Senate Amendment to House Amendment to Senate File 2422 H-8448 Amend the House amendment, S-5206, to Senate File 2422, as 1 amended, passed, and reprinted by the Senate, as follows: 2 1. By striking page 1, line 1, through page 13, line 21, and 3 inserting: 4 < Amend Senate File 2422, as amended, passed, and reprinted 5 by the Senate, as follows: 6 1. By striking everything after the enacting clause and 7 inserting: 8 < DIVISION I 9 PUBLIC ASSISTANCE PROGRAMS —— VERIFICATION 10 Section 1. Section 239.6, subsection 1, paragraph a, 11 subparagraph (4), Code 2026, is amended to read as follows: 12 (4) Information maintained by the United States citizenship 13 and immigration services of the United States department of 14 homeland security , including but not limited to information 15 accessible through the systematic alien verification for 16 entitlements online service, or successor federal verification 17 system . 18 Sec. 2. Section 239.6, subsection 2, Code 2026, is amended 19 by adding the following new paragraph: 20 NEW PARAGRAPH . g. The systematic alien verification for 21 entitlements online service maintained by the United States 22 citizenship and immigration services of the United States 23 department of homeland security to verify immigration and 24 United States citizenship information, or successor federal 25 verification system. 26 DIVISION II 27 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM AND MEDICAID —— 28 ELIGIBILITY AND ERROR RATE REPORTING 29 Sec. 3. Section 239.1, Code 2026, is amended by adding the 30 following new subsection: 31 NEW SUBSECTION . 01. “Alien” means any person not a citizen 32 or national of the United States. 33 Sec. 4. Section 239.2, Code 2026, is amended to read as 34 follows: 35 -1- S 5206.4423.S (2) 91 mb 1/ 9 #1.

239.2 Supplemental nutrition assistance program —— income 1 eligibility. 2 1. a. The department shall establish the gross countable 3 monthly income threshold for the supplemental nutrition 4 assistance program at less than or equal to one hundred sixty 5 percent of the federal poverty level for the household size. 6 b. The department shall consider the income and 7 financial resources of all household members in determining 8 the eligibility and benefit allotment of the household, 9 including all household members determined to be ineligible 10 to participate in SNAP under this section or pursuant to 7 11 U.S.C. §2015(f). Notwithstanding 7 C.F.R. §273.11(c)(3), the 12 individual’s income, deductible expenses, and resources shall 13 be counted, and none shall be prorated. 14 c. Pursuant to 7 U.S.C. §2015(f), an individual shall be 15 ineligible to participate in SNAP unless the individual is a 16 resident of the United States and meets at least one of the 17 following criteria: 18 (1) The individual is a citizen or national of the United 19 States. 20 (2) The individual is an alien lawfully admitted for 21 permanent residence as an immigrant, as defined in 8 U.S.C. 22 §1101(a)(15) and 1101(a)(20), excluding alien visitors, 23 tourists, diplomats, students, or other individuals admitted 24 temporarily with no intention of abandoning their residence in 25 a foreign country. 26 (3) The individual is an alien who has been granted the 27 status of Cuban and Haitian entrant, as defined in section 28 501(e) of the federal Refugee Education Assistance Act of 1980, 29 Pub. L. No. 96-422. 30 (4) The individual lawfully resides in the United States in 31 accordance with a compact of free association referred to in 8 32 U.S.C. §1612(b)(2)(G). 33 2. The department shall comply with federal reporting 34 requirements relating to a household member who is determined 35 -2- S 5206.4423.S (2) 91 mb 2/ 9

to be ineligible to participate in SNAP pursuant to 7 C.F.R. 1 §273.4(b). 2 Sec. 5. NEW SECTION . 239.12 SNAP error rate —— reporting. 3 Beginning with the fiscal quarter that starts on October 4 1, 2026, and every fiscal quarter thereafter, within thirty 5 calendar days of transmission of data to the food and nutrition 6 services of the United States department of agriculture, the 7 department shall submit a report to the general assembly 8 detailing payment error rates associated with SNAP for the 9 immediately preceding fiscal quarter. 10 DIVISION III 11 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVERS 12 Sec. 6. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 13 —— WAIVER OF EXPUNGEMENT RULES. 14 1. The department of health and human services shall 15 request a waiver from the food and nutrition services of the 16 United States department of agriculture to provide that, for 17 purposes of state administration of the supplemental nutrition 18 assistance program, expungement of benefits on a household’s 19 electronic benefit account under 7 C.F.R. §274.2(i) be 20 permitted after three months or ninety-one days of inactivity, 21 or of benefits remaining, on the electronic benefit account. 22 2. The department of health and human services shall 23 implement the waiver upon receipt of approval of the waiver 24 from the United States department of agriculture. 25 Sec. 7. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 26 —— WAIVER OF ELIGIBILITY VERIFICATION RULES. 27 1. No later than January 1, 2027, the department of 28 health and human services shall request a waiver from the 29 food and nutrition services of the United States department 30 of agriculture to provide that, for purposes of state 31 administration of the supplemental nutrition assistance 32 program, information from the sources under section 239.6, and 33 the following automated sources, shall be considered verified 34 for purposes of 7 C.F.R. §272.12(c): 35 -3- S 5206.4423.S (2) 91 mb 3/ 9

