H-8384

   Amend Senate File 2422, as amended, passed, and reprinted by the Senate, as follows:
   1.  By striking everything after the enacting clause and inserting: 
<DIVISION I
PUBLIC ASSISTANCE PROGRAMS —— ELIGIBILITY

   Section 1.  NEW SECTION.  234.6A  Program eligibility —— residency.
   1.  As used in this section, “public assistance program” means any of the following:
   a.  The state child care assistance program under section 237A.13.
   b.  The family investment program under chapter 239B.
   c.  The medical assistance program under chapter 249A.
   d.  The supplemental nutrition assistance program administered by the state pursuant to 7 C.F.R. pts. 270 – 283, as amended.
   e.  The special supplemental nutrition program for women, infants, and children as provided in 42 U.S.C. §1786 et seq.
   2.  a.  Unless prohibited under federal law, the department may require from an applicant to a public assistance program proof of at least twelve months of continuous residency within the state including any of the following:
   (1)  A statement from the applicant attesting to the applicant’s reasons for being in the state and length of residency within the state.
   (2)  A statement from the applicant’s employer confirming the applicant’s employment in the state.
   (3)  Any other statement from other persons with knowledge who can attest to the applicant’s reasons for being in the state and length of residency within the state.
   (4)  A copy of the applicant’s most recently filed Iowa state income tax return.
   b.  Paragraph “a” shall not apply to applicants who receive benefits under the federal Social Security Act, 42 U.S.C. §423 et seq.
   Sec. 2.  Section 239.6, subsection 1, paragraph a, subparagraph (4), Code 2026, is amended to read as follows:
   (4)  Information maintained by the United States citizenship and immigration services of the United States department of homeland security, including but not limited to information accessible through the systematic alien verification for entitlements online service.
   Sec. 3.  Section 239.6, subsection 2, Code 2026, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  g.  The systematic alien verification for entitlements online service maintained by the United States citizenship and immigration services of the United States department of homeland security or other accessible sources to verify immigration and United States citizenship information.
DIVISION II
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— ELIGIBILITY

   Sec. 4.  Section 239.1, Code 2026, is amended by adding the following new subsection:
   NEW SUBSECTION.  01.  “Alien” means any person not a citizen or national of the United States.
   Sec. 5.  Section 239.2, Code 2026, is amended to read as follows:
   239.2  Supplemental nutrition assistance program —— income eligibility.
   1.  a.  The department shall establish the gross countable monthly income threshold for the supplemental nutrition assistance program at less than or equal to one hundred sixty percent of the federal poverty level for the household size.
   b.  (1)  The department shall consider the income and financial resources of all household members in determining the eligibility and benefit allotment of the household, including all household members determined to be ineligible to participate in SNAP under this section or pursuant to 7 U.S.C. §2015(f). Notwithstanding 7 C.F.R. §273.11(c)(3), the individual’s income, deductible expenses, and resources shall be counted, and none shall be prorated.
   (2)  (a)  Notwithstanding subparagraph (1), the department shall exclude the earned income of household members who are between the ages of eighteen and twenty-two in determining the eligibility and benefit allotment of the household upon approval of the waiver submitted by the department under 2026 Iowa Acts, Senate File 2422, or successor legislation to provide that for purposes of state administration of SNAP, the earned income under 7 C.F.R. §273.9(c)(7) of household members that meet all the following criteria shall be excluded from household income:
   (i)  Less than twenty-two years of age.
   (ii)  Enrolled in an elementary or secondary school.
   (iii)  Resides with a natural parent, adoptive parent, stepparent, or other household member who exercises parental control over the household member described in subparagraph subdivisions (i) and (ii).
   (b)  The director of health and human services shall notify the Iowa Code editor upon approval of the waiver under subparagraph division (a).
   c.  Pursuant to 7 U.S.C. §2015(f), an individual shall be ineligible to participate in SNAP unless the individual is a resident of the United States and meets at least one of the following criteria:
   (1)  The individual is a citizen or national of the United States.
   (2)  The individual is an alien lawfully admitted for permanent residence as an immigrant, as defined in 8 U.S.C. §1101(a)(15) and 1101(a)(20), excluding alien visitors, tourists, diplomats, students, or other individuals admitted temporarily with no intention of abandoning their residence in a foreign country.
   (3)  The individual is an alien who has been granted the status of Cuban and Haitian entrant, as defined in section 501(e) of the federal Refugee Education Assistance Act of 1980, Pub. L. No. 96-422.
   (4)  The individual lawfully resides in the United States in accordance with a compact of free association referred to in 8 U.S.C. §1612(b)(2)(G).
   2.  The department shall comply with federal reporting requirements relating to a household member who is determined to be ineligible to participate in SNAP pursuant to 7 C.F.R. §273.4(b).
DIVISION III
MEDICAID AND IOWA HEALTH AND WELLNESS PLAN —— RETROACTIVE ELIGIBILITY

