Iowa HHS proposes centralized early childhood system modeled after behavioral health overhaul

The Iowa Department of Health and Human Services is proposing an overhaul of how early childhood and family services are delivered in the state, creating a new centralized system modeled after Iowa’s recently launched behavioral health and disability services structure.

Under the proposal, HHS would dissolve the state’s long-standing Early Childhood Iowa framework and replace it with a statewide Early Childhood and Family Services System organized into seven districts — mirroring the geographic and governance model used by Iowa’s Behavioral Health and Disability Services system.

HHS officials outlined the plan during a virtual town hall Thursday, describing it as a move toward greater consistency, accountability and access to services for families with young children, particularly those under age 6.

A shift to centralized districts

Early Childhood Iowa (ECI) is a statewide initiative that coordinates state and private resources to ensure children from birth to age 5 are healthy, safe and ready to succeed. It operates around 34 locally governed ECI areas covering all 99 counties, each overseen by volunteer boards and local directors. Those boards help determine service priorities and funding based on community needs, focusing on improving family support, health and education.

The proposed system would replace that structure with seven HHS-controlled districts, each governed by a district board and required to deliver a common set of “core services” statewide, regardless of ZIP code or county.

“One of the things that we are really laser focused on is that families should have a number to call, tailored service delivery and a place to go … or someone to come to them when they are in need,” Janee Harvey, director of HHS’ Division of Family Well-Being and Protection, said during the town hall.

“Not all families need the same thing,” but every family should have equitable access to support, Harvey said.

She said the centralized model would provide cohesion and uniformity across Iowa while still allowing districts to offer supplemental services based on local data and needs assessments.

Focus on prevention and early intervention

The proposed legislation would formally establish an early childhood and family services system within HHS to deliver primary prevention strategies, early intervention services and ongoing family and community resources.

According to HHS, prevention services would focus on helping families meet basic needs, reducing risk factors, increasing protective factors and improving overall family stability — with the aim of preventing child welfare involvement and foster care placements.

Core services under the new system would include:

HHS officials said decisions about service arrays would be driven by data collected at the district level, with advisory councils helping shape local plans within a broader statewide framework.

“We’re trying to prevent adversity from happening in the first place,” Harvey said, describing the goal as creating “more good days for families” and helping them stay “on a pathway to thriving.”

Addressing gaps — and funding

HHS leaders said the current ECI structure suffers from inconsistent service delivery, funding disparities, limited oversight and gaps in access from county to county. Centralizing the system, they argued, would reduce administrative costs, eliminate redundancies and improve accountability.

Harvey also said the new structure would allow Iowa to draw down an estimated $6 million to $7 million more in federal funding by aligning programs and maximizing ancillary funding opportunities.

The legislation had not yet been introduced as of Thursday, with HHS officials saying the bill was still being drafted by the Legislative Services Agency. Its release is expected in the coming days.

Local concerns about loss of community control

The proposal has raised alarm among local early childhood leaders, who say dismantling Early Childhood Iowa would undermine decades of community-driven planning and coordination.

Kristen Peyton, Early Childhood Iowa grant coordinator with Linn County Community Services, warned board members the proposal represents “a fundamental shift away from the community-based model that has guided early childhood investments in Iowa for more than 25 years.” In an email, Peyton said eliminating ECI would dismantle local governance, weaken coordination across systems and destabilize services for vulnerable children and families.

“ECI was intentionally designed to ensure local communities have a voice in identifying needs, aligning resources, and investing in evidence-based services that improve outcomes for children and families,” Peyton wrote. “... This proposal does not streamline services — it removes the infrastructure that ensures accountability, collaboration, and measurable results at the local level.”

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Democratic State Rep. Tracy Ehlert, an early childhood educator and business owner from Cedar Rapids, told The Gazette local ECI areas are “very concerned” about the proposal and have reached out to her with concerns.

“ECIs were created to help address local need around early childhood,” she said. “And more and more that ‘local’ part has been pushed away. That is concerning as not every area in the state has the same needs.”

She said she’s also concerned about HHS “taking on one more thing,” and what that might mean for the agency and its employees “who already have full workloads.”

House Health and Human Services Committee Chair Rep. Austin Harris said HHS has walked committee leaders through the bill but has not had time to fully analyze it.

“It’s something we’re going to take a serious look at and probably at least give it a subcommittee and continue the conversation,” Harris, R-Moulton, said.

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Asked about concerns raised by Early Childhood Iowa leaders — including fears that a district-based system could undermine decades of community-driven planning — Harris said he is open to hearing those arguments.

“I’m sure the Department of Health and Human Services did their homework on this, and I thought they made a good case in our meeting,” he said. “But I certainly want to hear the other side.”

Next steps

HHS launched a website with background materials, presentations, frequently asked questions and data snapshots related to the proposal. The department also is accepting public questions about the legislation at SystemAlignment@hhs.iowa.gov.

If approved by lawmakers, the early childhood restructuring would mark the latest major reorganization of Iowa’s health and human services landscape, following the state’s transition to regional behavioral health and disability services districts in 2025 — a change HHS officials said offers a blueprint for how a centralized early childhood system could function statewide.

“In 2026, our goals remain clear: ensure consistent access to health and human services for all Iowans while maximizing the impact of federal, state, and local resources; improve communication; and enhance partner collaboration,” Harvey wrote in an email to ECI officials.

The goal, she said, is to create a streamlined, accountable system that delivers consistent, effective services across Iowa.

Comments: (319) 398-8499; tom.barton@thegazette.com