Systems Transformation in Iowa’s Mental Health and Disability Service System

disabled man cooking at home

As Iowa’s UCEDD, the Center for Disabilities and Development (CDD) has worked with the State’s Department of Human Services (DHS) for several years on strengthening the mental health and disability service system. CDD assisted the Mental Health and Disability Services Division of DHS, and many other State partners and stakeholders across Iowa in developing a ''comprehensive, effectively working" plan to expand options for community living and full inclusion for people with disabilities. Addressing system issues comprehensively, and providing action steps to expand access to home and community-based services and reduce reliance on institutionally based care, the DHS State Olmstead Plan for Mental Health and Disability Services Plan is being used to guide system transformation over the long term, and serve as the foundation for legislative requests on budget and policy matters. The goals of the Plan are:

  • Welcoming communities
  • Improved access to supports and services
  • Community capacity
  • Quality
  • Accountability

Learn more about the Plan at

The Iowa Legislature, the Department of Human Services, and hundreds of stakeholders have been working for several years to redesign Iowa’s county-based mental health and disability services system. A strong effort supported by both Republicans and Democrats resulted in legislation calling for the redesigned system to be consistent with Olmstead principles, and to make a set of core services available to Iowans with intellectual disabilities or mental illness, reduce inequities in county funding, improve access and focus the service system on outcomes and performance reporting. Refer to DHS’s Redesign Website for current information.

CDD continues to assist in the redesign effort in several ways:

  • With CDD’s help, DHS secured approval for enhanced federal Medicaid match under the Balancing Incentive Payments Program (BIPP). A requirement of the BIPP is that Iowa increase the proportion of its long term supports and services (LTSS) funding spent on home and community based services to over 50% of total LTSS funding by September 30, 2015. BIPP-approved states are required to take steps to streamline access to the service system through a No Wrong Door system.
  • CDD has partnerships with the Department on Aging, the state’s two Aging and Disability Resource Centers, and Iowa’s information and referral networks, to assist in the design of a network of entry points across the state for Iowans with disabilities.
  • CDD is helping DHS create a standardized system to ensure all Iowans with disabilities who are entering the system get have reliable, unbiased and fair assessments of their needs to create a good foundation for their service plans.

Another important initiative underway since 2007 is the Money Follows the Person (MFP) demonstration, which is helping residents of intermediate care facilities for people with intellectual disabilities move into their own homes and apartments in the community of their choice. MFP is one example of Iowa’s efforts to ensure people have the choice of community living, in the spirit of the U.S. Supreme Court’s landmark Olmstead decision of 1999. In this decision, the Court recognized that States cannot shift overnight from heavy reliance on institutional services to supports in the community for everyone. States can, however, move towards compliance with Olmstead principles by developing comprehensive, effective plans to provide real choices to people who need long-term support. More information is available at the Olmstead Consumer Taskforce website.