H.F. 2438 DIVISION I 1 AUTHENTICATION SYSTEM FOR PUBLIC ASSISTANCE PROGRAMS 2 Section 1. NEW SECTION . 239.1 Definitions. 3 As used in this chapter, unless the context otherwise 4 requires: 5 1. “Applicant” means an individual who is applying for 6 public assistance benefits in the state. 7 2. “Department” means the department of human services. 8 3. “Public assistance” means the food assistance program 9 as defined in section 234.1, the Medicaid program as defined 10 in section 249A.1, the family investment program as defined in 11 section 239B.1, and the children’s health insurance program. 12 Sec. 2. NEW SECTION . 239.2 Identity authentication —— 13 rules. 14 Unless otherwise prohibited by federal law or regulation, 15 prior to the department awarding public assistance benefits, an 16 applicant shall complete a computerized identity authentication 17 process to confirm the identity of the applicant. Identity 18 authentication shall be accomplished through a knowledge-based 19 questionnaire consisting of financial and personal questions. 20 The questionnaire shall contain questions tailored to assist 21 persons without a bank account or those who have poor access 22 to financial and banking services or who do not have an 23 established credit history. The computerized identity 24 authentication process and questionnaire may be completed and 25 submitted online, in person, or via telephone by the applicant 26 or a person authorized by the applicant. The department may 27 adopt rules pursuant to chapter 17A to administer this section. 28 Sec. 3. PROGRAM REPORT. The department of human services 29 shall submit a report to the governor and the general assembly 30 by January 15, 2024, and by January 15 annually thereafter 31 through January 15, 2029, detailing the impact of the identity 32 authentication measures taken under this division of this Act. 33 DIVISION II 34 FOOD ASSISTANCE AND MEDICAID PROGRAM INTEGRITY AND COOPERATION 35 -1- LSB 6217HV (2) 89 pf/rh 1/ 9

H.F. 2438 Sec. 4. NEW SECTION . 234.12B Ensuring integrity in the food 1 assistance program —— rules. 2 1. State records —— individuals. The department of 3 human services shall receive and review all of the following 4 information concerning individuals enrolled in the food 5 assistance program that indicates a change in circumstances 6 that may affect eligibility: 7 a. Death records. On at least a monthly basis, information 8 from the department of public health including but not limited 9 to death records. 10 b. Employment information. On at least a quarterly basis, 11 information from the department of workforce development 12 including but not limited to changes in employment or wages. 13 c. Residency information. On at least a monthly basis, 14 information including but not limited to potential changes in 15 residency as identified by out-of-state electronic benefit 16 transfer transactions. 17 d. Incarceration information. On at least a monthly basis, 18 information from the department of corrections. 19 2. State records —— households. The department of human 20 services shall receive and review all of the following 21 information concerning individuals in households enrolled 22 in the food assistance program that indicates a change in 23 circumstances that may affect eligibility: 24 a. Tax information. On at least a quarterly basis, 25 information from the department of revenue including but not 26 limited to potential changes in income, wages, or residency as 27 identified by tax records. 28 b. Unemployment information. On at least a semi-monthly 29 basis, information from the department of workforce development 30 including but not limited to potential changes in employment, 31 income, or assets. 32 3. Federal records —— households. The department of human 33 services shall cross-check information relating to individuals 34 in households enrolled in the food assistance program with 35 -2- LSB 6217HV (2) 89 pf/rh 2/ 9

H.F. 2438 federal databases including but not limited to all of the 1 following, on at least a monthly basis: 2 a. Earned income information, death register information, 3 incarceration records, supplemental security income 4 information, beneficiary records, earnings information, and 5 pension information maintained by the United States social 6 security administration. 7 b. Income and employment information maintained in the 8 national directory of new hires database and child support 9 enforcement data maintained by the United States department of 10 health and human services. 11 c. Payment and earnings information maintained by the United 12 States department of housing and urban development. 13 d. National fleeing felon information maintained by the 14 United States federal bureau of investigation. 15 4. Rules. The department of human services may adopt rules 16 pursuant to chapter 17A to administer this section. 17 Sec. 5. NEW SECTION . 234.12C Cooperation with child support 18 enforcement. 19 An applicant for food assistance program benefits shall be 20 required to cooperate with the child support recovery unit as a 21 condition of eligibility as specified in 7 C.F.R. §273.11(o). 22 Sec. 6. NEW SECTION . 249A.58 Ensuring integrity in the 23 medical assistance program —— recipient and applicant information 24 reviewed —— rules. 25 1. State records —— recipients. The department shall 26 receive and review all of the following information concerning 27 recipients that indicates a change in circumstances that may 28 affect eligibility: 29 a. Death records. On at least a monthly basis, information 30 from the department of public health including but not limited 31 to death records. 32 b. Employment information. On at least a quarterly basis, 33 information from the department of workforce development 34 including but not limited to changes in employment or wages. 35 -3- LSB 6217HV (2) 89 pf/rh 3/ 9

