House File 2782 H-8461 Amend House File 2782 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < DIVISION I 4 DEPARTMENT OF VETERANS AFFAIRS —— FY 2026-2027 5 Section 1. DEPARTMENT OF VETERANS AFFAIRS. There is 6 appropriated from the general fund of the state to the 7 department of veterans affairs for the fiscal year beginning 8 July 1, 2026, and ending June 30, 2027, the following amounts, 9 or so much thereof as is necessary, to be used for the purposes 10 designated: 11 1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION 12 For salaries, support, maintenance, and miscellaneous 13 purposes, and for not more than the following full-time 14 equivalent positions: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 17 2. IOWA VETERANS HOME 18 For salaries, support, maintenance, and miscellaneous 19 purposes: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736 21 a. The Iowa veterans home billings involving the department 22 of health and human services shall be submitted to the 23 department on at least a monthly basis. 24 b. The Iowa veterans home expenditure report shall be 25 submitted monthly to the general assembly. 26 3. HOME OWNERSHIP ASSISTANCE PROGRAM 27 For transfer to the Iowa finance authority for the 28 continuation of the home ownership assistance program for 29 persons who are or were eligible members of the armed forces 30 of the United States or eligible service members pursuant to 31 section 16.54: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 33 DIVISION II 34 AGING AND DISABILITY SERVICES —— FY 2026-2027 35 -1- HF 2782.4478 (1) 91 ak/ko 1/ 37 #1.

Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 1 AND DISABILITY SERVICES. There is appropriated from the 2 general fund of the state to the department of health and human 3 services for the fiscal year beginning July 1, 2026, and ending 4 June 30, 2027, the following amount, or so much thereof as is 5 necessary, to be used for the purposes designated: 6 For aging programs for the department of health and human 7 services and area agencies on aging to provide citizens of 8 Iowa who are 60 years of age and older with case management; 9 for Iowa’s aging and disabilities resource centers; for the 10 return to community program; for the purposes of chapter 231E; 11 to administer the prevention of elder abuse, neglect, and 12 exploitation program pursuant to section 231.56A, in accordance 13 with the requirements of the federal Older Americans Act of 14 1965, 42 U.S.C. §3001 et seq., as amended; for the operation 15 of the dependent adult abuse services program pursuant to 16 chapter 235B; for matching funding for programs to enable 17 persons with severe physical or mental disabilities to function 18 more independently; for costs associated with centers for 19 independent living; and for other services which may include 20 but are not limited to adult day care, respite care, chore, 21 information and assistance, and material aid; for information 22 and options counseling for persons with disabilities; and 23 for salaries, support, administration, maintenance, and 24 miscellaneous purposes, and for not more than the following 25 full-time equivalent positions: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,379,531 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 101.00 28 1. Moneys appropriated in this section may be used to 29 supplement federal moneys received under federal regulations. 30 To receive moneys appropriated in this section, a local area 31 agency on aging shall match the moneys with moneys from other 32 sources according to rules adopted by the department. Moneys 33 appropriated in this section may be used for services not 34 specifically enumerated in this section only if approved by the 35 -2- HF 2782.4478 (1) 91 ak/ko 2/ 37

department as part of an area agency on aging’s area plan. 1 2. Of the moneys appropriated in this section, $949,282 2 is allocated to be used for the comprehensive family support 3 program created in section 231.80 as enacted under this Act. 4 3. Of the moneys appropriated in this section, $33,632 5 is allocated to be used to build community capacity through 6 the coordination and provision of training opportunities in 7 accordance with the consent decree of Conner v. Branstad, No. 8 4-86-CV-30871 (S.D. Iowa, July 15, 1994). 9 DIVISION III 10 BEHAVIORAL HEALTH —— FY 2026-2027 11 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 12 BEHAVIORAL HEALTH. There is appropriated from the general fund 13 of the state to the department of health and human services for 14 the fiscal year beginning July 1, 2026, and ending June 30, 15 2027, the following amount, or so much thereof as is necessary, 16 to be used for the purposes designated: 17 For behavioral health prevention, education, early 18 intervention, treatment, recovery support, and crisis 19 services in order to support statewide access to treatment for 20 behavioral health conditions; stabilization and mitigation of 21 behavioral health crises; and recovery for individuals and 22 families impacted by behavioral health conditions. Activities 23 shall align with accepted best practice guidance standards for 24 behavioral health including those published by the centers for 25 disease control and prevention of the United States department 26 of health and human services, and the substance abuse and 27 mental health services administration of the United States 28 department of health and human services, for health promotion; 29 universal, selective, and indicated prevention; treatment; and 30 recovery services and supports; and shall include a 24-hour 31 helpline, public information resources, professional training, 32 youth prevention, program evaluation, and efforts at the state 33 and local levels, and for not more than the following full-time 34 equivalent positions: 35 -3- HF 2782.4478 (1) 91 ak/ko 3/ 37

