A round of last-minute funding cuts to state public health programs has left administrators scrambling as they attempt to provide continued services to Iowans while grappling with the realities of dramatically reduced budgets.

In all, 10 public health programs saw their funding through the state's Department of Public Health completely eliminated going into the 2018 budget year, including one that has since closed its doors. The cuts, announced in mid-June, took effect July 1.

Among them is the Iowa Epilepsy Foundation, which lost all of the $144,097 it was scheduled to receive this year from the state's Department of Public Health — 60 percent of its total budget.

Program administrators were at once both anxious, calling it a "worst-case" scenario, and defiant, pledging to scrape together enough money to ensure the 30,000 Iowans diagnosed with epilepsy could continue receiving services.

"We’re OK, and they're going to be OK," said Tiffany Hoffmann, president of foundation's advisory board. "We’re not going anywhere. That’s the bottom line. … If (the state is) not going to fund your program, you still have to provide a program, because it's a very needed organization here in Iowa."

Following $156,482 in cuts, Iowa’s hearing aid and audiological services program has shuttered, said Brenda Dobson, a division director with the department.

Unlike many other states, Iowa does not require insurance companies to cover the costs of hearing aids for children, which can cost up to $2,500. Instead, the state has set aside funding to help families cover those costs — about $163,000 in 2016, which helped provide care to 133 kids. That program is no longer available.

The budget reductions come on the heels of an anticipated $350 million budget shortfall in 2017, with lawmakers outlining a much more cautious budget plan for 2018 that cuts back funding to nearly every area of state government.

As part of those reductions, the Department of Public Health has seen its budget scaled back by nearly 14 percent since 2016.

It absorbed $2 million worth of cuts in 2017. Lawmakers cut another $4.4 million from the department's 2018 budget while instructing department officials to use their discretion to trim $1.3 million more.

The department notified organizations of those discretionary cuts in June, eliminating funding for programs that provide dental services to children and families, hearing aids to children not covered by health insurance, and vision-loss prevention education, among others.

The 10 programs that lost all of their Department of Public Health funding include:

Dental services at the University of Iowa: $23,000

Audiological Services for Kids: $156,482

Inherited Metabolic Disorders Assistance: $153,755

Epilepsy Foundation: $144,097

Melanoma Research: $150,000

Autism Assistance Program: $384,552

University of Iowa Mental Health Workforce Initiative: $105,656

Public Health Modernization Fund Transfer: $83,315

Prevent Blindness Iowa: $96,138

Iowa Primary Care Trust Fund Transfer: $52,911

Many of those programs receive funding from other sources in addition to the state. However, many also will lose out on matching dollars from federal programs as a result of state cuts.

"This reduction will be particularly difficult for us and our local and state partners who provide critical services protecting the health of Iowans," department director Gerd Clabaugh wrote in a memo to Gov. Kim Reynolds dated June 13.

He wrote that the department has emphasized its investments on "the issues Iowans struggle most with," including obesity, tobacco use and substance abuse.

Reynolds spokeswoman Brenna Smith said in an email that Iowa still "provides social services like health care, housing support and job training to vulnerable Iowans through Medicaid, (Temporary Assistance for Needy Families) and other programs."

Program leaders, caught off guard by the last-minute changes to their budgets, say they're still grappling with the consequences of the cuts.

"It is still a transition," said Peggy Swails, program manager for the Regional Autism Assistance Program, which provides support to families of children diagnosed with autism. The Department of Public Health eliminated the $384,552 it was scheduled to provide to the group, representing about 70 percent of organization's budget.

"Just trying to be able to keep our momentum is going to be hard," Swails said. "Because I’ve had to reduce some staff. They weren’t direct clinical care, but they helped administer and coordinate all our activities that went on out in our regional centers to support our family navigators."

A spokesman for the University of Iowa, which administers several of the programs that saw funding cut, said administrators are evaluating cuts from the Department of Public Health and elsewhere and are still making decisions about how to proceed.

"We're looking at the big picture to try to figure out what will be the next steps," said Tom Moore, a spokesman for University of Iowa Health Care. "We don't have the details yet."

Hoffmann said Epilepsy Foundation leaders have spent the last three weeks rallying from the bad news and brainstorming ways to ensure services continue to the people they serve. The cuts, she said, will force a dramatic shift in the way the three-person organization operates, with a renewed focus on boosting volunteer and fundraising efforts so that it can continue offering services.

“We can continue to provide programs and services for people," Hoffmann said. "It’s just going to take a different type of organization from us right now.”