S.F. _____ Section 1. 2008 Iowa Acts, chapter 1188, section 16, as 1 amended by 2009 Iowa Acts, chapter 182, section 84, is amended 2 to read as follows: 3 SEC. 16. MEDICAL ASSISTANCE, HAWK-I, AND HAWK-I EXPANSION 4 PROGRAMS —— COVERING CHILDREN —— APPROPRIATION. There 5 is appropriated from the general fund of the state to the 6 department of human services for the designated fiscal years, 7 the following amounts, or so much thereof as is necessary, for 8 the purpose designated: 9 To cover children as provided in this Act under the medical 10 assistance, hawk-i, and hawk-i expansion programs and outreach 11 under the current structure of the programs: 12 FY 2008-2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,800,000 13 FY 2009-2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,207,001 14 10,049,532 15 FY 2010-2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,800,000 16 The amendment to the amount of the appropriation made in this 17 section for FY 2009-2010 incorporates the amount of the uniform 18 reduction made pursuant to executive order number 19 issued 19 October 8, 2009. Of the funds appropriated for FY 2009-2010, 20 $510,249 is allocated for the supplemental dental services 21 under the hawk-i program. 22 Sec. 2. 2009 Iowa Acts, chapter 182, is amended by adding 23 the following new section: 24 NEW SECTION . SEC. 5A. EMERGENCY CONTINGENCY FUND FOR 25 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES. 26 1. There is appropriated from the federal recovery and 27 reinvestment fund created in section 8.41A to the department 28 of human services for the fiscal year beginning July 1, 2009, 29 and ending June 30, 2010, an amount sufficient to fully fund 30 the family investment program under chapter 239B for the fiscal 31 year. 32 2. The appropriation made in this section is from federal 33 funding available from the emergency contingency fund 34 for temporary assistance for needy families state program 35 -1- LSB 5971XC (9) 83 jp/tm 1/ 9

S.F. _____ established pursuant to the federal American Recovery and 1 Reinvestment Act of 2009, Pub. L. No. 111-5, § 2101. The 2 funding shall be expended only after the funding appropriated 3 for the family investment program in sections 5, 6, and 7 4 of this Act have been exhausted. The appropriation shall be 5 expended in accordance with the federal law making the funding 6 available and chapter 239B, notwithstanding section 8.41, 2009 7 Iowa Acts, chapter 183, section 58, or any other provision to 8 the contrary. 9 3. The department shall report quarterly to the legislative 10 services agency and the department of management concerning the 11 expenditure of the funding appropriated in this section during 12 the previous quarter. 13 Sec. 3. 2009 Iowa Acts, chapter 182, section 9, unnumbered 14 paragraph 2, as amended by 2009 Iowa Acts, chapter 179, section 15 84, is amended to read as follows: 16 For medical assistance reimbursement and associated costs 17 as specifically provided in the reimbursement methodologies 18 in effect on June 30, 2009, except as otherwise expressly 19 authorized by law, including reimbursement for abortion 20 services which shall be available under the medical assistance 21 program only for those abortions which are medically necessary: 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 681,949,840 23 590,459,096 24 The amendment to the amount of the appropriation made in this 25 section incorporates the amounts of the uniform reduction made 26 pursuant to executive order number 19 issued October 8, 2009, 27 and the transfers made to and from this appropriation pursuant 28 to the authority in section 8.39 and addressed in the notice of 29 appropriation transfer from the department of management dated 30 December 11, 2009. 31 Sec. 4. 2009 Iowa Acts, chapter 182, section 9, subsection 32 11, is amended to read as follows: 33 11. Of the funds appropriated to the medical assistance 34 program in this section 2009 Iowa Acts, chapter 183, section 35 -2- LSB 5971XC (9) 83 jp/tm 2/ 9

S.F. _____ 61, subsection 8, paragraph “a” , the following amounts shall be 1 transferred to appropriations made in this division of this Act 2 to the state mental health institutes: 3 a. Cherokee mental health institute . . . . . . . . . . . $ 9,098,425 4 b. Clarinda mental health institute . . . . . . . . . . . $ 1,977,305 5 c. Independence mental health institute . . . . . . . $ 9,045,894 6 d. Mount Pleasant mental health institute . . . . . $ 5,752,587 7 Sec. 5. 2009 Iowa Acts, chapter 182, section 9, is amended 8 by adding the following new subsection: 9 NEW SUBSECTION . 23. Of the funds appropriated in this 10 section, $6,000,000 is allocated for rebasing of nursing 11 facility reimbursement and $237,173 for interpreter services 12 associated with 2009 Iowa Acts, chapter 118, section 29. 13 Sec. 6. 2009 Iowa Acts, chapter 182, section 16, subsection 14 1, unnumbered paragraph 2, is amended to read as follows: 15 For child and family services: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 90,591,451 17 84,023,306 18 The amendment to the amount of the appropriation made in 19 this section incorporates the amounts of the uniform reduction 20 made pursuant to executive order number 19 issued October 8, 21 2009, and the transfer made to this appropriation pursuant to 22 the authority in section 8.39 and addressed in the notice of 23 appropriation transfer from the department of management dated 24 December 11, 2009. 25 Sec. 7. 2009 Iowa Acts, chapter 182, section 16, subsection 26 7, is amended to read as follows: 27 7. Notwithstanding section 234.35 or any other provision of 28 law to the contrary, state funding for shelter care shall be 29 limited to $7,686,460 $8,186,460 . The department may continue 30 or amend shelter care provider contracts to include the child 31 welfare emergency services for children who might otherwise be 32 served in shelter care that were implemented pursuant to 2008 33 Iowa Acts, chapter 1187, section 16, subsection 7. 34 Sec. 8. 2009 Iowa Acts, chapter 182, section 24, subsection 35 -3- LSB 5971XC (9) 83 jp/tm 3/ 9

