HF 3 (LSB 1340YH (11) 90)

HOUSE FILE 3

BY  GRASSLEY, HOLT, GOLDING, WHEELER, STONE, DUNWELL, MOMMSEN, COLLINS, GUSTOFF, FISHER, MOORE, JENEARY, CARLSON, VONDRAN, STOLTENBERG, WULF, SHIPLEY, BRADLEY, SHERMAN, DEYOE, GRABER, WILLS, RINKER, P. THOMPSON, JOHNSON, HARRIS, BODEN, NORDMAN, SORENSEN, GEHLBACH, KAUFMANN, OSMUNDSON, THOMSON, M. THOMPSON, WOOD, HORA, WINDSCHITL, BOSSMAN, and GERHOLD

A BILL FOR

An Act relating to public assistance program integrity, making appropriations, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
AUTHENTICATION SYSTEM FOR PUBLIC ASSISTANCE PROGRAMS

    Section 1.  NEW SECTION.  239.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Applicant” means an individual who is applying for public assistance benefits in the state.
   2.  “Asset” or “asset test” means all assets of the members of the applicant’s household, including all of the following:
   a.  All bank accounts, excluding retirement accounts of members of the household.
   b.  All cash, excluding the first two thousand dollars of members of the household.
   c.  All lottery and gambling income of the household whether received as a lump sum or installment payments.
   d.  All real estate, excluding the primary household residence and surrounding lot.
   e.  All other personal property excluding personal belongings, household goods, and one vehicle.
   3.  “Department” means the department of health and human services.
   4.  “Public assistance” means the supplemental nutrition assistance program or SNAP, the medical assistance program or Medicaid program as defined in section 249A.2, the family investment program as defined in section 239B.1, and the children’s health insurance program.
   5.  “Real-time eligibility system” means real-time electronic access to a system that allows verification of all applicable public assistance program eligibility information based on the most recent information available to the department through nonmodeled earned and unearned income, such as commercially available wage data.
   6.  “Recipient” means an individual who is receiving public assistance benefits in the state.
   7.  “Supplemental nutrition assistance program” or “SNAP” means benefits provided by the federal program administered through 7 C.F.R. pts. 270 – 283, as amended.
    Sec. 2.  NEW SECTION.  239.2  Identity authentication —— rules.
   Unless otherwise prohibited by federal law or regulation, prior to the department awarding public assistance benefits, an applicant shall complete a computerized identity authentication process to confirm the identity of the applicant. Identity authentication shall be accomplished through a knowledge-based questionnaire consisting of financial and personal questions. The questionnaire shall contain questions tailored to assist persons without a bank account or those who have poor access to financial and banking services or who do not have an established credit history. The computerized identity authentication process and questionnaire may be completed and submitted online, in person, or via telephone by the applicant or a person authorized by the applicant. The department may adopt rules pursuant to chapter 17A to administer this section.
    Sec. 3.  NEW SECTION.  239.3  Asset test for supplemental nutrition assistance program.
   1.  For the purposes of determining eligibility for receipt of SNAP benefits, the department shall conduct an asset test on all members of the applicant’s household. The allowable financial resources to be included in or excluded from a determination of eligibility for SNAP shall be those specified in 7 U.S.C. §2014(g)(1).
   2.  Prior to determining eligibility for SNAP benefits, the department shall access, at a minimum, for every member of the applicant’s household, the following information from the following federal, state, and miscellaneous sources, or successor sources:
   a.  Federal sources and information:
   (1)  Earned and unearned income information maintained by the internal revenue service.
   (2)  The following sources and information maintained by the United States social security administration:
   (a)  Earned income information.
   (b)  Death register information.
   (c)  Prisoner or incarceration status information.
   (d)  Supplemental security income information maintained in the state data exchange database.
   (e)  Beneficiary records and earnings information maintained in the beneficiary and earnings data exchange database.
   (f)  Earnings and pension information maintained in the beneficiary earnings exchange record system database.
   (3)  The following sources and information maintained by the United States department of health and human services:
   (a)  Income and employment information maintained in the national directory of new hires database by the office of child support enforcement of the administration for children and families.
   (b)  Other federal data sources maintained by the office of child support enforcement of the administration for children and families.
   b.  State sources and information:
   (1)  The department’s sources and information including but not limited to all of the following:
   (a)  Income and employment information maintained by the child support recovery unit.
   (b)  Child care assistance information maintained by the department.
   (c)  Enrollment status in other public assistance programs.
   (2)  The department of workforce development sources and information including all of the following:
   (a)  Employment information.
   (b)  Employer weekly, monthly, and quarterly reports of income and unemployment insurance payments.
   (3)  The Iowa public employees’ retirement system for earnings and pension information.
   c.  Miscellaneous sources:
   (1)  Any existing real-time database of persons currently receiving benefits in other states, such as the national accuracy clearinghouse.
   (2)  Any databases maintained by the Iowa lottery commission.
   (3)  Any existing real-time eligibility system that includes employment and income information maintained by a consumer reporting agency, as defined by the federal Fair Credit Reporting Act, 15 U.S.C. §1681a, for the purpose of obtaining real-time employment and income information.
   3.  Prior to determining eligibility for SNAP benefits, the department shall access information for every member of the applicant’s household from the following public records:
   a.  A nationwide public records data source of physical asset ownership. The data source may include but is not limited to real property, automobiles, watercraft, aircraft, and luxury vehicles, or any other vehicle owned by the applicant.
   b.  National and state financial institutions in order to locate undisclosed depository accounts or verify account balances of disclosed accounts.
   4.  The department shall enter into a memorandum of understanding with any department, division, bureau, section, unit, or any other subunit of a department to obtain the information specified in this section.
   5.  The provisions of this section shall not apply if every member of the applicant’s household receives supplemental security income.
    Sec. 4.  PROGRAM REPORT.  The department of health and human services shall submit a report to the governor and the general assembly by January 15, 2025, and by January 15 annually thereafter through January 15, 2030, detailing the impact of the identity authentication measures taken under this division of this Act.
DIVISION II
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM AND MEDICAID PROGRAM INTEGRITY AND COOPERATION

