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Cedar Rapids, Iowa 52401
State to end program for Iowans with serious mental and behavioral health challenges
‘No one is prepared to handle this’: Providers alarmed by lack of notice; worry families will not receive the same support with transition to new model
Jul. 10, 2025 5:30 am, Updated: Jul. 10, 2025 12:11 pm
The Gazette offers audio versions of articles using Instaread. Some words may be mispronounced.
Editor’s note: The Gazette reached out to the Iowa Department of Health and Human Services for answers to questions for this story. Those answers were received after the story published. They were added to the story on July 10, 2025.
Iowa nonprofits that provide support and services to Iowans with complex mental health challenges say they are alarmed and concerned by plans to end a state program that provides holistic care coordination for children and adults with mental health conditions, with little notice given.
“It was a surprise for every single private provider across the state,” said Theresa Lewis, executive director of The Arc of East Central Iowa.
The nonprofit is one of four providers in Linn County that help children and adults with disabilities and complex mental health challenges, and their families, access necessary services and attend doctor appointments under a state program.
“We really had no notice whatsoever,” Lewis said. “… There’s just so many unknowns.”
The Iowa Department of Health and Human Services (HHS) announced June 30 that it was discontinuing the Integrated Health Home (IHH) program and transitioning to a new Certified Community Behavioral Health Clinic (CCBHC) model, beginning July 1. The IHH program will officially end on Dec. 31.
Through IHH, a team of professionals that includes care coordinators, nurses and peer support specialists work together to address individual needs and provide complete care for adults with serious mental illness and children with serious emotional disturbances. They help with paperwork for benefits, guide individuals through applications, and coordinate all services, including medical and behavioral care, regardless of funding sources. The program is administered by the Iowa Medicaid agency.
The IHH program is being phased out to align with a new Certified Community Behavioral Health Clinics (CCBHCs) model, which aims to provide a more integrated and accessible approach to mental and behavioral health care, according to information on the HHS website. CCBHCs are required to meet specific federal criteria.
Iowa HHS received a one-year, $1 million federal planning grant in 2023 to support the design and implementation of an Iowa CCBHC program. The funding provided assistance to states in certifying clinics as CCBHCs, establishing prospective payment systems for Medicaid reimbursable services, and preparing an application to participate in a four-year demonstration program. Iowa was chosen last year as one of 10 states to participate in the demonstration program.
What is a CCBHC?
CCBHCs are specially designed outpatient clinics that offer a wide range of mental health and substance use services to everyone, regardless of age, diagnosis, insurance coverage or where they live.
They must meet specific certification criteria and provide nine core services, including 24-hour mobile crisis teams emergency crisis intervention and crisis stabilization, as well as primary care screening, risk assessment, targeted case management, treatment planning, outpatient services, psychiatric rehabilitation, peer support, counseling and family support services, and intensive community-based mental health care for veterans.
An Iowa HHS representative did not immediately respond to a list of questions emailed by The Gazette seeking details about Iowa Medicaid sunsetting the program and the transition to the new behavioral health clinic model, and referred The Gazette to an FAQ sent out to providers by the state agency.
An HHS spokesperson, after this story published Thursday morning, sent an emailed statement to The Gazette. The department stressed that there is no immediate change, and that IHH will continue to be a Medicaid-covered service until the program sunsets in January 2026.
“Iowa Medicaid has been actively discussing the future of IHH with providers and members for over a year,” Iowa HHS spokesperson Alex Murphy said in a statement. “There have been significant issues in the IHH program over the last several years, resulting in a heavy administrative burden for providers to come into compliance with the required standards.”
Additionally, a class-action lawsuit was filed in 2023 on behalf of Medicaid-eligible children who had serious emotional disturbances that alleged a "longstanding failure" to provide legally required and medically necessary intensive home and community-based services. A January 2025 settlement agreement laid out the evaluation of IHH performance and creation of a new approach to intensive care coordination.
“While the formal announcement and timeline to end Iowa’s IHH program were recent, it comes after a very long period of evaluation and engagement with stakeholders and adheres to the timeline from the settlement agreement,” Murphy said. “... Iowa HHS’ goal is to make it easier for people to get access to care without so many steps, hurdles, or administrative barriers between people and the care and support they need.”