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 23,127,121 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 70.00 2 1. Of the moneys appropriated in this section, $300,000 3 is allocated to support the work of the children’s behavioral 4 health system including evidence-based behavioral health 5 prevention, treatment, and recovery services and supports for 6 children and their families. 7 2. Of the moneys appropriated in this section, $950,000 8 is allocated for an integrated substance use disorder managed 9 care system. The department shall maintain the level of mental 10 health and substance use disorder treatment services provided 11 by the managed care contractors, and shall take the steps 12 necessary to continue the federal waivers as needed to maintain 13 the level of services. 14 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 15 WAGERING RECEIPTS FUND. There is appropriated from the 16 sports wagering receipts fund created in section 8.57I, to the 17 department of health and human services for the fiscal year 18 beginning July 1, 2026, and ending June 30, 2027, the following 19 amount, or so much thereof as is necessary, to be used for 20 behavioral health prevention, education, early intervention, 21 treatment, recovery support, and crisis services in order to 22 support statewide access to treatment for behavioral health 23 conditions; stabilization and mitigation of behavioral health 24 crises; and recovery for individuals and families impacted by 25 behavioral health conditions: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 27 DIVISION IV 28 PUBLIC HEALTH —— FY 2026-2027 29 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 30 HEALTH. There is appropriated from the general fund of the 31 state to the department of health and human services for the 32 fiscal year beginning July 1, 2026, and ending June 30, 2027, 33 the following amount, or so much thereof as is necessary, to be 34 used for the purposes designated: 35 -4- HF 2782.4478 (1) 91 ak/ko 4/ 37

For programs that support health promotion, protect the 1 health and safety of the public, conduct disease surveillance 2 and investigation to reduce the incidence of morbidity and 3 mortality, serve individuals with chronic conditions including 4 but not limited to cancer, support the Iowa donor registry as 5 specified in section 142C.18, and strengthen the health care 6 delivery system and workforce to improve health outcomes for 7 all Iowans, and for not more than the following full-time 8 equivalent positions: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 21,168,369 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 348.60 11 1. Of the moneys appropriated in this section, $191,000 12 is allocated to the university of Iowa hospitals and clinics 13 to administer a child vision screening program through 14 continuation of an existing contract. The program shall submit 15 a report to the department regarding the use of funds allocated 16 under this subsection. The report shall include the objectives 17 and results for the program year including the target 18 population and how the funds allocated assisted the program in 19 meeting the objectives; the number, age, and location within 20 the state of individuals served; the type of services provided 21 to the individuals served; the distribution of moneys based on 22 the services provided; and the continuing needs of the program. 23 2. Of the moneys appropriated in this section, $144,000 is 24 allocated for the public purpose of allowing the department 25 to continue an existing contract with an existing affiliated 26 organization to provide education, client-centered programs, 27 and client and family support, for people living with epilepsy 28 and their families. The moneys allocated in excess of $50,000 29 shall be matched dollar for dollar by the existing affiliated 30 organization. Moneys under this section shall be distributed 31 in their entirety on July 1, 2026, for the purpose specified. 32 3. Of the moneys appropriated in this section, the following 33 amounts are allocated to the department of health and human 34 services to be used as follows to support the goals of 35 -5- HF 2782.4478 (1) 91 ak/ko 5/ 37