   Sec. 6.  NEW SECTION.  249A.3B  Medicaid —— retroactive eligibility.
   1.  Notwithstanding any provision of state law to the contrary, effective January 1, 2027, in compliance with section 71112 of Pub. L. No. 119-21, commonly referred to as the One Big Beautiful Bill Act, the department shall adopt rules to provide that the eligibility of a individual who is a pregnant woman, a child, or a resident of a nursing facility licensed under chapter 135C shall be applied retroactively for no more than two months prior to the month in which the individual submits a completed medical assistance program application.
   2.  The department shall not adopt rules, or submit a request for a waiver or state plan amendment to the centers for Medicare and Medicaid services of the United States department of health and human services, to permit the department to provide medical assistance program eligibility retroactively to any other adult individual except as provided in subsection 1.
   Sec. 7.  Section 249N.4, subsection 5, Code 2026, is amended to read as follows:
   5.  A member is eligible for coverage effective the first day of the month following the month of application for enrollment.  The department shall not adopt rules or submit a request for a waiver or state plan amendment to the centers for Medicare and Medicaid services of the United States department of health and human services to permit the department to provide program eligibility prior to the month in which the individual submits a completed application for enrollment.
   Sec. 8.  2017 Iowa Acts, chapter 174, section 12, subsection 15, paragraph a, subparagraph (7), as amended by 2018 Iowa Acts, chapter 1165, section 107, is amended by striking the subparagraph.
   Sec. 9.  MEDICAID RETROACTIVE ELIGIBILITY —— WAIVER.  The department of health and human services shall submit a request for a section 1115 demonstration waiver to the centers for Medicare and Medicaid services of the United States department of health and human services for approval to allow, for purposes of state administration of Medicaid, for implementation by the department of no retroactive eligibility for any adult individual who is not a pregnant woman, a child, or a resident of a nursing facility licensed under chapter 135C, upon the submission of a completed Medicaid application, instead of three months as required under 42 C.F.R. §435.915. The department shall implement the waiver upon receipt of approval of the waiver by the centers for Medicare and Medicaid services of the United States department of health and human services.
DIVISION IV
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— ERROR RATE REPORT AND WAIVERS

   Sec. 10.  NEW SECTION.  135.16E  Supplemental nutrition assistance program error rate —— report.
   Beginning with the fiscal quarter that starts on October 1, 2026, and every fiscal quarter thereafter, within thirty calendar days of transmission of data to the food and nutrition services of the United States department of agriculture, the department shall submit a report to the general assembly detailing payment error rates associated with the supplemental nutrition assistance program for the immediately preceding fiscal quarter. For the purposes of this section, “supplemental nutrition assistance program” has the same meaning as defined in section 239.1.
   Sec. 11.  FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF EARNED INCOME RULES.
   1.  The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition assistance program, the earned income under 7 C.F.R. §273.9(c)(7) of household members that meet all of the following criteria shall be excluded from household income:
   a.  Less than twenty-two years of age.
   b.  Enrolled in an elementary or secondary school.
   c.  Resides with a natural parent, adoptive parent, stepparent, or other household member who exercises parental control over the household member described in paragraphs “a” and “b”.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver from the United States department of agriculture.
   Sec. 12.  FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF ELIGIBILITY VERIFICATION RULES.
   1.  The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition assistance program, information from the following automated sources be considered verified upon receipt for purposes 
of 7 C.F.R. §272.12(c):
   a.  The national directory of new hires maintained by the office of child support services of the United States office for the administration of children and families.
   b.  The unemployment insurance benefits data released by the Iowa department of workforce development.
   c.  The United States social security administration benefits, death, social security number, and citizenship records.
   d.  The residency and identity data released by the United States department of transportation.
   e.  The state incarceration data released by the Iowa department of corrections.
   f.  The automated employment verification service known as work number, or equivalent third-party income verification platforms.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver from the United States department of agriculture.
   Sec. 13.  FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF EXPUNGEMENT RULES.
   1.  The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition assistance program, expungement of benefits on a household’s electronic benefit account under 7 C.F.R. §274.2(i) be permitted after three months or ninety-one days of inactivity, or of benefits remaining, on the electronic benefit account.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver from the United States department of agriculture.
   Sec. 14.  FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF PAYMENT QUALITY CONTROL SAMPLING PROCEDURES.
   1.  The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition assistance program, when reporting the state’s payment error rate as outlined by 7 C.F.R. §275.14, and food and nutrition services handbooks 310 and 311, the department of health and human services be permitted to report the payment error rate based only on errors directly attributable to the department.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver from the United States department of agriculture.
DIVISION V
MEDICAID —— EMPLOYED PERSONS WITH DISABILITIES AND EXCEPTIONS TO POLICY REVIEW

