Buena Vista County public health leaders say the state’s latest push to reorganize local public health services is creating more questions than answers.
Public Health Administrator Tracy Gotto and Assistant Administrator Lacey Anderson briefed the county board of supervisors Tuesday morning, outlining what they know — and what they still don’t — about Iowa’s proposed public health realignment.
Gotto told supervisors the state has sent mixed signals for months.
State officials had previously indicated they did not plan to pursue another major restructuring after last year’s overhaul of Iowa’s mental health and substance‑use system, which consolidated 13 mental‑health regions and 19 addiction‑treatment networks into seven statewide behavioral health districts. That system began rolling out in 2025 and is still being implemented across the state. But Gotto said counties were recently notified that public health realignment is back on the table.
Supervisors asked whether the new structure would mirror the mental‑health districts. Gotto said that appears to be the direction.
He noted that the state tried a similar “lead entity” model during the early stages of mental‑health regionalization — and counties ultimately rejected it.
One point of clarity: current legislation still requires each county to maintain a public health presence. Gotto said that’s expected to remain in place, but he worries counties will be asked to shoulder more responsibilities without additional support.
Gotto pointed to tuberculosis treatment as an example. The state eliminated its TB funding this year, shifting all costs to counties.
Supervisors also raised concerns about liability, staffing, and whether any county would be willing to serve as the lead administrative entity. Gotto said none in the region have expressed interest.
The Iowa Department of Health and Human Services will hold a regional town hall on April 23, where Director Dr. Kelly Garcia and her deputy are expected to outline the plan. Gotto urged supervisors to attend, saying it may be the only chance counties have to ask questions before decisions are finalized.