increased access, health system integration, and engagement: 1 a. $600,000 for distribution to a nonprofit organization 2 that established the first statewide drug donation repository 3 for continuation of the pharmaceutical infrastructure for 4 safety net providers established as described in 2007 Iowa 5 Acts, chapter 218, section 108, and for the prescription drug 6 donation repository program established in chapter 135M. 7 Moneys under this paragraph shall be distributed in their 8 entirety on July 1, 2026, for the purpose specified. 9 b. $374,000 for distribution to free clinics, as defined in 10 section 135.24, and a nonprofit organization that facilitates 11 the initiation, operation, and collaboration of free clinics 12 for necessary infrastructure, statewide coordination, provider 13 recruitment, service delivery, and provision of assistance to 14 patients in securing a medical home inclusive of oral health 15 care. Of the moneys allocated, $40,000 shall be used to lower 16 fees associated with using an electronic prescribing system. 17 Moneys under this paragraph shall be distributed in their 18 entirety on July 1, 2026, for the purpose specified. 19 c. $25,000 for distribution to an organization that raises 20 awareness about issues related to rural health clinics for 21 necessary infrastructure and service delivery transformation. 22 Moneys under this paragraph shall be distributed in their 23 entirety on July 1, 2026, for the purpose specified. 24 4. Of the moneys appropriated in this section, $400,000 25 is allocated for rural psychiatric residencies for residents 26 selected on or before June 30, 2026. 27 5. Of the moneys appropriated in this section, $20,000 is 28 allocated to make radon test kits available, free of charge, 29 to homeowners and renters in the state. The department shall 30 provide a link on the department’s internet site for homeowners 31 and renters in the state to order radon test kits. 32 6. Of the moneys appropriated in this section, $1,500,000 is 33 allocated for awarding grants for medical residency programs in 34 the state that meet the following criteria: 35 -6- HF 2782.4478 (1) 91 ak/ko 6/ 37

a. The medical residency program is not related to the 1 practice of family medicine. 2 b. The medical residency program is not located in a county 3 that has a population of one hundred fifty thousand or more 4 based on the most recent federal decennial census, and in which 5 the main campus of an institution of higher learning governed 6 by the state board of regents is located. 7 7. The university of Iowa hospitals and clinics under 8 the control of the state board of regents shall not receive 9 indirect costs from the moneys appropriated in this section. 10 The university of Iowa hospitals and clinics billings to the 11 department shall be, at a minimum, on a quarterly basis. 12 DIVISION V 13 COMMUNITY ACCESS AND ELIGIBILITY —— CHILD SUPPORT SERVICES —— 14 TANF —— FY 2026-2027 15 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 16 ACCESS AND ELIGIBILITY. There is appropriated from the 17 general fund of the state to the department of health and human 18 services for the fiscal year beginning July 1, 2026, and ending 19 June 30, 2027, the following amount, or so much thereof as is 20 necessary, to be used for the purposes designated: 21 To be used for salaries, support, maintenance, and 22 miscellaneous purposes and for family investment program (FIP) 23 assistance in accordance with chapter 239B, and for other costs 24 associated with providing needs-based benefits or assistance 25 including but not limited to maternal and child health, oral 26 health, obesity prevention, the promoting independence and 27 self-sufficiency through employment, job opportunities and the 28 basic skills (PROMISE JOBS) program, supplemental nutrition 29 assistance program (SNAP) employment and training, the FIP 30 diversion program, family planning, rent reimbursement, 31 and eligibility determinations for medical assistance, food 32 assistance, and the children’s health insurance program, and 33 for not more than the following full-time equivalent positions: 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 76,371,516 35 -7- HF 2782.4478 (1) 91 ak/ko 7/ 37

