Impact Report 2025: Grit

When uncertainty around Medicaid funding grew in Washington, D.C. in early 2025, advocates for people with intellectual and developmental disabilities (IDD) and other diverse needs got to work, sending emails, making phone calls, and visiting their Congressional representatives. 

Robyn Agu was also busy locally, often sharing her first-hand experience with friends and acquaintances during family walks around her Altoona, Iowa neighborhood. Her goal: make sure her Congressional representatives, friends and neighbors saw the faces and heard the names of people who rely on services made possible through Medicaid

People like Deannalue Bales and Patrick “Ricky” Flatjord, whom Robyn and her husband, Abraham, care for as Mosaic at Home® Shared Living Home Providers.

The neighborhood conversations were eye-opening, Robyn said, with her neighbors often surprised to learn that people with IDD—like Deannalue and Ricky—could be impacted by funding cuts to Medicaid, leading Robyn to realize more education is needed.

“It’s really important for people to see who we’re talking about,” Robyn said, adding that once her neighbors learn that Deannalue and Ricky’s care is funded by Medicaid they are supportive.

Beyond the neighborhood, Robyn’s advocacy efforts led her to Washington, D.C. last spring with the Progress Iowa group. U.S. Rep. Zach Nunn was among the lawmakers the group addressed.

After the trip to Washington, D.C., Robyn and Deannalue visited Rep. Nunn at his Des Moines office twice before securing an in-person meeting with him and Mosaic Iowa Operations Director Brandi Bretthauer. During the meeting, Robyn shared the different levels of care Deannalue and Ricky receive and the critical need for Medicaid. They also invited him to visit their home for a firsthand look at the benefits of at-home care.

While Congress went on to approve significant cuts to federal Medicaid funding over the next decade as part of House Resolution 1, Mosaic is grateful to Robyn and other advocates who answered our call to be bold and the impact they made. 

However, the work and advocacy efforts are not over with decisions about how to make up for the loss of federal funding now falling to state officials.

For her willingness to step up and advocate, Robyn received Mosaic’s first Advocate of the Year award last fall.

“Robyn has been bold in advocating with us to protect Medicaid, and we are honored to recognize her,” said Cheryl Wicks, Mosaic’s Vice President of External Affairs. 

Robyn, a former case manager who also worked as a nurse for Mosaic in Central Iowa from 2004 to 2007, believes that Medicaid cuts will affect the entire healthcare system, including people with private insurance and already-struggling rural hospitals.

Personally, she’s concerned about disruptions in Deannalue and Ricky’s services that could affect their daily medications, doctor’s care and possibly change their living situation. With tears in her eyes, Robyn said she can’t imagine the pair thriving in a state institution setting.

“Deannalue would go rapidly downhill,” she said. “Same with Ricky. To think he would be back where people don’t know him and don’t know what he wants and likes or what he’s trying to say, is extremely upsetting.”

At 61 years old, Deannalue has experienced a range of care services since leaving her parents’ home in her early 20s. She first lived in a 15-person group home and later in an apartment with a roommate before moving back to a group home. While living in the group home, Deannalue, the youngest of five children, longed to be part of a family again. So when she heard about the Mosaic at Home program, she wanted to try it out.

Robyn and Abraham, who met as case workers 27 years ago and later worked in a group home together, and their three daughters welcomed Deannalue into their home five years ago.

“What she told me is she was happy when she lived with her family and she wanted to be where there was a mom, dad and others in the house,” Robyn said.

Ricky’s arrival nearly three-and-a-half years ago fulfilled another wish for Deannalue.

“I wanted to be part of a family of seven, just like mine,” she said.

Robyn and Deannalue agree that Ricky is “a perfect match” for the family.

Ricky also lived in a group home after spending his youth with a foster family. The Agu’s desire to care for Ricky came after Abraham retired from his job at the height of the COVID-19 pandemic to protect Deannalue from the virus.

Robyn said she’s seen positive growth in Ricky and Deannalue.

“One of Ricky’s goals is to be involved in making choices for himself,” Robyn said. “He might choose between what shirts he’s going to wear when I ask him.”

He also likes to be part of the group, which wasn’t the case when he first arrived.

Ricky and Deannalue aren’t the only ones to experience positive outcomes from the host-home setting.

“We’ve had so much growth as a family,” Robyn said. “Our daughters have more gratitude because they see the challenges Ricky and Deannalue have. It has shaped their outlook tremendously.”

Robyn isn’t letting Medicaid’s uncertain future deter her family’s path or the care they provide to Ricky and Deannalue.