    Sec. 5.  Section 234.1, subsection 3, Code 2023, is amended by striking the subsection.
    Sec. 6.  Section 234.1, Code 2023, is amended by adding the following new subsections:
   NEW SUBSECTION.  3A.  “Department” means the department of health and human services.
   NEW SUBSECTION.  5A.  “Supplemental nutrition assistance program” or “SNAP” means the same as defined in section 239.1.
    Sec. 7.  Section 234.12A, Code 2023, is amended to read as follows:
   234.12A  Electronic benefits transfer program.
   1.  The department of human services shall maintain an electronic benefits transfer program utilizing electronic funds transfer systems for the food supplemental nutrition assistance program. The electronic benefits transfer program implemented under this section shall not require a retailer to make cash disbursements or to provide, purchase, or upgrade electronic funds transfer system equipment as a condition of participation in the program.
   2.  A point-of-sale terminal which is used only for purchases from a retailer by electronic benefits transfer utilizing electronic funds transfer systems is not a satellite terminal as defined in section 527.2.
   3.  For the purposes of this section, “retailer” means a business authorized by the United States department of agriculture to accept food supplemental nutrition assistance program benefits.
    Sec. 8.  NEW SECTION.  234.12B  Ensuring integrity in the supplemental nutrition assistance program —— rules.
   1.  State records —— individuals.  The department shall receive and review all of the following information concerning individuals enrolled in the supplemental nutrition assistance program that indicates a change in circumstances that may affect eligibility:
   a.  Death records.  On at least a monthly basis, information from the department including but not limited to death records.
   b.  Employment information.  On at least a quarterly basis, information from the department of workforce development including but not limited to changes in employment or wages.
   c.  Residency information.  On at least a monthly basis, information including but not limited to potential changes in residency as identified by out-of-state electronic benefit transfer transactions.
   d.  Incarceration information.  On at least a monthly basis, information from the department of corrections.
   2.  State records —— households.  The department shall receive and review all of the following information concerning individuals in households enrolled in the supplemental nutrition assistance program that indicates a change in circumstances that may affect eligibility:
   a.  Tax information.  On at least a quarterly basis, information from the department of revenue including but not limited to potential changes in income, wages, or residency as identified by tax records.
   b.  Unemployment information.  On at least a semi-monthly basis, information from the department of workforce development including but not limited to potential changes in employment, income, or assets.
   3.  Federal records —— households.  The department shall cross-check information relating to individuals in households enrolled in the supplemental nutrition assistance program with federal databases including but not limited to all of the following, on at least a monthly basis:
   a.  Earned income information, death register information, incarceration records, supplemental security income information, beneficiary records, earnings information, and pension information maintained by the United States social security administration.
   b.  Income and employment information maintained in the national directory of new hires database and child support enforcement data maintained by the United States department of health and human services.
   c.  Payment and earnings information maintained by the United States department of housing and urban development.
   d.  National fleeing felon information maintained by the United States federal bureau of investigation.
   4.  Rules.  The department may adopt rules pursuant to chapter 17A to administer this section.
    Sec. 9.  NEW SECTION.  234.12C  Cooperation with child support enforcement.
   An applicant for supplemental nutrition assistance program benefits shall be required to cooperate with the child support recovery unit as a condition of eligibility as specified in 7 C.F.R. §273.11(o).
    Sec. 10.  NEW SECTION.  234.12D  Required employment and training for supplemental nutrition assistance program eligibility.
   The department shall not exercise the state option to provide any exemptions from the employment and training requirements as specified in 7 U.S.C. §2015(o)(6)(E).
    Sec. 11.  NEW SECTION.  249A.58  Ensuring integrity in the medical assistance program —— recipient and applicant information reviewed —— rules.
   1.  State records —— recipients.  The department shall receive and review all of the following information concerning recipients that indicates a change in circumstances that may affect eligibility:
   a.  Death records.  On at least a monthly basis, information from the department including but not limited to death records.
   b.  Employment information.  On at least a quarterly basis, information from the department of workforce development including but not limited to changes in employment or wages.
   c.  Residency information.  On at least a monthly basis, information including but not limited to potential changes in residency as identified by out-of-state electronic benefit transfer transactions.
   d.  Tax records.  On at least a quarterly basis, information from the department of revenue including but not limited to potential changes in income, wages, or residency as identified by tax records.
   e.  Unemployment information.  On at least a semi-monthly basis, information from the department of workforce development including but not limited to potential changes in employment, income, or assets.
   2.  Federal records —— recipients.  The department shall cross-check information relating to recipients with federal databases including but not limited to all of the following, on at least a monthly basis:
   a.  Earned income information, death register information, incarceration records, supplemental security income information, beneficiary records, earnings information, and pension information maintained by the United States social security administration.
   b.  Income and employment information maintained by the national directory of new hires database and child support enforcement data maintained by the United States department of health and human services.
   c.  Payment and earnings information maintained by the United States department of housing and urban development.
   d.  National fleeing felon information maintained by the United States federal bureau of investigation.
   3.  Real-time record review —— applicants.  Prior to determining the eligibility of an applicant for Medicaid, the department shall access information for every member of the applicant’s household from the data sources specified in this section and shall conduct a review of nationwide public records data sources of physical asset ownership. The nationwide public records data sources may include but are not limited to records of real property and automobiles, watercraft, aircraft, luxury vehicles, and any other vehicles owned by the applicant.
   4.  Residency information —— applicants.  Prior to determining the eligibility of an applicant for Medicaid, the department shall require proof of residency from the applicant.
   5.  Rules.  The department may adopt rules pursuant to chapter 17A to administer this section.
    Sec. 12.  MEDICAID PROGRAM WAIVER FROM USE OF AUTOMATIC RENEWAL AND PREPOPULATED FORMS.  The department of health and human services shall request a Medicaid section 1115 demonstration waiver from the centers for Medicare and Medicaid services of the United States department of health and human services to enable the department to suspend the requirements to use prepopulated eligibility renewal forms and to renew eligibility automatically based on available information.
DIVISION III
IOWA HEALTH AND WELLNESS PLAN —— REENROLLMENT