S.F. _____ 1, unnumbered paragraph 2, is amended to read as follows: 1 For distribution to counties for state case services 2 for persons with mental illness, mental retardation, and 3 developmental disabilities in accordance with section 331.440: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 11,446,288 5 10,008,418 6 The amendment to the amount of the appropriation made in this 7 section incorporates the amount of the uniform reduction made 8 pursuant to executive order number 19 issued October 8, 2009. 9 Sec. 9. 2009 Iowa Acts, chapter 182, section 27, unnumbered 10 paragraph 2, is amended to read as follows: 11 For field operations, including salaries, support, 12 maintenance, and miscellaneous purposes, and for not more than 13 the following full-time equivalent positions: 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 63,032,831 15 57,410,144 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 2,000.13 17 The amendment to the amount of the appropriation made in 18 this section incorporates the amounts of the uniform reduction 19 made pursuant to executive order number 19 issued October 8, 20 2009, and the transfer made from this appropriation pursuant to 21 the authority in section 8.39 and addressed in the notice of 22 appropriation transfer from the department of management dated 23 December 23, 2009. 24 Sec. 10. 2009 Iowa Acts, chapter 182, section 48, is amended 25 by adding the following new subsection: 26 NEW SUBSECTION . 4. There is appropriated from the IowaCare 27 account created in section 249J.24 to the department of human 28 services for the fiscal year beginning July 1, 2009, and ending 29 June 30, 2010, the following amount, or so much thereof as is 30 necessary, to be used for the purposes designated: 31 For distribution to a publicly owned acute care teaching 32 hospital located in a county with a population over 350,000: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,500,000 34 Sec. 11. 2009 Iowa Acts, chapter 183, section 61, subsection 35 -4- LSB 5971XC (9) 83 jp/tm 4/ 9

S.F. _____ 8, is amended to read as follows: 1 8. From funding designated for government stabilization, 2 for the department of human services: 3 a. For the medical assistance program: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,237,173 5 25,874,211 6 Of the funds appropriated in this lettered paragraph, 7 $6,000,000 is allocated for rebasing of nursing facility 8 reimbursement and $237,173 for interpreter services associated 9 with 2009 Iowa Acts, Senate File 389, if enacted. 10 b. For coverage of children under the medical assistance 11 and hawk-i programs and for additional coverage provisions for 12 children under 2009 Iowa Acts, Senate File 389, if enacted: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,263,231 14 0 15 Of the funds appropriated in this lettered paragraph, 16 $510,249 is allocated for supplemental dental services under 17 the hawk-i program. 18 c. For transfer to the department of public health to be 19 used for 0.25 full-time equivalent position and other costs 20 associated with the volunteer health care provider program: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 20,000 22 d. For the property tax relief fund in lieu of an equal 23 amount of the appropriation made from the general fund of the 24 state in section 426B.1, subsection 2: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 10,480,000 26 0 27 Notwithstanding section 426B.1, subsection 2, for the fiscal 28 year beginning July 1, 2009, the amount of the appropriation 29 made from the general fund of the state in section 426B.1, 30 subsection 2, shall be reduced by $2,964,543 $3,328,089 and the 31 appropriation made from the property tax relief fund and for 32 the fiscal year to supplement the medical assistance program 33 in section 426B.1, subsection 3, shall be reduced by the same 34 amount. 35 -5- LSB 5971XC (9) 83 jp/tm 5/ 9