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 883.90 1 1. Of the child support collections assigned under FIP, 2 the federal share of the child support collections shall be 3 credited to the child support services appropriation made in 4 this division of this Act. Of the remainder of the child 5 support collections assigned under FIP, a portion shall be 6 credited to community access and eligibility, and the remaining 7 moneys may be used to increase recoveries, to sustain cash flow 8 in the collection services center refund account as provided in 9 section 252B.13A, or for technology needs. If child support 10 collections assigned under FIP are greater than estimated or 11 are otherwise determined not to be required for maintenance of 12 efforts, the state share of either amount is appropriated to 13 the department for child support services as described in this 14 division of this Act, or may be transferred to or retained in 15 the collection services center refund account. 16 2. Of the moneys appropriated in this section, $3,075,000 is 17 allocated for continuation of the department’s initiative to 18 provide for adequate developmental surveillance and screening 19 during a child’s first five years. The moneys shall first be 20 used to fully fund the current participating counties to ensure 21 that those counties are fully operational, with the remaining 22 moneys to be used for expanding participation to additional 23 counties. Full implementation and expansion shall include 24 enhancing the scope of the initiative through collaboration 25 with child health specialty clinics to promote the use of 26 developmental surveillance and screening to support healthy 27 child development through early identification and response to 28 biomedical and social determinants of healthy development by 29 providing practitioner consultation and continuous improvement 30 through training and education, particularly for children 31 with behavioral conditions and needs. The department shall 32 also collaborate with the Medicaid program and child health 33 specialty clinics to assist in coordinating the activities 34 of the first five initiative into the establishment of 35 -8- HF 2782.4478 (1) 91 ak/ko 8/ 37

patient-centered medical homes developed to improve health 1 quality and population health while reducing health care costs. 2 To the maximum extent possible, moneys allocated in this 3 subsection shall be utilized as matching moneys for Medicaid 4 program reimbursement. 5 3. Of the moneys appropriated in this section, $1,145,102 is 6 allocated to the Iowa commission on volunteer service created 7 in section 15H.2 for programs and grants. 8 4. The university of Iowa hospitals and clinics under 9 the control of the state board of regents shall not receive 10 indirect costs from the moneys appropriated in this section. 11 The university of Iowa hospitals and clinics billings to the 12 department shall be, at a minimum, on a quarterly basis. 13 Sec. 7. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CHILD 14 SUPPORT SERVICES. There is appropriated from the general fund 15 of the state to the department of health and human services for 16 the fiscal year beginning July 1, 2026, and ending June 30, 17 2027, the following amount, or so much thereof as is necessary, 18 to be used for the purposes designated: 19 For child support services, including salaries, support, 20 maintenance, and miscellaneous purposes, and for not more than 21 the following full-time equivalent positions: 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,644,114 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 464.00 24 1. Federal access and visitation grant moneys shall be used 25 for services designed to increase compliance with the child 26 access provisions of court orders, including but not limited to 27 neutral visitation sites and mediation services. 28 2. Moneys appropriated in this section may be used 29 throughout the fiscal year in the manner necessary for 30 cash flow management. For cash flow management under this 31 subsection, the department may temporarily draw more than the 32 amount appropriated provided the amount appropriated is not 33 exceeded at the close of the fiscal year. 34 Sec. 8. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 35 -9- HF 2782.4478 (1) 91 ak/ko 9/ 37

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT. There is 1 appropriated from the special fund created in section 8.41 to 2 the department of health and human services for the fiscal year 3 beginning July 1, 2026, and ending June 30, 2027, from moneys 4 received under the federal temporary assistance for needy 5 families (TANF) block grant pursuant to the federal Personal 6 Responsibility and Work Opportunity Reconciliation Act of 1996, 7 Pub. L. No. 104-193, and successor legislation, including TANF 8 block grant moneys received in any prior fiscal year that 9 were deposited in the special fund and remain unencumbered 10 or unobligated on June 30, 2026, the following amounts, or 11 so much thereof as is necessary, to be used for the purposes 12 designated: 13 1. For community access and eligibility: 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,566,312 15 2. For community access and eligibility to provide 16 pregnancy prevention grants on the condition that family 17 planning services are funded: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 19 Pregnancy prevention grants shall be awarded to programs 20 in existence on or before July 1, 2026, if the programs have 21 demonstrated positive outcomes. Grants shall be awarded 22 to pregnancy prevention programs developed after July 1, 23 2026, if the programs are based on existing models that have 24 demonstrated positive outcomes. Grants must comply with the 25 requirements provided in 1997 Iowa Acts, chapter 208, section 26 14, subsections 1 and 2, including the requirement that a 27 program awarded a grant must emphasize sexual abstinence. 28 Priority in awarding grants shall be given to programs 29 that serve areas of the state which demonstrate the highest 30 percentage of unplanned pregnancies of females of childbearing 31 age within the geographic area to be served by the grant. 32 3. To meet one of the four purposes of TANF as specified 33 in 45 C.F.R. §260.20, including by modernizing the program 34 to promote economic mobility and self-sufficiency, ensuring 35 -10- HF 2782.4478 (1) 91 ak/ko 10/ 37

