Black Hawk County health officials warn local services will be cut after state contract termination

Kaitlyn, a public-health department representative, told the Black Hawk County Board of Supervisors on March 24 that the Iowa Department of Health and Human Services has terminated a contract with Nira Pharmacy that had included reimbursements the department reinvested in local public-health programs. "What's been reported in the news involves a lack of a reimbursement to Iowa HHS from Nira in the ballpark of $22 million," Kaitlyn said.

The $22 million, Kaitlyn said, had been used to support sexually transmitted infection prevention, HIV treatment, immunizations and tuberculosis programs at the state level and in county subcontracts. She said the termination is already causing immediate prioritization of scarce resources: remaining 340B medication supplies are being directed to high-risk populations and people without other coverage, while lower-risk populations may be asked to obtain medications and management through their own insurance. "They're prioritizing certain populations that they're asking us to use 340 meds that we have on hand," she said.

Why this matters: county staff and supervisors said the shift will move financial responsibility from the state to the county and could reduce locally available services. Kaitlyn described operational effects: incentive funding for directly observed therapy (DOT) for active tuberculosis case management has been removed even though the practice is expected to continue, and the county was notified that its contract for disease-intervention specialists and partner services for STIs — a roughly $50,000 contract for FY27 — is expected to be terminated as of April 15.

Kaitlyn explained what intensive TB case management entails: contact investigations to find exposed people and provide prophylactic medication, regular testing to detect conversion to latent disease, and follow-up to ensure completion of long treatment courses (sometimes six to nine months or longer). "Sometimes it's through video DOT... and sometimes it's an in-person visit," she said, describing efforts the county uses to make sure treatments are completed.

Supervisors asked how the county compares to others on STD rates and what a loss of state support might mean financially. Kaitlyn said she did not have comparative rates on hand and offered to return with specifics, and she emphasized that staff are coordinating with Iowa HHS, which is reported to be seeking an emergency contract with another pharmacy to restore medication distribution. "They are working on an emergency contract with another pharmacy... so it isn't until July or August it's restored," she said.

County next steps: staff said they are working daily on contingency plans to continue serving residents, will provide updates as the state finalizes any emergency contracting, and will return to the board with further details on potential local cost impacts and service changes.

The board did not take formal action on the update; staff said they will report back in a couple of weeks as the state provides more information.