Iowa
Iowa reaches final settlement in lawsuit alleging state hasn’t provided adequate mental health care for kids
Iowa’s youth struggle to find mental, behavioral health services
Rachel Callahan constantly hit roadblocks over several years as she worked to find mental health services for her son.
Iowa will take steps to ensure Medicaid-eligible children with mental illness diagnoses will receive the necessary mental and behavioral health care services as part of a recently announced settlement agreement.
The lawsuit, filed in early 2023 by Disability Rights Iowa and other national health and law advocacy organizations, accused Iowa of “longstanding failure” to provide Medicaid-eligible children with legally required and medically necessary mental and behavioral health services.
The suit was filed against Iowa Department of Health and Human Services Director Kelly Garcia.
The plaintiffs alleged that Iowa administers an inadequate mental health system, despite receiving federal funds for children’s mental health care. As a result, Medicaid-eligible children younger than 21 who require intensive home and community-based services face a high risk of being placed in institutions away from their families and communities, they argued.
More than 300,000 youth — or about three out of every eight Iowa youth under the age of 21 — are covered by Medicaid. Of that population, nearly 90,000 had a serious emotional disturbance in state fiscal year 2020, according to court records.
Advocates behind the lawsuit say the steps proposed by the state in the agreement present a “radical change” that will ultimately be a positive move for youth in Iowa who need mental and behavioral health services.
“That’s a lot of children that this is going to directly impact in terms of the services they’re able to receive, and change the trajectory of not only their immediate circumstances and immediate mental health needs, but also their long-term prospects,” Catherine Johnson, executive director of Disability Rights Iowa, told the Register.
A preliminary settlement was reached in December after more than a year of negotiation between the plaintiffs and the state health and human services agency. The judge issued preliminary approval of the agreement last week, and set a final approval hearing for early May.
What does this settlement mean?
To address the plaintiffs’ alleged shortfalls in behavioral health services for children, the state agreed to ensure key services are available statewide to Medicaid-eligible children with serious emotional disturbances. The state is required to complete this process by the end of 2032.
The settlement agreement includes a detailed implementation plan Iowa HHS, which has been dubbed by state officials as the Iowa REACH initiative.
The plan includes specific steps the state will take to develop and deliver intensive home and community-based mental health services to children statewide when deemed medically necessary, and will be lead by a team from across the agency who will be responsible for overseeing the plan.
The agreement, along with the state’s REACH strategy, signals “a major step in the right direction for Iowa youth and their families,” Garcia said in a statement Wednesday.
“Iowa HHS is fully committed to implementing new strategies and evaluating current outcomes to ensure we are meeting the needs that our children and youth deserve and families expect,” she said.
Johnson praised the significant work to develop the settlement agreement, noting that the plan laid out by the state would create major structural change to Iowa’s current mental and behavioral health system for youth. Because of this plan, she said youth will be able to stay with their families in their community, receiving the services and supports they need to succeed.
“They get to go to school with their friends and they don’t have to go to an institution or a hospital that’s scary and they don’t know anyone,” Johnson said. “They get to stay with the people that love them, and grow up with mental health services in place. Your future is different, perhaps, than it might have been without this brand new structure.
“I think it’s just very, very significant, and I’m really excited for the implementation to begin so that Iowa can have these services in place as soon as possible for our kids.”
What are the terms of the settlement?
Among the terms of the settlement, the state must ensure Medicaid-eligible children receive mental health services “in the most integrated setting appropriate to their needs and are free from serious risks of segregation and institutionalization, including the unnecessary use of out-of-home placements.”
These changes must ensure Iowa youth receive the supports necessary to maximize their success growing into healthy and independent adults, the settlement agreement states.
To reach that goal, the state must develop and implement certain relevant services, which include intensive care coordination. This is a “single point of accountability” for ensuring medically necessary Medicaid services are coordinated and delivered appropriately to Iowa youth, according to the settlement agreement.
State officials also agreed to provide intensive in-home and community therapeutic services, with the goal to “maximize the child’s ability to live and participate in the community and to function independently.” That includes individual and family therapy.
The state must also boost its 24/7 mobile crisis intervention and stabilization services for young Iowans as part of this settlement agreement.
To support their effort, state officials say they will utilize additional Medicaid services to support children with serious emotional disturbances and “to help maintain them in their homes and communities and avoid higher levels of care and out-of-home placements.”
These additional services include respite care or other supports meant to help children build skills and help the family’s ability to successfully care for the child at home.
However, state officials warn that while it can request funding from state lawmakers for these initiatives, the settlement ultimately does not have authority over the Iowa Legislature.
Both parties also agreed to an independent monitor tasked with evaluating the state’s progress in implementing the proposed plan. The monitor — which will be a third-party selected at a later date — will issue reports on the state’s effort each year, per the settlement agreement.
Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com or at (319) 339-7354.