that families are able to overcome benefit cliffs, encouraging 1 healthy families, and streamlining service delivery to reduce 2 duplication: 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000,000 4 4. For early intervention and supports for child abuse 5 prevention and the family development and self-sufficiency 6 (FaDSS) grant program in accordance with section 216A.107: 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,013,980 8 5. For accountability, compliance, program integrity, 9 technology needs, and other resources necessary to meet 10 federal and state reporting, tracking, and case management 11 requirements, and other departmental needs: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 13 6. For state child care assistance: 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 42,281,826 15 7. For child protective services: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 65,364,100 17 DIVISION VI 18 MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— 19 HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 20 PROGRAMS —— FY 2026-2027 21 Sec. 9. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— MEDICAL 22 ASSISTANCE PROGRAM, STATE SUPPLEMENTARY ASSISTANCE, AND HEALTHY 23 AND WELL KIDS IN IOWA PROGRAM. There is appropriated from the 24 general fund of the state to the department of health and human 25 services for the fiscal year beginning July 1, 2026, and ending 26 June 30, 2027, the following amount, or so much thereof as is 27 necessary, to be used for the purposes designated: 28 For medical assistance program reimbursement and associated 29 costs as specifically provided in the reimbursement 30 methodologies in effect on June 30, 2026, except as otherwise 31 expressly authorized by law, consistent with options under 32 federal law and regulations, and contingent upon receipt of 33 approval from the office of the governor of reimbursement for 34 each abortion performed under the medical assistance program; 35 -11- HF 2782.4478 (1) 91 ak/ko 11/ 37

for the state supplementary assistance program; for the health 1 insurance premium payment program; and for maintenance of 2 the healthy and well kids in Iowa (Hawki) program pursuant 3 to chapter 514I, including supplemental dental services, 4 for receipt of federal financial participation under Tit. 5 XXI of the federal Social Security Act, which creates the 6 children’s health insurance program; and for other specified 7 health-related programs: 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,992,550,706 9 1. Of the moneys appropriated in this section, 10 $1,919,596,113 is allocated for medical assistance program 11 reimbursement and associated costs. Of the moneys allocated 12 in this subsection, $3,383,880 shall be used for program 13 administration, outreach, and enrollment activities of the 14 state family planning services program pursuant to section 15 217.41B , and of this amount, the department may use $200,000 16 for administrative expenses. 17 2. Iowans support reducing the number of abortions 18 performed in our state. Moneys appropriated under this section 19 shall not be used for abortions, unless otherwise authorized 20 under this section. 21 3. The provisions of this section relating to abortions 22 shall also apply to the Iowa health and wellness plan created 23 pursuant to chapter 249N . 24 4. Of the moneys appropriated in this section, $4,479,762 is 25 allocated for the state supplementary assistance program. 26 5. Of the moneys appropriated in this section, $68,474,831 27 is allocated for maintenance of the Hawki program pursuant 28 to chapter 514I , including supplemental dental services, for 29 receipt of federal financial participation under Tit. XXI of 30 the federal Social Security Act, which creates the children’s 31 health insurance program. 32 Sec. 10. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HEALTH 33 PROGRAM OPERATIONS. There is appropriated from the general 34 fund of the state to the department of health and human 35 -12- HF 2782.4478 (1) 91 ak/ko 12/ 37