How many CCBHCs are there in the state?
There are 10 CCBHCs in the state covering 71 of Iowa's 99 counties, according to a map by Iowa HHS.
They include the UnityPoint Health-Abbe Center for Community Mental Health in Cedar Rapids; Pathways Behavioral Services in Waterloo; UnityPoint Health — Robert Young Center in Muscatine; Prairie Ridge Integrated Behavioral Healthcare in Mason City; Southern Iowa Mental Health Center in Ottumwa; Plains Area Mental Health Center in Le Mars; Seasons Center for Behavioral Health in Spencer; and Heartland Family Service in Omaha.
That compares to 29 Integrated Home Heath providers serving all but 15 counties in the state.
Why end the Integrated Health Home (IHH) program?
Iowa HHS has been working over the past two years to align all mental health and substance abuse treatment services under a new behavioral health system to better connect Iowans with the care they need, regardless of where they seek help.
“For some Medicaid members it is confusing and challenging to understand how to access services and assistance for behavioral health and substance use, including case management,” according to the FAQ. “There are many entry points into case management, especially with the addition of CCBHC.”
Sunsetting the IHH program will streamline efforts, reduce duplication of services, standardize case management training, enhance reporting and quality measures, and decrease the ratio of members to case managers to improve service access and quality, the state says.
“Unlike IHH, which focused on care coordination for a limited population of Medicaid enrollees with mental health diagnoses, CCBHCs serve anyone who walks through their doors,” Murphy said.
According to HHS:
- Timeline: The transition began on July 1, with meetings for adults with intellectual and developmental disabilities or chronic mental illness. Children's programs will begin transitioning in August.
- Full Transition by Dec. 31: All eligible adults are expected to be transitioned to other services by Sept. 30. Affected adults will be “triaged on an individual basis to identify the best option for the member,” according to HHS. All children should be transitioned out of the IHH program by Dec. 31.
- Transition for children: Children under the fee-for-service Medicaid payment model who have a Children’s Mental Health Waiver will be referred to Iowa HHS for Targeted Case Management. Children not under the fee-for-service model who receive waiver services will receive case management from a private managed care organization. Children who have an MCO but do not currently receive Medicaid waiver services will either receive case management through an MCO or a new Certified Community Behavioral Health Clinic.
- Public Input: A public comment period is open until 4:30 p.m. on July 30, allowing stakeholders to provide feedback on the transition plan. Comments may be emailed to: QIMP_Public_Comment@hhs.Iowa.gov, and should indicate “SPA IA-25-0030” in the subject line of the email. Iowa HHS says there will be multiple opportunities for impacted Iowans to share feedback and receive more information, including town halls, Medicaid open office hours and a website with updated FAQs, a transition timeline and additional resources.
- Ongoing Support: Iowa HHS says it has a structured transition plan to minimize disruptions for members, providers and Managed Care Organizations (MCOs). HHS says it will meet with providers on a biweekly basis to provide transition assistance.
Beginning this month, MCOs will reach out to IHH providers to discuss transitioning care coordination for IHH members, according to Iowa HHS.
“IHH care coordinators will contact each current member to ensure they understand their options, assess for potential gaps in care, and create an individualized transition plan to ensure needs are addressed,” the agency said in a statement. “MCOs will hire additional team members to serve individuals transitioning from IHH care coordination. It is likely that many care coordinators currently employed by IHHs will be able to secure new roles with an MCO if they choose to do so.”
‘No one is prepared to handle this’
Providers told The Gazette that little has been shared by Iowa HHS about the impetus for the abrupt decision to end the IHH program and what the transition will look like. They say they are concerned about the quality of service post-transition, logistic challenges and staff layoffs.
Tresa Stearns, community based manager at Tanager in Cedar Rapids, said several mothers have either called or sat in her office crying, upset at losing their IHH support team through Tanager. Stearns said one mother detailed the difficulty she’s had contacting and getting a response from her child’s MCO. Another called crying, worried who will attend future meetings with school officials to help advocate for her son.