a. The third-party automated asset verification services 1 contracted by the department or an equivalent third-party asset 2 verification platform. 3 b. The automated employment verification service known 4 as the work number or an equivalent third-party income 5 verification platform. 6 2. The department of health and human services shall 7 implement the waiver upon receipt of approval of the waiver 8 from the United States department of agriculture. 9 DIVISION IV 10 MEDICAID AND IOWA HEALTH AND WELLNESS PLAN —— RETROACTIVE 11 ELIGIBILITY 12 Sec. 8. NEW SECTION . 249A.3B Medicaid —— retroactive 13 eligibility. 14 1. Notwithstanding any provision of state law to the 15 contrary, effective January 1, 2027, in compliance with section 16 71112 of Pub. L. No. 119-21, commonly referred to as the One 17 Big Beautiful Bill Act, the department shall adopt rules to 18 provide that the eligibility of an individual who is a pregnant 19 woman, a child, or a resident of a nursing facility licensed 20 under chapter 135C shall be applied retroactively for no more 21 than two months prior to the month in which the individual 22 submits a completed medical assistance program application. 23 2. The department shall not adopt rules, or submit a 24 request for a waiver or state plan amendment to the centers for 25 Medicare and Medicaid services of the United States department 26 of health and human services, to permit the department to 27 provide medical assistance program eligibility retroactively to 28 any other adult individual except as provided in subsection 1. 29 Sec. 9. Section 249N.4, subsection 5, Code 2026, is amended 30 to read as follows: 31 5. A member is eligible for coverage effective the first day 32 of the month following the month of application for enrollment. 33 The department shall not adopt rules or submit a request for 34 a waiver or state plan amendment to the centers for Medicare 35 -4- S 5206.4423.S (2) 91 mb 4/ 9

and Medicaid services of the United States department of health 1 and human services to permit the department to provide program 2 eligibility prior to the month in which the individual submits 3 a completed application for enrollment. 4 Sec. 10. 2017 Iowa Acts, chapter 174, section 12, subsection 5 15, paragraph a, subparagraph (7), as amended by 2018 Iowa 6 Acts, chapter 1165, section 107, is amended by striking the 7 subparagraph. 8 Sec. 11. MEDICAID RETROACTIVE ELIGIBILITY —— WAIVER. The 9 department of health and human services shall submit a 10 request for a section 1115 demonstration waiver to the centers 11 for Medicare and Medicaid services of the United States 12 department of health and human services for approval to 13 allow, for purposes of state administration of Medicaid, for 14 implementation by the department of no retroactive eligibility 15 for any adult individual who is not a pregnant woman, a child, 16 or a resident of a nursing facility licensed under chapter 17 135C, upon the submission of a completed Medicaid application, 18 instead of three months as required under 42 C.F.R. §435.915. 19 The department shall implement the waiver upon receipt of 20 approval of the waiver by the centers for Medicare and Medicaid 21 services of the United States department of health and human 22 services. 23 DIVISION V 24 MEDICAID —— MEDICAID MANAGED CARE ORGANIZATION HEALTH CARE TAX 25 FUND; EXPENDITURE NEUTRALITY; AND EXCEPTIONS TO POLICY 26 Sec. 12. Section 249A.13, subsection 2, Code 2026, is 27 amended to read as follows: 28 2. Moneys in the fund are appropriated to the department 29 of health and human services for the purposes of the medical 30 assistance program. Unless expressly approved by the general 31 assembly through legislation, or as required by federal law 32 or regulations, the department shall not take any action that 33 reduces moneys deposited in the fund from a health maintenance 34 organization contracting with the department to administer the 35 -5- S 5206.4423.S (2) 91 mb 5/ 9