While most of the focus for the Iowa State Cyclones will be on the football program for the next couple of months, the basketball program will also be getting set soon for a new campaign. Coming off a strong season, expectations for them will be high.
The 2025-26 season will go down as a memorable one for the Cyclones. This was a team that exceeded most expectations and ended up being one of the best teams in the country.
Iowa State started out the campaign with a 16-0 record, and the group looked like a real contender. While there were some hiccups during a challenging conference schedule, the Cyclones were one of the best teams in the country.
In March Madness, Iowa State was a number two seed, proving to be one of the top eight teams in the country. As they get set for next season, their goal will undoubtedly be to be ranked highly again. However, they may have to prove themselves a bit.
Joe Lunardi of ESPN recently updated his very early bracketology report for the upcoming 2026-27 campaign for the Cyclones. After being a number two seed last year in the NCAA Tournament, he currently has them on the five line.
Iowa State Has Work To Do
While being a five seed in the NCAA Tournament would indicate a Top 25 season for the Cyclones, expectations for the program are higher than that at this point.
Iowa State has become one of the more consistent programs in the country over the last several years, and they will undoubtedly want to take a step forward this coming season.
Due to a lot of production leaving, it is understandable that how they are viewed now could be very different from how they are perceived come March. Due to all of the new players that are coming in, it is going to take time for them to gel.
The Cyclones have a few key returning players led by Killyan Toure, Jamarion Batemon, and Blake Buchanan. Both Toure and Buchanan were starters for the team last season, and that should remain the same this year. However, Batemon also played a significant role coming off the bench, and his scoring ability might put him next to Toure in the starting lineup this coming year.
Overall, while the team did lose a lot of production, they have a good amount of depth with the new players coming in and some key freshmen returning. If things go right and the team gels quickly, they should be better than a five seed.
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Iowa State coach T.J. Otzelberger on Tre Singleton player comparisons
Iowa State coach T.J. Otzelberger on Tre Singleton player comparisons
It didn’t take Tre Singleton long to learn the lesson that has dawned on so many Iowa State basketball transfers before him.
“There’s not much to do around Ames,” the Northwestern transplant said July 14, “besides get better and be good at basketball.”
Perhaps not a slogan the Ames Chamber of Commerce will be adopting any time soon, but a sentiment – and, maybe, self-fulfilling prophecy – that the Cyclones themselves have turned into something of a brand, going back to the early days of Fred Hoiberg’s Transfer U tenure.
Get in the lab. Get better. Get wins.
Repeat.
“Cut all the distractions,” Singleton said of the setup. “It helps you key in on the things you need to work on to get better at.
“It helps me come in here every day with the focus of being better.”
That’s a focus Iowa State and its fans hope they’ll be able to appreciate this winter when Singleton is expected to take on a significant role for a Cyclones team that will reconfigure itself after losing three starters off last year’s Sweet 16 squad.
Most notably, Singleton has the look and feel of a Joshua Jefferson approximation. At least in terms of style and role. Expecting a transfer coming off a promising, but certainly not elite freshman season to just slide into the spot previously occupied by an All-American and first-round NBA Draft pick would probably be … unwise.
“I think it’s best to stay away from any comparisons to other guys because Tre needs to be the best version of himself,” said Iowa State coach T.J. Otzelberger. “There’s differences between him and Joshua, even though I know there’s a natural inclination to draw that comparison.”
That natural inclination comes from their similar size (both 6-foot-8 though Jefferson has 30 pounds on 215-pound Singleton), versatility as playmaking power forwards, ability to rebound and high-IQ play.
I think the expectation for Singleton (and Iowa State fans) is to see if the sophomore can operate in that same Jefferson role, if not with the same sort of production and overall impact.
“We see him as somebody who can create advantages for us offensively to make plays,” Otzelberger said. “He’s a gifted passer. He takes a lot of pride in making the right play.”
I think the high-end hope would be that Singleton can approach that Jeffersonian impact in a year or two.
“Tre,” Otzelberger said, “is a very gifted player.”
Singleton’s bet on Iowa State’s development model and the Cyclones’ bet on Singleton to maximize it seems like the sort of transfer portal match that’s often overlooked amid doom-and-gloom bellyaching about player movement.
I’m sure the dozens (dozens!) of Northwestern hoops fans would disagree, but Singleton’s move from a middling Big Ten program with a sparse NBA track record to a Big 12 contender with a strong developmental program seems like not only an inoffensive use of the portal but one that rewards both ascendant players and programs.
We’ll see how it plays out, but Singleton and Iowa State feels like a win-win marriage of skillset, opportunity and culture.
“I chose Iowa State,” Singleton said, “because it fits me as a person. “
Besides, Evanston has the lakeshore and a world-class city 20 miles away. Which, sure, I’d call amenities, but aspiring NBA players might consider distractions.
You take your wins where you can get them, I suppose.
Iowa State columnist Travis Hines has covered the Cyclones for the Des Moines Register and Ames Tribune since 2012. Contact him at thines@amestrib.com or (515) 284-8000. Follow him on X at @TravisHines21.