S.F. _____ e. For the risk pool created in the property tax relief fund 1 in accordance with section 426B.5: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 10,000,000 3 f. For a demonstration project providing health care 4 coverage premium assistance for direct care workers to 5 implement recommendations developed pursuant to 2008 Iowa Acts, 6 chapter 1188, section 72: 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 400,000 8 g. For the department’s field operations, if 2009 Iowa Acts, 9 Senate File 389, chapter 118, is enacted: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 680,596 11 0 12 The funds appropriated in this lettered paragraph shall be 13 used for 17.00 additional full-time equivalent positions for 14 implementation costs associated with 2009 Iowa Acts, Senate 15 File 389, if enacted chapter 118 . 16 h. For child and family services: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,500,000 18 0 19 Of the amount appropriated in this lettered paragraph, 20 $500,000 shall be used for additional funding of shelter care. 21 i. For distribution to counties for state case services 22 for persons with mental illness, mental retardation, and 23 developmental disabilities in accordance with section 331.440, 24 to supplement the amount appropriated in 2009 Iowa Acts, 25 chapter 182, section 24: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 286,789 27 Sec. 12. RISK POOL —— STATE CASE SERVICES. Moneys in the 28 risk pool created in section 426B.5 that remain unencumbered 29 or unobligated on the effective date of this division of this 30 Act shall be transferred to the appropriation made in 2009 Iowa 31 Acts, chapter 182, section 24, to be used by the department 32 of human services for distribution to counties for state case 33 services for persons with mental illness, mental retardation, 34 and developmental disabilities for the fiscal year beginning 35 -6- LSB 5971XC (9) 83 jp/tm 6/ 9

S.F. _____ July 1, 2009, and ending June 30, 2010. 1 Sec. 13. EFFECTIVE UPON ENACTMENT. This Act, being deemed 2 of immediate importance, takes effect upon enactment. 3 EXPLANATION 4 This bill relates to public funding and regulatory matters 5 and makes and revises appropriations made for health and 6 human services for the fiscal year beginning July 1, 2009, by 7 switching the funding sources for various appropriations, as 8 adjusted for the governor’s uniform reduction in appropriations 9 made in executive order number 19. 10 The FY 2009-2010 appropriation in a multiyear appropriation 11 from the general fund made in 2008 Iowa Acts, chapter 1188, 12 for health coverage for children under the medical assistance 13 (Medicaid), hawk-i, and hawk-i expansion programs is increased. 14 The bill states that the changed amount incorporates the 15 uniform reduction made by the governor in executive order 16 number 19 and includes an allocation for supplemental dental 17 services under the hawk-i program. 18 A new Iowa Acts section of 2009 Iowa Acts, chapter 182, 19 providing appropriation for health and human services, 20 appropriates certain emergency contingent federal funding to 21 the department of human services for the family investment 22 program for FY 2009-2010. The source of the federal funding is 23 from the emergency contingency fund for temporary assistance 24 for needy families state program established pursuant to the 25 federal American Recovery and Reinvestment Act (ARRA) of 2009, 26 Pub. L. No. 111-5, § 2101. The appropriation is only to be 27 expended in the event that other state and federal funding 28 appropriated in the Act being amended for purposes of the 29 family investment program has been exhausted and is limited to 30 the amount necessary to fully fund the program for the fiscal 31 year. 32 The appropriation from the general fund for the Medicaid 33 program is reduced. The bill states that the changed amount 34 incorporates the uniform reduction made by the governor in 35 -7- LSB 5971XC (9) 83 jp/tm 7/ 9

S.F. _____ executive order number 19 and transfers made to and from this 1 appropriation. The language providing for transfer of Medicaid 2 funding to the state mental health institutes is amended to 3 clarify that the appropriation made from the ARRA funding for 4 the Medicaid program, as increased by the bill, is the funding 5 source for the transferred funding. 6 The appropriation from the general fund for child and 7 family services is reduced. The bill states that the changed 8 amount incorporates the uniform reduction made by the governor 9 in executive order number 19 and the transfer from this 10 appropriation. The allocation made for shelter care services 11 is increased to reflect the shift in the allocation of ARRA 12 funding. 13 The appropriation from the general fund for state case 14 services for persons with mental illness, mental retardation, 15 and developmental disabilities is reduced. The bill states 16 that the changed amount incorporates the uniform reduction made 17 by the governor in executive order number 19. 18 The appropriation from the general fund for the field 19 operations of the department of human services is reduced. The 20 bill states that the changed amount incorporates the uniform 21 reduction made by the governor in executive order number 19 and 22 the transfer from this appropriation. 23 The section of 2009 Iowa Acts, chapter 182, making 24 appropriations from the IowaCare account, is amended to provide 25 an additional appropriation of $2.5 million for distribution to 26 a publicly owned hospital in a county with a population over 27 350,000 for treatment of indigent patients and other services. 28 Various appropriations in 2009 Iowa Acts, chapter 183, 29 section 61, of ARRA funding for the department of human 30 services are amended. The appropriation for the Medicaid 31 program is increased and the appropriations for coverage of 32 children under the Medicaid and hawk-i programs, for the 33 property tax relief fund, and for child and family services are 34 eliminated. The ARRA appropriations that were eliminated are 35 -8- LSB 5971XC (9) 83 jp/tm 8/ 9

S.F. _____ replaced, as adjusted for the governor’s uniform appropriations 1 reduction, earlier in the bill with appropriations from the 2 general fund of the state. 3 An additional appropriation is made from ARRA funds to the 4 department of human services and any moneys remaining in the 5 risk pool on the division’s effective date are transferred to 6 be used for state case services. 7 The bill takes effect upon enactment. 8 -9- LSB 5971XC (9) 83 jp/tm 9/ 9