services for the fiscal year beginning July 1, 2026, and ending 1 June 30, 2027, the following amount, or so much thereof as is 2 necessary, to be used for the purposes designated: 3 For health program operations and the autism support program 4 under section 225D.2, and for not more than the following 5 full-time equivalent positions: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 40,342,766 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 97.00 8 1. The department of inspections, appeals, and licensing 9 shall provide all state matching moneys for survey and 10 certification activities performed by the department of 11 inspections, appeals, and licensing. The department of health 12 and human services shall be solely responsible for distributing 13 the federal matching moneys for such activities. 14 2. Of the moneys appropriated in this section, a sufficient 15 amount is allocated for the administration of the health 16 insurance premium payment program, including salaries, support, 17 maintenance, and miscellaneous purposes. 18 3. Of the moneys appropriated in this section, $750,000 is 19 allocated for a nonprofit organization that provides access 20 to emergency poison information and treatment. Pursuant to 21 the directive under 2014 Iowa Acts, chapter 1140, section 22 102, the federal matching moneys available to the nonprofit 23 organization from the department under the federal Children’s 24 Health Insurance Program Reauthorization Act of 2009 shall be 25 subject to the federal administrative cap rule of 10 percent 26 applicable to moneys provided under Tit. XXI of the federal 27 Social Security Act, and shall be included in the department’s 28 calculations of the cap. 29 4. Unless otherwise provided by law, if a contract for 30 services provided under this section initially entered into 31 during the fiscal year beginning July 1, 2026, and ending 32 June 30, 2027, provides for an annual increase of the cost of 33 services provided under the contract, the annual increase shall 34 not exceed the amount by which the consumer price index for 35 -13- HF 2782.4478 (1) 91 ak/ko 13/ 37

all urban consumers increased during the immediately preceding 1 calendar year. This subsection does not affect a contract 2 entered into on or before June 30, 2026, that is for a term of 3 more than one year. 4 Sec. 11. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 5 PHARMACEUTICAL SETTLEMENT ACCOUNT. There is appropriated 6 from the pharmaceutical settlement account created in section 7 249A.33 to the department of health and human services for the 8 fiscal year beginning July 1, 2026, and ending June 30, 2027, 9 the following amount, or so much thereof as is necessary, to be 10 used for the purposes designated: 11 Notwithstanding any provision of law to the contrary, to 12 supplement the appropriation made in this Act from the general 13 fund of the state for health program operations under the 14 medical assistance program for the same fiscal year: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 16 Sec. 12. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— QUALITY 17 ASSURANCE TRUST FUND. 18 1. Notwithstanding any provision of law to the contrary, and 19 subject to the availability of moneys, there is appropriated 20 from the quality assurance trust fund created in section 249L.4 21 to the department of health and human services for the fiscal 22 year beginning July 1, 2026, and ending June 30, 2027, the 23 following amount, or so much thereof as is necessary, for the 24 purposes designated: 25 To supplement the appropriation made in this Act from the 26 general fund of the state to the department of health and human 27 services for medical assistance for the same fiscal year: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 29 2. Notwithstanding section 249L.4, subsection 2, after the 30 appropriation in subsection 1, any moneys remaining in the 31 quality assurance trust fund for the fiscal year beginning 32 July 1, 2026, and ending June 30, 2027, are appropriated to 33 the department of health and human services to supplement the 34 appropriation made in this Act from the general fund of the 35 -14- HF 2782.4478 (1) 91 ak/ko 14/ 37

state for the medical assistance program for the same fiscal 1 year. 2 Sec. 13. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HOSPITAL 3 HEALTH CARE ACCESS TRUST FUND. 4 1. Notwithstanding any provision of law to the contrary, and 5 subject to the availability of moneys, there is appropriated 6 from the hospital health care access trust fund created in 7 section 249M.4, to the department of health and human services 8 for the fiscal year beginning July 1, 2026, and ending June 30, 9 2027, the following amount, or so much thereof as is necessary, 10 for the purposes designated: 11 To supplement the appropriation made in this Act from the 12 general fund of the state to the department of health and human 13 services for medical assistance for the same fiscal year: 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 15 2. Notwithstanding section 249M.4, subsection 2, after 16 the appropriation in subsection 1, any moneys remaining in 17 the hospital health care access trust fund for the fiscal 18 year beginning July 1, 2026, and ending June 30, 2027, are 19 appropriated to the department of health and human services to 20 supplement the appropriation made in this Act from the general 21 fund of the state for the medical assistance program for the 22 same fiscal year. 23 Sec. 14. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 24 BEHAVIORAL HEALTH FUND. Notwithstanding section 225A.7, 25 subsection 2, and subject to the availability of moneys, there 26 is appropriated from the behavioral health fund established in 27 section 225A.7, to the department of health and human services 28 for the fiscal year beginning July 1, 2026, and ending June 30, 29 2027, the following amount, or so much thereof as is necessary, 30 for the purposes designated: 31 To supplement the appropriation made in this Act from the 32 general fund of the state to the department of health and human 33 services for medical assistance for the fiscal year beginning 34 July 1, 2026, and ending June 30, 2027: 35 -15- HF 2782.4478 (1) 91 ak/ko 15/ 37