See the unique cotton candy art at the Iowa State Fair
Cotton candy has been a popular treat at the State Fair for decades, but one family is pushing the fluffy limit on the sweet classic.
It’s all about the food at the Iowa State Fair, and a panel of judges has named their top new foods coming to the fair in 2026.
From an initial list of 84 entries, the field was narrowed to 11 contenders. Judges tasted each of the 11 new foods and voted for three finalists during a Facebook livestream event from the fairgrounds on Tuesday, July 14.
Those three will compete for fairgoers’ votes for the 2026 Best New Food at the Iowa State Fair.
Last year, Winn & Sara’s Kitchen’s bacon chicken ranch eggroll took home the top honor.
These three finalists will face off in public voting Aug. 13-19 at the Iowa State Fair. The winner will be announced Aug. 21.
What are the top three new foods at the 2026 Iowa State Fair?
All-American Scrambled Egg Roll
Winn & Sara’s Kitchen will try for its third-straight win with a breakfast offering. The All-American Scrambled Egg Roll is stuffed with bacon, sausage, hash browns, eggs and cheddar, finished with cheesy ranch.
- Cost: $15
- Vendor: Winn & Sara’s Kitchen
- Where: Next to the craft beer tent, west of the Jacobson Building
Porky Parm Gnocchi
The Pork Parm Gnocchi features gluten-free potato gnocchi with sausage, parmesan cream and pesto. It’s topped with an America 250 flag and a suvenir piggy pal.
- Cost: $14
- Vendor: Destination Grille
- Where: Between the Jacobson Building and the Craft Beer Tent
Ultimate Minneapple Pie
An offering from a Minnesota State Fair vendor making its first Iowa State Fair appearance, the Ultimate Minneapple Pie includes fried apple pie with ice cream and apple syrup.
- Cost: $14
- Vendor: Minneapple Pie
- Where: Near the Anne and Bill Riley Stage
More standout new foods at the 2026 fair
Here are the eight other items that rounded out the top 11:
- 1776 Dubai Strawberries from The Strawberry Station, $19. Fresh strawberries topped with milk chocolate, pistachio crème and crunchy kataifi. Find it at West Marketplace.
- Cajun Cluck ’N’ Chaos from Cluckin’ Coop, $14. Cajun chicken sloppy joe with slaw, spicy pickles, pickled egg and pickle cotton candy. This lunch-cafeteria special is served right across the street from the Animal Learning Center at Little Hands on the Farm.
- Crunchy Lamb Wrap from HoQ, $19. Deep‑fried naan stuffed with risotto, lamb and cheese. Located east of the Administration Building.
- Garlic Dill Pickle Cheese Curds from Brad and Harry’s Cheese Curds, $9. Garlic‑dill mashup curds. You can find Brad and Harry’s Cheese Curds west of the Jacobson Building.
- Star Spangled Swine from Whatcha Smokin’ BBQ, $15. Pork belly with apple‑chipotle rub and honey crystals. Located next to the Iowa craft beer tent, west of the Jacobson Building.
- Strawberry Bliss from Iowa Specialty Crop Growers Association, $8. Shortbread, strawberry, meringue and milk chocolate. Located in the Agriculture Building, under the southwest stairs.
- Stuffed Tater Kegs from Tater Todd and Hot Doug’s, $10. Loaded potato bites with breakfast or cheese options. Located in front of the Agriculture Building.
- Sweet Americana from Over the Top, $13. Strawberry shortcake, lemon bar and blueberry crisp ice creams. Over the Top’s stand is on Grand Avenue, just outside the Varied Industries Building.
Previous winners of Best New Foods at the Iowa State Fair
- 2013: Zag’s Po Boys — Shrimp Corn Dog
- 2014: Multiple vendors — Funnel Cake on a Stick
- 2015: The Rib Shack — Ultimate Bacon Brisket Bomb
- 2016: Iowa Turkey Federation — Not Your Mamma’s Taco
- 2017: Steer ‘N’ Stein — Pork Almighty
- 2018: Applishus — Apple Eggroll
- 2019: G Mig’s Wrap Stand — Georgie’s Roast with the Most Wrap
- 2020: No fair due to COVID-19
- 2021: Cluckin’ Coop by the Iowa Egg Council/Iowa Poultry Association — Chicken Egg Salad with Fry Bread
- 2022: The Rib Shack — The Finisher
- 2023: What’s Your Cheez — Deep-Fried Bacon Brisket Mac-n-Cheese Grilled Cheese
- 2024: Winn & Sara’s Kitchen — Bacon Cheeseburger Eggroll
- 2025: Winn & Sara’s Kitchen — Bacon chicken ranch Eggroll
Cooper Worth is a service/trending reporter for the Des Moines Register. Reach him at cworth@gannett.com or follow him on X @CooperAWorth.
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