   Sec. 15.  Section 249A.3, subsection 2, paragraph a, subparagraph (1), Code 2026, is amended to read as follows:
   (1)  (a)  As allowed under 42 U.S.C. §1396a(a)(10)(A)(ii)(XIII), individuals with disabilities, who are less than sixty-five years of age, who are members of families whose income is less than two hundred fifty three hundred percent of the most recently revised official poverty guidelines published by the United States department of health and human services for the family, who have earned income and who are eligible for mandatory medical assistance or optional medical assistance under this section if earnings are disregarded. 
   (b)  As allowed by 42 U.S.C. §1396a(r)(2), unearned income shall also be disregarded in determining whether an individual is eligible for assistance under this subparagraph.
   (c)  For the purposes of determining the amount of an individual’s resources under this subparagraph and as allowed by 42 U.S.C. §1396a(r)(2), a maximum of ten thousand dollars of available resources for an individual, and twenty-one thousand dollars of available resources for a couple shall be disregarded, and any additional resources held in a retirement account, in a medical savings account, or in any other account approved under rules adopted by the department shall also be disregarded.
   (b)  (d)  Individuals eligible for assistance under this subparagraph, whose individual income exceeds one hundred fifty percent of the official poverty guidelines published by the United States department of health and human services for an individual, shall pay a premium. The amount of the premium shall be based on a sliding fee schedule adopted by rule of the department and shall be based on a percentage of the individual’s income. The maximum premium payable by an individual whose income exceeds one hundred fifty percent of the official poverty guidelines shall be commensurate with the cost of state employees’ group health insurance in this state. The payment to and acceptance by an automated case management system or the department of the premium required under this subparagraph shall not automatically confer initial or continuing program eligibility on an individual.  The department shall maintain a page on the department’s internet site where individuals can electronically pay any premium owed by an individual to the department. A premium paid to and accepted by the department’s premium payment process that is subsequently determined to be untimely or to have been paid on behalf of an individual ineligible for the program shall be refunded to the remitter in accordance with rules adopted by the department. Any unpaid premium shall be a debt owed to the department.
   Sec. 16.  Section 249A.4, Code 2026, is amended by adding the following new subsections:
   NEW SUBSECTION.  15.  Submit a report to the general assembly, including the official payment error rate and a summary of the data submitted in the payment error rate measurement report, within thirty calendar days of receipt by the department of the annual official payment error rate from the centers for Medicare and Medicaid services of the United States department of health and human services.
   NEW SUBSECTION.  16.  Submit an annual report to the general assembly on or before October 1 on petitions for a waiver, also referred to by the department as exceptions to policy, of rules governing the Medicaid program filed pursuant to the rules of the department. The report must include all the following for the immediately preceding fiscal year:
   a.  The total number of exceptions to policy granted.
   b.  The cumulative cost of the exceptions to policy that were granted.
   c.  The types of exceptions to policy that were granted.
   d.  Identifiable trends noted by the department including any of the following:
   (1)  The number of exceptions to policy granted in a particular geographic location.
   (2)  The types of Medicaid services that were the basis for exceptions to policy.
   (3)  The Medicaid program eligibility classification of individuals granted exceptions to policy.
   Sec. 17.  MEDICAID EXCEPTIONS TO POLICY REVIEW —— REPORT TO GENERAL ASSEMBLY.  The department of health and human services shall conduct a review of petitions for a waiver, also referred to by the department as exceptions to policy, of rules governing the Medicaid program granted by the department between January 1, 2020, and January 1, 2026, and shall submit a report on or before December 15, 2026, of the findings of the review. The report shall include all of the following:
   1.  The total number of exceptions to policy granted.
   2.  The cumulative cost of the exceptions to policy that were granted.
   3.  The types of exceptions to policy that were granted.
   4.  Identifiable trends noted by the department including any of the following:
   a.  The number of exceptions to policy granted in a particular geographic location.
   b.  The types of Medicaid services that were the basis for exceptions to policy.
   c.  The Medicaid program classification of individuals granted exceptions to policy.
   Sec. 18.  CONTINGENT EFFECTIVE DATE.  The following takes effect contingent upon receipt of federal approval by the department of health and human services from the centers for Medicare and Medicaid services of the United States department of health and human services:
   The section of this division of this Act amending section 249A.3, subsection 2, paragraph “a”, subparagraph (1), Code 2026, relating to Medicaid eligibility for employed individuals with disabilities.
DIVISION VI
MEDICAID REIMBURSEMENT RATE —— SPECIAL POPULATION NURSING FACILITIES