medical assistance program under this chapter. Such moneys 1 shall not be diverted, reduced, or used by the department for 2 any other purposes than those permitted by this subsection. 3 Sec. 13. NEW SECTION . 249A.59 Medicaid waivers and state 4 plan amendments —— expenditure neutrality. 5 1. For purposes of this section, unless the context 6 otherwise requires, “expenditure neutral” means that the cost of 7 a federally approved change to an existing, or new request for 8 a, Medicaid waiver or state plan amendment will not result in a 9 net increase in expenditures from the appropriation enacted for 10 the fiscal year the change or new request is made, as certified 11 by an actuary retained by the department. 12 2. a. The department shall not implement a change to a 13 Medicaid waiver or a state plan amendment approved by the 14 centers for Medicare and Medicaid services of the United 15 States department of health and human services, or submit a 16 new request, if the change or new request is not expenditure 17 neutral, unless expressly approved by the general assembly 18 through legislation prior to implementation of the change or 19 submission of the new request. 20 b. The department shall not implement a change to a Medicaid 21 waiver or a state plan amendment approved by the centers for 22 Medicare and Medicaid services of the United States department 23 of health and human services, or submit a new request, if the 24 change or new request expands coverage under the Medicaid 25 program to individuals or classes of individuals, unless 26 expressly approved by the general assembly through legislation 27 prior to implementation of the change or submission of the new 28 request. 29 3. This section shall not apply when the department 30 implements a federally approved change to, or submits a new 31 request to the federal government for, a Medicaid waiver 32 or state plan amendment that meets any of the following 33 requirements: 34 a. The change or new request was submitted for federal 35 -6- S 5206.4423.S (2) 91 mb 6/ 9

approval prior to January 1, 2026, regardless of whether 1 federal approval has been received by the department by January 2 1, 2026. 3 b. The change or new request is required by federal law 4 or regulation, or is necessary to comply with federal law or 5 regulations. 6 c. The change or new request is necessary to comply with a 7 settlement agreement, consent decree, or other resolution of a 8 state violation of the federal Medicaid program. A change or 9 new request initiated under this paragraph shall be reported 10 to the general assembly, with an estimate of the fiscal impact 11 of the change or new request to the extent it is known, within 12 thirty days of the date of the settlement agreement, consent 13 decree, or other resolution of a state violation of the federal 14 Medicaid program. 15 d. The change or new request involves the development or 16 implementation of actuarially sound capitation rates consistent 17 with 42 C.F.R. §438.4. 18 4. The department may adopt rules pursuant to chapter 17A to 19 administer this section. 20 Sec. 14. NEW SECTION . 249A.60 Medicaid —— exceptions to 21 policy. 22 The department shall make publicly available, pursuant to 23 section 217.22, information on petitions for a waiver, also 24 referred to by the department as exceptions to policy, of the 25 rules governing the rules of department, including but not 26 limited to the following: 27 1. The total number of exceptions to policy granted. 28 2. The cumulative cost of the exceptions to policy that were 29 granted. 30 3. The types of exceptions to policy that were granted. 31 4. Identifiable trends noted by the department including 32 any of the following: 33 a. The number of exceptions to policy granted in a 34 particular geographic location. 35 -7- S 5206.4423.S (2) 91 mb 7/ 9

b. The types of Medicaid services that were the basis for 1 exceptions to policy. 2 c. The Medicaid program classification of individuals 3 granted exceptions to policy. 4 Sec. 15. EFFECTIVE DATE. The following takes effect on 5 January 1, 2027: 6 The section of this division of this Act amending section 7 249A.13, subsection 2. 8 DIVISION VI 9 MEDICAID —— HOSPITAL DIRECTED PAYMENT PROGRAM 10 Sec. 16. Section 249O.2, Code 2026, is amended by adding the 11 following new subsection: 12 NEW SUBSECTION . 01. Unless otherwise authorized by the 13 general assembly through legislation, the department shall 14 continue to implement a hospital directed payment program 15 under this chapter utilizing rates up to the maximum amount as 16 permitted under 42 C.F.R. §438.6. 17 DIVISION VII 18 PROGRAM ADMINISTRATION —— ELECTRONIC BENEFITS FUNDS PAYMENT 19 Sec. 17. Section 217.24, Code 2026, is amended to read as 20 follows: 21 217.24 Payment by electronic funds transfer. 22 1. The department shall continue expanding the practice of 23 making payments to program participants and vendors by means 24 of electronic funds transfer. The department shall seek the 25 capacity for making payment by such means for all programs 26 administered by the department. 27 2. The department, in coordination with the department of 28 management’s division of information technology, shall seek 29 the capacity to allow premium payments by program participants 30 to be made by electronic benefits transfer for all programs 31 administered by the department that require premium payments. 32 By January 1, 2028, the department shall allow premium payments 33 made by participants pursuant to section 249A.3, subsection 34 2, paragraph “a” , subparagraph (1), to be made by electronic 35 -8- S 5206.4423.S (2) 91 mb 8/ 9

benefits transfer. 1 DIVISION VIII 2 EFFECTIVE DATE 3 Sec. 18. EFFECTIVE DATE. This Act, being deemed of 4 immediate importance, takes effect upon enactment. > 5 2. Title page, by striking lines 1 through 5 and inserting 6 < An Act relating to public assistance programs under the 7 purview of the department of health and human services, 8 including the supplemental nutrition assistance program, 9 Medicaid, and the Iowa health and wellness plan, and including 10 effective date provisions. >> 11 -9- S 5206.4423.S (2) 91 mb 9/ 9