    Sec. 13.  IOWA HEALTH AND WELLNESS PLAN —— MEMBER REENROLLMENT FOLLOWING TERMINATION FOR NONPAYMENT OF MONTHLY CONTRIBUTIONS.  The department of health and human services shall seek approval of an amendment to the section 1115 demonstration waiver for the Iowa health and wellness plan from the centers for Medicare and Medicaid services of the United States department of health and human services to provide the following:
   1.  An Iowa health and wellness plan member who is not otherwise exempt from payment of a monthly contribution, who is subject to payment of a monthly contribution as the result of failure to complete required healthy behaviors, and whose eligibility for the program is terminated due to nonpayment of monthly contributions, shall be allowed to subsequently reenroll in the program without first paying any outstanding monthly contributions, if the member has not been terminated from the program previously for nonpayment of monthly contributions. 
   2.  Following an initial termination from the Iowa health and wellness plan pursuant to subsection 1, if an Iowa health and wellness plan member is subsequently terminated from the program pursuant to subsection 1 for nonpayment of monthly contributions, the member shall be subject to payment of any outstanding monthly contributions accrued since the subsequent termination not to exceed the aggregate annual copayment and monthly contribution limits prior to reenrollment in the program.
   3.  This section shall not apply to an Iowa health and wellness plan member who is deemed to be in substantial compliance with the healthy behaviors requirement to complete a wellness examination by providing proof of a scheduled wellness examination appointment, if the appointment is scheduled no later than ninety days beyond the end of the applicable enrollment period.
DIVISION IV
MEDICAID DEMONSTRATION WAIVER REQUEST —— IOWA HEALTH AND WELLNESS PLAN

