Iowa Health and Human Services (HHS) announced plans to transition the state’s public health system into a regional model by 2028. The move will shift the oversight of funds for each county to a lead entity in each region.
The plan is meant to improve coordination across counties and create more consistent services across the state. Iowa HHS said it wants Iowans to be able to access essential services easily, regardless of where they live.
The move will group the state’s 99 counties into seven regions, called public health districts. One public health department from each region will become a lead agency and will administer state funds to the rest of their region’s health departments rather than Iowa HHS.
In region 5, the Polk County Health Department is applying to become the lead entity. Director Juliann Van Liew said during a Board of Health meeting on Sept. 18 that she sees the benefits of making this change. But she said county health departments, including Polk County, will see cuts to some of the grants that fund their services.
“When we bring on that lead agency, that lead agency is going to need to take a cut in order to administer that grant,” Van Liew explained.
Van Liew said Polk County receives about $2 million in grants to fund public health services, immunizations and childhood lead poisoning testing. Under the new model, she said the lead agency in region 5 will have to take around a 15% cut from those funds to cover the administrative costs.
She said the state capped the amount at 15%, so it may vary for other regions. Each region's lead agency will take the cut from the region’s combined public health funds, which will leave local health departments with a gap in funds for their staff and services. Van Liew said this will leave region 5 with around a $300,000 gap.
“The fact is that less local capacity from less dollars means fewer services for Iowa residents,” she said.
Van Liew said the issue is that there aren’t extra funds to support one health department overseeing an entire region’s public health funds.
“Iowa HHS has not said what they will do with those resources and staff that currently support all the administrative work that now we will be absorbing at the local level,” she said. “So, financially, the state wins out here in keeping those staff who are doing those functions, giving us those functions, and making locals take that out of grant money.”
In rural southern Iowa, Wayne County Public Health is a central resource. Susan Moore, director of the health department, said it has specific needs as an underserved county in rural Iowa.
“We have limited services to healthcare. We have transportation problems. We have mental health access issues,” Moore said. “All of these things, people come to the county health department looking for help.”
Moore said Wayne County also has the only delivery hospital within a 70-mile radius, which brings in people from all over southern Iowa. Her department collaborates with the hospital to help people sign up for health services or to provide supplies like diapers.
Moore said she’s worried that if funds are pulled to pay for regional oversight, counties like hers will lose out on the services that meet their specific needs. She said the funding cut could impact their staff as well as services like immunizations.
The shift is meant to make services more consistent across counties, but Moore said the region’s goals may not align with what a rural county needs to provide.
“Public health is ever-evolving, ever-changing, and it’s based on and driven by the needs of your community,” she said. “I think that will be a little bit harder in a regionalized model.”
Van Liew, with the Polk County Health Department, said consistency across counties doesn’t have to mean things will be the same across counties. As a potential lead agency, she wants to make sure counties can meet the region’s goals in a way that works for them.
“So, making sure that there’s consistency across the system, but the methods for how we implement a strategy or what that looks like — those should be different, and those should be designed and driven by those local health department leaders,” Van Liew said.
Iowa HHS will roll out the first phase of the system in January. It said the lead agencies will work with local providers to develop the district’s service plan, but county health departments will still have authority over their staff and the services they provide. Iowa HHS will implement the regional system in July 2028, and oversight will shift to each region’s lead agency.