H.F. 2438 c. Residency information. On at least a monthly basis, 1 information including but not limited to potential changes in 2 residency as identified by out-of-state electronic benefit 3 transfer transactions. 4 d. Tax records. On at least a quarterly basis, information 5 from the department of revenue including but not limited to 6 potential changes in income, wages, or residency as identified 7 by tax records. 8 e. Unemployment information. On at least a semi-monthly 9 basis, information from the department of workforce development 10 including but not limited to potential changes in employment, 11 income, or assets. 12 2. Federal records —— recipients. The department shall 13 cross-check information relating to recipients with federal 14 databases including but not limited to all of the following, on 15 at least a monthly basis: 16 a. Earned income information, death register information, 17 incarceration records, supplemental security income 18 information, beneficiary records, earnings information, and 19 pension information maintained by the United States social 20 security administration. 21 b. Income and employment information maintained by the 22 national directory of new hires database and child support 23 enforcement data maintained by the United States department of 24 health and human services. 25 c. Payment and earnings information maintained by the United 26 States department of housing and urban development. 27 d. National fleeing felon information maintained by the 28 United States federal bureau of investigation. 29 3. Real-time record review —— applicants. Prior to 30 determining the eligibility of an applicant for Medicaid, the 31 department shall access information for every member of the 32 applicant’s household from the data sources specified in this 33 section and shall conduct a review of nationwide public records 34 data sources of physical asset ownership. The nationwide 35 -4- LSB 6217HV (2) 89 pf/rh 4/ 9

H.F. 2438 public records data sources may include but are not limited to 1 records of real property and automobiles, watercraft, aircraft, 2 luxury vehicles, and any other vehicles owned by the applicant. 3 4. Rules. The department may adopt rules pursuant to 4 chapter 17A to administer this section. 5 DIVISION III 6 IOWA HEALTH AND WELLNESS PLAN —— REENROLLMENT 7 Sec. 7. IOWA HEALTH AND WELLNESS PLAN —— MEMBER 8 REENROLLMENT FOLLOWING TERMINATION FOR NONPAYMENT OF MONTHLY 9 CONTRIBUTIONS. The department of human services shall seek 10 approval of an amendment to the section 1115 demonstration 11 waiver for the Iowa health and wellness plan from the centers 12 for Medicare and Medicaid services of the United States 13 department of health and human services to provide the 14 following: 15 1. An Iowa health and wellness plan member who is not 16 otherwise exempt from payment of a monthly contribution, who 17 is subject to payment of a monthly contribution as the result 18 of failure to complete required healthy behaviors, and whose 19 eligibility for the program is terminated due to nonpayment 20 of monthly contributions, shall be allowed to subsequently 21 reenroll in the program without first paying any outstanding 22 monthly contributions, if the member has not been terminated 23 from the program previously for nonpayment of monthly 24 contributions. 25 2. Following an initial termination from the Iowa health and 26 wellness program pursuant to subsection 1, if an Iowa health 27 and wellness plan member is subsequently terminated from the 28 program pursuant to subsection 1 for nonpayment of monthly 29 contributions, the member shall be subject to payment of any 30 outstanding monthly contributions accrued since the subsequent 31 termination not to exceed the aggregate annual copayment and 32 monthly contribution limits prior to reenrollment in the 33 program. 34 3. This section shall not apply to an Iowa health and 35 -5- LSB 6217HV (2) 89 pf/rh 5/ 9

H.F. 2438 wellness plan member who is deemed to be in substantial 1 compliance with the healthy behaviors requirement to complete a 2 wellness examination by providing proof of a scheduled wellness 3 examination appointment, if the appointment is scheduled 4 no later than ninety days beyond the end of the applicable 5 enrollment period. 6 DIVISION IV 7 IMPLEMENTATION PROVISIONS 8 Sec. 8. IMPLEMENTATION PROVISIONS. 9 1. The department of human services shall request federal 10 approval including for any state plan amendment or waiver 11 necessary to administer this Act. 12 2. If the department of human services determines that any 13 provision of this Act would result in the denial of funds or 14 services from the federal government that would otherwise be 15 available or would be inconsistent with the requirements of 16 federal law or regulation, such provision shall be suspended, 17 but only to the extent necessary to eliminate the inconsistency 18 with federal requirements. 19 3. The department of human services shall implement the 20 provisions of this Act in an incremental fashion, beginning 21 July 1, 2022, with a goal of full implementation no later 22 than June 30, 2024, to minimize duplication of efforts and to 23 maximize coordination with the implementation time frames of 24 other departmental resource enhancements. 25 EXPLANATION 26 The inclusion of this explanation does not constitute agreement with 27 the explanation’s substance by the members of the general assembly. 28 This bill relates to various public assistance programs 29 and includes provisions regarding authentication of public 30 assistance program applicant identity, integrity in and 31 cooperation between certain programs, and reenrollment 32 following member termination from the Iowa health and wellness 33 plan. 34 DIVISION I. The division requires that prior to the 35 -6- LSB 6217HV (2) 89 pf/rh 6/ 9

