Settlement to bring ‘services that make the difference’ for Iowa kids, advocate says

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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 agreement resolves a 2023 lawsuit brought against the state and 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.

One of the plaintiffs in the case was Disability Rights Iowa, a legal nonprofit organization that advocates for the rights of Iowans with disabilities.

The Gazette spoke recently with Catherine Johnson, the executive director of Disability Rights Iowa, to get her thoughts on the settlement agreement and what it will mean for Iowa children and families in the future.

What follows is a transcription of that conversation, edited for clarity and brevity.

Q: Give us your thoughts on the settlement agreement.

A: I think that the settlement agreement is really comprehensive. It is creating a structure for Iowa’s mental health system that addresses the needs of children and youth that meet the definition of our class: severe emotional disturbance, or SED youth. It’s about 90,000 youth in Iowa that are within that class definition. And it’s creating a structure of intensive home- and community-based services that just have not existed up to this point. And so some of those services that are relevant are intensive care coordination, mobile crisis services, intensive in-home and community services, therapeutic services, and then there’s some Medicaid waiver services for respite and other supports that are identified in the settlement agreement. All of those together create a structure of services and supports in the community for our youth in Iowa. It will allow youth to stay in their community with their families and receive the services that they need. It allows them to continue going to school with their friends, to continue playing sports or music or doing whatever extracurricular activities they enjoy doing. So I think this is just an extremely impactful, really life-changing settlement that is going to create a structure for our very important children and youth that just hasn’t existed to now.

Q: You mentioned the home- and community-based services and how the lack of those services was disrupting families. Can you elaborate on that and how this settlement agreement will hopefully address that?

A: Prior to this settlement and these services being identified and the work the state is doing to create these statewide services, what frequently happened is that children that needed intensive home- and community-based services attempted to get them, but the services were lacking. And so they ended up having to go in times of crisis to emergency rooms, into intensive crisis centers to receive services, into an institutional setting to receive those services — away from their home to receive those services. So this settlement removes that and allows the services to be in the community where the children are so that they do not have to go away from their friends and their family and their schooling to a place where they know no one to receive these services.

Q: What are a few things that you will be watching for in particular as the state implements the terms of this settlement agreement?

A: You know, there is no one piece of this settlement agreement that you can tease out and say, ‘That’s the most important part.’ It really is creating a patchwork of services and a program and a structure. So the entire settlement agreement is important. So we will be watching, and very eagerly watching, the implementation plan of all these services and the statewide part of the services. There will be an independent monitor that will be assigned to this that will help kind of guide the process. We’ll make sure that all of the different terms and deadlines in the settlement are met and really serve as kind of the facilitator, I guess I would say, of the settlement agreement.

Q: You mentioned the independent monitor. That seems like a really important role that will be a crucial part of this implementation process. Is that accurate?

A: One hundred percent agreed. This is the person who will ensure that the settlement agreement deadlines and terms are met, and both in terms of the statewide services but also in terms of the different assessments and the data gathering. There’s a lot of different parts to the settlement agreement, so the independent monitor is the one who is following that process, reporting back to both the state Department of Health and Human Services and all of the plaintiffs’ counsel, and then reporting back to the court. This is a settlement agreement that’s a long-term settlement agreement. It’s a seven-year plan. So it’s someone who is going to be with these plaintiffs, with the defendants, and with this agreement for a very long period of time. So it is an extremely important person. It’s very important that the independent monitor have knowledge of Medicaid and the services that are identified.

Q: Acknowledging this was a legal process, how was the state of Iowa as a negotiating partner during the negotiations of this settlement agreement?

A: You know, we spent the past year working collaboratively on the terms that are in the settlement. And I think that Iowa should be proud of this settlement. If you look at what you would want to create in a structure, these are the services that make the difference, and the assessments and the eligibility criteria. All of those are significant pieces, and making all of these services available statewide is also significant. So it took a long time to really, I think, find a way forward with creating what needed to be created. But I think that the settlement agreement, in some ways, really speaks for itself. It’s extremely detailed. I think you can tell by reading it the level of thought and care and attention that went into arriving at an appropriate settlement agreement that addresses the needs that were addressed in the original complaint.

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