   Sec. 19.  Section 249A.2, Code 2026, is amended by adding the following new subsection:
   NEW SUBSECTION.  15.  “Special population nursing facility” refers to a nursing facility that serves one of the following populations and has been designated as a special population nursing facility by the department:
   a.  One hundred percent of the residents served are aged thirty and under and require a skilled level of care.
   b.  Seventy percent of the residents served require a skilled level of care for neurological disorders.
   c.  One hundred percent of the residents require care from a facility licensed by the department of inspections, appeals, and licensing as an intermediate care facility for persons with mental illness.
   d.  One hundred percent of the residents require care from a facility licensed by the department of inspections, appeals, and licensing as an intermediate care facility for persons with medical complexity.
   Sec. 20.  NEW SECTION.  249A.38C  Medicaid reimbursement rate —— special population nursing facilities.
   The provider reimbursement rate for each special population nursing facility must be the special population nursing facility’s average allowable per diem costs as adjusted in compliance with applicable federal laws and regulations, including the upper payment limits specified in 42 C.F.R. §447.272(b). If a special population nursing facility subject to this section increases the special population nursing facility’s number of beds or expands to provide additional services on or after July 1, 2026, the reimbursement rate in this section shall apply to such additional beds or services.
DIVISION VII
MEDICAID —— EXPENDITURE NEUTRALITY

   Sec. 21.  NEW SECTION.  249A.32C  Medicaid waivers and state plan amendments —— expenditure neutrality.
   1.  For purposes of this section, unless the context otherwise requires, “expenditure neutral” means that the cost of a federally approved change to an existing, or new request for a, Medicaid waiver or state plan amendment will not result in a net increase in expenditures from the general fund of the state, as certified by an independent actuary retained by the department and confirmed by the legislative services agency.
   2.  The department shall not implement a change to a Medicaid waiver or state plan amendment approved by the centers for Medicare and Medicaid services of the United States department of health and human services if the change is not expenditure neutral, unless expressly approved by the general assembly through legislation prior to the implementation of the change.
   3.  This section shall not apply when the department implements a federally approved change to, or submits a new request for, a Medicaid waiver or state plan amendment that meets any of the following requirements:
   a.  The change or new request was submitted for federal approval prior to July 1, 2026, regardless of whether federal approval has been received by the department by July 1, 2026.
   b.  The change or new request has previously been approved by the general assembly through legislation, or is necessary to administer legislation enacted prior to the department implementing the change or submitting a new request.
   c.  The change or new request is required by federal law or regulation, or is necessary to comply with federal law or regulation.
   d.  The change or new request is necessary to comply with a settlement agreement, consent decree, or other resolution of a state violation of the federal Medicaid program. A change or new request initiated under this paragraph shall be reported to the general assembly, with an estimate of the fiscal impact of the change or new request to the extent it is known, within thirty days of the date of the settlement agreement, consent decree, or other resolution of a state violation of the federal Medicaid program.
   e.  The change or new request involves the development or implementation of actuarially sound capitation rates consistent with 42 C.F.R. §438.4.
   4.  The department may adopt rules pursuant to chapter 17A to administer this section.>
   2.  Title page, by striking lines 1 through 5 and inserting <An Act relating to public assistance programs under the purview of the department of health and human services, including the supplemental nutrition assistance program, Medicaid, the Iowa health and wellness plan, and Medicaid for unemployed persons with disabilities, and including effective date provisions.>

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HARRIS of Appanoose