    Sec. 14.  MEDICAID DEMONSTRATION WAIVER REQUEST —— COMMUNITY ENGAGEMENT REQUIREMENTS FOR IOWA HEALTH AND WELLNESS PLAN MEMBERS.
   1.  The department of health and human services shall submit a request by July 1, 2023, and annually by July 1 thereafter until federal approval is received from the centers for Medicare and Medicaid services of the United States department of health and human services, for a section 1115 demonstration waiver to require that as a condition of eligibility, Iowa health and wellness plan members participate in community engagement activities.
   2.  The waiver request submitted by the department shall require that, unless an individual is exempt pursuant to subsection 3, as a condition of eligibility for the Iowa health and wellness plan, a recipient shall do one of the following:
   a.  Work twenty hours or more per week, averaged on a monthly basis.
   b.  Participate in and comply with the requirements of a work program for twenty hours or more per week, as determined by the department.
   c.  Volunteer twenty hours or more per week, as determined by the department.
   d.  Meet a combination of work and work program participation requirements for a total of twenty hours or more per week, as determined by the department.
   e.  Participate in and comply with the PROMISE JOBS program pursuant to chapter 239B.
   3.  The following individuals shall be exempt from the requirements specified in subsection 2:
   a.  An individual medically certified as physically or mentally unfit for employment.
   b.  A woman who is pregnant.
   c.  A parent or caretaker responsible for the care of a dependent child under one year of age.
   d.  A parent or caretaker personally providing the care for a dependent child with a serious medical condition or disability, as determined by the department.
   e.  An individual receiving unemployment compensation and complying with work requirements of the federal or state unemployment compensation system.
   f.  An individual participating in a substance use disorder treatment and rehabilitation program.
   4.  The department shall implement the Medicaid waiver upon receipt of federal approval and shall adopt rules pursuant to chapter 17A to administer the waiver provisions.
DIVISION V
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— ELIGIBLE FOODS

    Sec. 15.  SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— ELIGIBLE FOODS.
   1.  The department of health and human services shall request a waiver from the food and nutrition service of the United States department of agriculture to provide that, for the purposes of state administration of the supplemental nutrition assistance program, eligible foods as defined in 7 C.F.R. §271.2 include only those items defined as supplemental foods in 7 C.F.R. §246.2 as specified in the most current Iowa special supplemental nutrition program for women, infants, and children approved foods list.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver.
    Sec. 16.  DEPARTMENT OF AGRICULTURE AND LAND STEWARDSHIP —— DOUBLE UP FOOD BUCKS PROGRAM —— SUPPLEMENTAL APPROPRIATION.  There is appropriated from the general fund of the state to the department of agriculture and land stewardship for the fiscal year beginning July 1, 2023, and ending June 30, 2024, in addition to any other funding appropriated for such purpose for the same fiscal year, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   To provide grants to support the double up food bucks program administered by the Iowa healthiest state initiative to make fresh fruits and vegetables sold at farmers markets, grocery stores, and other participating locations accessible to individuals and families who reside in this state and receive assistance through the federal supplemental nutrition assistance program:
   ...................................................................... $  1,000,000