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,580,938 1 Sec. 15. REIMBURSEMENT RATES. 2 1. Reimbursement for medical assistance, state 3 supplementary assistance, and social service providers and 4 services reimbursed under the purview of the department of 5 health and human services shall remain at the reimbursement 6 rate in effect on June 30, 2026, or shall be determined 7 pursuant to the reimbursement methodology in effect on June 30, 8 2026, with the exception of the following: 9 a. If reimbursement is otherwise negotiated by contract or 10 pursuant to an updated fee schedule. 11 b. As otherwise provided in this section. 12 2. a. (1) Notwithstanding any provision of law to the 13 contrary, for the fiscal year beginning July 1, 2026, and 14 ending June 30, 2027, the department of health and human 15 services shall reimburse case-mix nursing facility rates based 16 on the methodology in effect on June 30, 2026. 17 (2) July 1, 2025, through December 31, 2025, the department 18 of health and human services shall calculate each nursing 19 facility’s case-mix index for rates effective July 1, 2026. 20 (3) January 1, 2026, through June 30, 2026, the department 21 of health and human services shall calculate each nursing 22 facility’s case-mix index for rates effective January 1, 2027. 23 (4) All nursing facility rate adjustments under this 24 paragraph shall be budget neutral. 25 b. For the fiscal year beginning July 1, 2026, $1,167,867 26 shall be used to increase to the extent possible reimbursement 27 rates for ambulatory surgical centers compared to rates in 28 effect on June 30, 2026. 29 c. For the fiscal year beginning July 1, 2026, $3,000,000 30 shall be used to increase to the extent possible, compared 31 with rates in effect on June 30, 2026, reimbursement rates for 32 providers of Medicaid home and community-based services waiver 33 services used most frequently by elderly waiver recipients 34 including attendant care, homemaker, and assisted living 35 -16- HF 2782.4478 (1) 91 ak/ko 16/ 37

services. 1 d. (1) Adjustments to Medicaid reimbursement rates 2 developed using cost reports shall be applied starting on the 3 effective date specified in the applicable rate letter issued 4 to a provider. 5 (2) Minimum Medicaid reimbursement rates for all provider 6 and service types shall be no lower than the reimbursement 7 rates established in the department’s minimum fee schedule. 8 (3) Any increase in a Medicaid reimbursement rate specified 9 under this section shall be effective October 1, 2026. 10 DIVISION VII 11 FAMILY WELL-BEING AND PROTECTION —— FY 2026-2027 12 Sec. 16. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— STATE 13 CHILD CARE ASSISTANCE. There is appropriated from the general 14 fund of the state to the department of health and human 15 services for the fiscal year beginning July 1, 2026, and ending 16 June 30, 2027, the following amount, or so much thereof as is 17 necessary, to be used for the purposes designated: 18 For state child care assistance in accordance with sections 19 237A.13 and 237A.14, and for not more than the following 20 full-time equivalent positions: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 32,723,000 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 53.00 23 1. If the appropriation made for purposes of the state child 24 care assistance program for the fiscal year is determined to 25 be insufficient, it is the intent of the general assembly to 26 appropriate sufficient moneys for the fiscal year to avoid 27 application of waiting list requirements. 28 2. A portion of the state match for the federal child care 29 and development block grant shall be provided as necessary to 30 meet federal matching moneys requirements through the state 31 general fund appropriation made for child development grants 32 and other programs for at-risk children in section 279.51. 33 Sec. 17. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— EARLY 34 INTERVENTION AND SUPPORTS. There is appropriated from the 35 -17- HF 2782.4478 (1) 91 ak/ko 17/ 37