eligible for the services, the total and per-child costs of services, denials of services and appeals success rates, demographics, and more. The quarterly reports must be available on a public dashboard.

An independent monitor will determine whether the state has complied with terms of the agreement. The independent monitor, according to the settlement, must be mutually agreed upon by the plaintiffs and defendants, and have “substantial experience” in Medicaid and children’s mental and behavioral health services.

The parties agreed the state will complete implementation of the agreement by the end of 2032.

“This settlement agreement marks a crucial step toward securing robust Medicaid home- and community-based services for Iowa’s children, along with better care coordination services and mobile crisis response services,” Kim Lewis, with the National Health Law Program, said in the joint news release. “We will continue to advocate for policies that ensure children in Iowa and across the country have access to essential mental health services.”

The settlement was welcomed by the leader of the Iowa chapter of the National Alliance on Mental Illness. NAMI was not involved in the lawsuit.

“NAMI Iowa is happy to hear about this positive step toward a better children's behavioral health system, and Iowa families can receive better services in the future,” NAMI Iowa Executive Director Ryan Crane said in a statement to The Gazette.

Comments: (515) 355-1300, erin.murphy@thegazette.com