   A grant recipient that receives funding pursuant to this section shall provide at least a dollar-for-dollar match of the grant assistance.
   Notwithstanding section 8.33, moneys appropriated under this section shall not revert at the close of the fiscal year, but shall remain available for the purposes designated.
    Sec. 17.  CONTINGENT EFFECTIVE DATE.  The following takes effect on the date the department of health and human services receives federal approval of the waiver request relating to supplemental nutrition assistance program eligible foods as specified under this division of this Act, if the waiver is approved:
   The section of this division of this Act making a supplemental appropriation to the department of agriculture and land stewardship to provide grants to support the double up food bucks program.
DIVISION VI
IMPLEMENTATION PROVISIONS

    Sec. 18.  IMPLEMENTATION PROVISIONS.
   1.  The department of health and human services shall request federal approval including for any state plan amendment or waiver necessary to administer this Act.
   2.  If the department of health and human services determines that any provision of this Act would result in the denial of funds or services from the federal government that would otherwise be available or would be inconsistent with the requirements of federal law or regulation, such provision shall be suspended, but only to the extent necessary to eliminate the inconsistency with federal requirements.
   3.  Unless otherwise provided in a division of this Act, the department of health and human services shall implement the provisions of this Act in an incremental fashion, beginning July 1, 2023, with a goal of full implementation no later than June 30, 2025, to minimize duplication of efforts and to maximize coordination with the implementation time frames of other departmental resource enhancements.
   4.  The provisions of this Act requiring federal approval shall be implemented upon receipt of federal approval.
   5.  The provisions of this Act not requiring federal approval shall be implemented as specified in this Act, or if not specified in this Act, no later than June 30, 2025.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to various public assistance programs. 
   DIVISION I. This division requires that prior to the department of health and human services (HHS) awarding public assistance benefits to an applicant, the applicant shall complete a computerized identity authentication process to confirm the identity of the applicant through the use of a knowledge-based questionnaire consisting of financial and personal questions tailored to assist persons without a bank account or those who have poor access to financial and banking services or who do not have an established credit history. The identity authentication process and questionnaire may be submitted online, in person, or via telephone by the applicant or a person authorized by the applicant. The bill also requires HHS to conduct an asset test on all members of the household of an applicant for supplemental nutrition assistance program (SNAP) benefits. The bill specifies the minimum information, federal, state, and other data sources, and public records that HHS must access prior to determining eligibility for an applicant’s SNAP benefits. The bill requires HHS to enter into a memorandum of understanding with any department or subunit of a department to obtain the information specified. The bill’s provisions do not apply if every member of the applicant’s household receives supplemental security income. The bill authorizes HHS to adopt administrative rules to administer the bill and requires HHS to submit an annual report to the governor and the general assembly to assess the impact of the bill.
   DIVISION II. This division relates to SNAP and Medicaid program integrity by requiring HHS to, within specified time frames, receive and review state and federal information from various entities concerning individuals or individuals in households enrolled in the SNAP or the Medicaid program that indicates a change in circumstances that may affect eligibility. The information relates to death, employment, residency, incarceration, tax, and unemployment information and involves the provision of such information to HHS by the departments of workforce development, corrections, and revenue, and information identified by out-of-state electronic benefit transfer transactions. Additionally, the bill requires HHS to, on at least a monthly basis, cross-check information relating to individuals in households enrolled in SNAP or the Medicaid program, as applicable, with specified federal databases maintained by the United States social security administration, the United States department of health and human services, the United States department of housing and urban development, and the United States federal bureau of investigation. With regard to the Medicaid program only, the bill also requires that prior to determining eligibility for the Medicaid program, HHS shall access information for every member of an applicant’s household from the data sources outlined in the bill and conduct a review of nationwide public records data sources of physical asset ownership. The data sources may include but are not limited to records of real property and automobiles, watercraft, aircraft, luxury vehicles, and any other vehicles owned by the applicant. An applicant for Medicaid must also provide proof of residency. The bill also requires an applicant for SNAP benefits to cooperate with the child support recovery unit as a condition of eligibility as specified under federal law.