Tanager works with area school districts to help students struggling with mental and behavioral challenges. Staff attend meetings with teachers and parents to discuss Individualized Education Program and 504 plans that provide support for students with disabilities. Tanager staff as well help provide families with housing, food assistance, medication management and therapy services.
"How is this improving services for my child? We can't even get information about what the service is going to look like. This is going to result in a lot more crisis for my family,“ Stearns recounted of her phone conversation with a mother of a child with disabilities.
Tanager is one of three providers in Linn County, along with The Arc of East Central Iowa and Four Oaks Family and Children Services, that help families of children with serious emotional disturbances access necessary services under the IHH program.
The Linn County children's human service agency offers programs that focus on prevention, treatment and outreach and serve more than 4,000 children, teens and young adults each year. It currently serves about 390 children through IHH.
Stearns said Tanager has had 577 face-to-face visits with IHH patients and 746 provider contacts in the past six months to help collaborate between providers, share information and receive updates on wait lists for services a client might be placed on.
“We also help fill out paperwork and documents and provide local community resources to families, and attend school meetings,” she said. “The level of care and contact a family will receive will be far different from what they have received, and will leave families without the services they need in place."
Stearns said information of what services will look like for families “has almost been non-existent.”
“The infrastructure has not been shared with us, and CCBHCs have said they are not prepared to meet the needs of the families that would transition to them,” she said. “And they are pushing for this in an unrealistic time frame to meet the needs of the children and families that need the service. No one is prepared to handle this.”
Okpara Rice, chief executive officer at Tanager, said the IHH program has been effective at keeping children out of emergency rooms and helping families navigate complex health care systems more efficiently.
Rice said the provider community is agile and trying to make the transition as smooth as possible. He said Tanager also hopes to help the 14 to 15 staff members impacted by ending the state program find new positions, either internally or elsewhere, and continue serving the community effectively.
‘We have no idea what will be offered’
The Arc of East Central Iowa’s current IHH program limits each case manager to 40 individuals due to the intensive needs of their population. Lewis said staff and parents fear MCOs will have much larger caseloads, preventing personalized attention.
Their current program actively intervenes in critical situations — such as preventing suicide — sometimes multiple times per week. Lewis said she doubts MCOs can provide the same rapid, direct support.
“At least once a week, our care coordinators are going out and finding people who might be homeless, who are experiencing a significant crisis and say they want to commit suicide, and getting them the direct help that they need,” she said. “So you know, our program has saved lives every single week that we have had this program, and that's because of our ability to mobilize; to be out there and to provide the level of care that individuals really need in order to be happy and healthy.”
The Arc serves about 75 individuals with intellectual and developmental disabilities and co-occurring mental health conditions, a complex population requiring specialized, holistic care. Lewis said she and parents are concerned MCOs may not understand or address these unique needs.
“You really can't start to make progress with an individual until you understand their intellectual or developmental needs,” Lewis said. “And we saw that as a gap in the community, and we wanted to fill that for individuals.”
Arc’s care coordinators provide comprehensive support that goes beyond standard case management, including skill building, medication management and connecting individuals to various services.
With potentially thousands of Medicaid recipients, MCOs may not be able to provide the same individualized, intensive support their current program offers to high-risk and complicated individuals, Lewis said.
“We have no idea what will be offered once they transition over to a managed care organization,” she said.
UnityPoint Health, which is on the state’s 10 new CCBHCs and provides IHH services to adults, said in statement to The Gazette that it “will continue to provide high quality compassionate care to all patients.”
“We are committed to working with Iowa Health and Human Services on any future changes to the Integrated Health Home program to ensure a smooth transition for all patients and families impacted,” according to the statement.
Four Oaks, like The Arc, provides services to children and adults in Linn County. President and CEO Mary Beth O’Neill, in a statement to The Gazette, said: “We recognize this news will affect not only those we serve, but also our dedicated staff who deliver services with compassion and expertise.
“At Four Oaks, we are committed to identifying solutions for the families who depend on this service. We will work with HHS to determine the next steps and supports that families can access. We will also be meeting individually with staff to discuss employment opportunities.”
Comments: (319) 398-8499; tom.barton@thegazette.com
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