H.F. 2438 department of human services (DHS) awarding public assistance 1 benefits to an applicant, the applicant shall complete a 2 computerized identity authentication process to confirm the 3 identity of the applicant through the use of a knowledge-based 4 questionnaire consisting of financial and personal questions 5 tailored to assist persons without a bank account or those 6 who have poor access to financial and banking services or 7 who do not have an established credit history. The identity 8 authentication process and questionnaire may be submitted 9 online, in person, or via telephone by the applicant or a 10 person authorized by the applicant. The bill authorizes DHS to 11 adopt administrative rules to administer the bill and requires 12 DHS to submit an annual report to the governor and the general 13 assembly to assess the impact of the bill. 14 DIVISION II. The division relates to food assistance 15 program and Medicaid program integrity by requiring DHS 16 to, within specified time frames, receive and review state 17 and federal information from various entities concerning 18 individuals or individuals in households enrolled in the food 19 assistance program or the Medicaid program that indicates 20 a change in circumstances that may affect eligibility. 21 The information relates to death, employment, residency, 22 incarceration, tax, and unemployment information and involves 23 the provision of such information to DHS by the departments of 24 public health, workforce development, corrections, and revenue, 25 and information identified by out-of-state electronic benefit 26 transfer transactions. Additionally, the bill requires DHS to, 27 on at least a monthly basis, cross-check information relating 28 to individuals in households enrolled in the food assistance 29 program or the Medicaid program, as applicable, with specified 30 federal databases maintained by the United States social 31 security administration, the United States department of health 32 and human services, the United States department of housing 33 and urban development, and the United States federal bureau 34 of investigation. With regard to the Medicaid program only, 35 -7- LSB 6217HV (2) 89 pf/rh 7/ 9

H.F. 2438 the bill also requires that prior to determining eligibility 1 for the Medicaid program, DHS shall access information for 2 every member of an applicant’s household from the data sources 3 outlined in the bill and conduct a review of nationwide 4 public records data sources of physical asset ownership. The 5 data sources may include but are not limited to records of 6 real property and automobiles, watercraft, aircraft, luxury 7 vehicles, and any other vehicles owned by the applicant. The 8 bill also requires an applicant for food assistance program 9 benefits to cooperate with the child support recovery unit as a 10 condition of eligibility as specified under federal law. 11 DIVISION III. The division requires DHS to seek approval 12 of an amendment to the section 1115 demonstration waiver for 13 the Iowa health and wellness plan from the centers for Medicare 14 and Medicaid services of the United States department of 15 health and human services to provide both of the following: 16 (1) that an Iowa health and wellness plan member who is not 17 otherwise exempt from payment of a monthly contribution, who 18 is subject to payment of a monthly contribution as the result 19 of failure to complete required healthy behaviors, and whose 20 eligibility for the program is terminated due to nonpayment of 21 monthly contributions shall be allowed to subsequently reenroll 22 in the program without first paying any outstanding monthly 23 contributions, if the member has not been terminated from the 24 program previously for nonpayment of monthly contributions, and 25 (2) following an initial termination from the Iowa health and 26 wellness program, if an Iowa health and wellness plan member 27 is subsequently terminated from the program for nonpayment of 28 monthly contributions, the member shall be subject to payment 29 of any outstanding monthly contributions accrued since the 30 subsequent termination and not to exceed program limits prior 31 to reenrollment in the program. 32 The bill does not apply to an Iowa health and wellness plan 33 member who is deemed to be in substantial compliance with the 34 requirement to complete a wellness examination by providing 35 -8- LSB 6217HV (2) 89 pf/rh 8/ 9

H.F. 2438 proof of a scheduled examination appointment if the appointment 1 is scheduled no later than 90 days beyond the end of the 2 applicable enrollment period. 3 DIVISION IV. The division provides implementation 4 provisions for the bill. The bill requires DHS to request 5 federal approval including for any state plan amendment or 6 waiver necessary to administer the bill. If DHS determines 7 that any provision of the bill would result in the denial 8 of funds or services from the federal government that would 9 otherwise be available or would be inconsistent with the 10 requirements of federal law or regulation, such provision shall 11 be suspended, but only to the extent necessary to eliminate the 12 inconsistency with federal requirements. DHS shall implement 13 the provisions of the bill in an incremental fashion, beginning 14 July 1, 2022, with a goal of full implementation no later 15 than June 30, 2024, to minimize duplication of efforts and to 16 maximize coordination with the implementation time frames of 17 other departmental resource enhancements. 18 -9- LSB 6217HV (2) 89 pf/rh 9/ 9