   The bill also directs HHS to request federal approval for a Medicaid section 1115 demonstration waiver to suspend requirements to use prepopulated eligibility renewal forms and to renew eligibility automatically based on available information.
   DIVISION III. This division requires HHS to seek federal approval of an amendment to the section 1115 demonstration waiver for the Iowa health and wellness plan to provide both of the following: (1) that an Iowa health and wellness plan member who is not otherwise exempt from payment of a monthly contribution, who is subject to payment of a monthly contribution as the result of failure to complete required healthy behaviors, and whose eligibility for the program is terminated due to nonpayment of monthly contributions shall be allowed to subsequently reenroll in the program without first paying any outstanding monthly contributions, if the member has not been terminated from the program previously for nonpayment of monthly contributions, and (2) following an initial termination from the Iowa health and wellness plan, if an Iowa health and wellness plan member is subsequently terminated from the program for nonpayment of monthly contributions, the member shall be subject to payment of any outstanding monthly contributions accrued since the subsequent termination and not to exceed program limits prior to reenrollment in the program. The bill does not apply to an Iowa health and wellness plan member who is deemed to be in substantial compliance with the requirement to complete a wellness examination by providing proof of a scheduled examination appointment if the appointment is scheduled no later than 90 days beyond the end of the applicable enrollment period.
   DIVISION IV. This division requires HHS to submit a request for federal approval by July 1, 2023, and annually by July 1, thereafter until federal approval is received, for a waiver to require that as a condition of eligibility, Iowa health and wellness plan members participate in community engagement activities. The bill specifies the types of community engagement activities to be required under the waiver submitted and provides exceptions to required participation in community engagement activities. The bill directs HHS to implement the waiver upon receipt of federal approval and to adopt administrative rules to administer the waiver provisions.
   DIVISION V. This division requires HHS to request a waiver from the United States department of agriculture, food and nutrition service, to provide that the eligible foods under the state administration of SNAP only include those items defined as supplemental foods in the most current Iowa special supplemental nutrition program for women, infants, and children (WIC) approved food list. The department is directed to implement the waiver upon receipt of approval of the waiver.
   The division also relates to the double up food bucks program by making a supplemental appropriation from the general fund of the state to the department of agriculture and land stewardship for fiscal year 2023-2024, in addition to any other funding appropriated for such purpose for the same fiscal year, to provide grants to support the double up food bucks program administered by the Iowa healthiest state initiative to make fresh fruits and vegetables sold at farmers markets, grocery stores, and other participating locations accessible to individuals and families who reside in this state and receive assistance through SNAP. The division requires a double up food bucks program grant recipient to provide at least a dollar-for-dollar match of the grant assistance. Moneys appropriated under the division do not revert at the close of the fiscal year but remain available for the purposes of the double up food bucks program.
   The supplemental appropriation for the double up food bucks program takes effect on the date HHS receives federal approval of the SNAP waiver, if the waiver is approved.
   DIVISION VI. This division provides implementation provisions for the bill. The bill requires HHS to request federal approval including for any state plan amendment or waiver necessary to administer the bill. If HHS determines that any provision of the bill would result in the denial of funds or services from the federal government that would otherwise be available or would be inconsistent with the requirements of federal law or regulation, such provision shall be suspended, but only to the extent necessary to eliminate the inconsistency with federal requirements. Unless otherwise provided in a division of the bill, HHS shall implement the provisions of the bill in an incremental fashion, beginning July 1, 2023, with a goal of full implementation no later than June 30, 2025, to minimize duplication of efforts and to maximize coordination with the implementation time frames of other departmental resource enhancements. The provisions of the bill requiring federal approval shall be implemented upon receipt of federal approval. The provisions of the bill not requiring federal approval shall be implemented as specified in the bill, and if it not specified in the bill, then not later than June 30, 2025.