House File 3 - Introduced HOUSE FILE 3 BY GRASSLEY , HOLT , GOLDING , WHEELER , STONE , DUNWELL , MOMMSEN , COLLINS , GUSTOFF , FISHER , MOORE , JENEARY , CARLSON , VONDRAN , STOLTENBERG , WULF , SHIPLEY , BRADLEY , SHERMAN , DEYOE , GRABER , WILLS , RINKER , P. THOMPSON , JOHNSON , HARRIS , BODEN , NORDMAN , SORENSEN , GEHLBACH , KAUFMANN , OSMUNDSON , THOMSON , M. THOMPSON , WOOD , HORA , WINDSCHITL , BOSSMAN , and GERHOLD A BILL FOR An Act relating to public assistance program integrity, making 1 appropriations, and including effective date provisions. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 1340YH (11) 90 pf/rh

H.F. 3 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. “Asset” or “asset test” means all assets of the members 8 of the applicant’s household, including all of the following: 9 a. All bank accounts, excluding retirement accounts of 10 members of the household. 11 b. All cash, excluding the first two thousand dollars of 12 members of the household. 13 c. All lottery and gambling income of the household whether 14 received as a lump sum or installment payments. 15 d. All real estate, excluding the primary household 16 residence and surrounding lot. 17 e. All other personal property excluding personal 18 belongings, household goods, and one vehicle. 19 3. “Department” means the department of health and human 20 services. 21 4. “Public assistance” means the supplemental nutrition 22 assistance program or SNAP, the medical assistance program 23 or Medicaid program as defined in section 249A.2, the family 24 investment program as defined in section 239B.1, and the 25 children’s health insurance program. 26 5. “Real-time eligibility system” means real-time electronic 27 access to a system that allows verification of all applicable 28 public assistance program eligibility information based on the 29 most recent information available to the department through 30 nonmodeled earned and unearned income, such as commercially 31 available wage data. 32 6. “Recipient” means an individual who is receiving public 33 assistance benefits in the state. 34 7. “Supplemental nutrition assistance program” or “SNAP” 35 -1- LSB 1340YH (11) 90 pf/rh 1/ 18

H.F. 3 means benefits provided by the federal program administered 1 through 7 C.F.R. pts. 270 – 283, as amended. 2 Sec. 2. NEW SECTION . 239.2 Identity authentication —— 3 rules. 4 Unless otherwise prohibited by federal law or regulation, 5 prior to the department awarding public assistance benefits, an 6 applicant shall complete a computerized identity authentication 7 process to confirm the identity of the applicant. Identity 8 authentication shall be accomplished through a knowledge-based 9 questionnaire consisting of financial and personal questions. 10 The questionnaire shall contain questions tailored to assist 11 persons without a bank account or those who have poor access 12 to financial and banking services or who do not have an 13 established credit history. The computerized identity 14 authentication process and questionnaire may be completed and 15 submitted online, in person, or via telephone by the applicant 16 or a person authorized by the applicant. The department may 17 adopt rules pursuant to chapter 17A to administer this section. 18 Sec. 3. NEW SECTION . 239.3 Asset test for supplemental 19 nutrition assistance program. 20 1. For the purposes of determining eligibility for receipt 21 of SNAP benefits, the department shall conduct an asset test 22 on all members of the applicant’s household. The allowable 23 financial resources to be included in or excluded from a 24 determination of eligibility for SNAP shall be those specified 25 in 7 U.S.C. §2014(g)(1). 26 2. Prior to determining eligibility for SNAP benefits, 27 the department shall access, at a minimum, for every member 28 of the applicant’s household, the following information from 29 the following federal, state, and miscellaneous sources, or 30 successor sources: 31 a. Federal sources and information: 32 (1) Earned and unearned income information maintained by 33 the internal revenue service. 34 (2) The following sources and information maintained by the 35 -2- LSB 1340YH (11) 90 pf/rh 2/ 18

H.F. 3 United States social security administration: 1 (a) Earned income information. 2 (b) Death register information. 3 (c) Prisoner or incarceration status information. 4 (d) Supplemental security income information maintained in 5 the state data exchange database. 6 (e) Beneficiary records and earnings information maintained 7 in the beneficiary and earnings data exchange database. 8 (f) Earnings and pension information maintained in the 9 beneficiary earnings exchange record system database. 10 (3) The following sources and information maintained by the 11 United States department of health and human services: 12 (a) Income and employment information maintained in the 13 national directory of new hires database by the office of child 14 support enforcement of the administration for children and 15 families. 16 (b) Other federal data sources maintained by the office of 17 child support enforcement of the administration for children 18 and families. 19 b. State sources and information: 20 (1) The department’s sources and information including but 21 not limited to all of the following: 22 (a) Income and employment information maintained by the 23 child support recovery unit. 24 (b) Child care assistance information maintained by the 25 department. 26 (c) Enrollment status in other public assistance programs. 27 (2) The department of workforce development sources and 28 information including all of the following: 29 (a) Employment information. 30 (b) Employer weekly, monthly, and quarterly reports of 31 income and unemployment insurance payments. 32 (3) The Iowa public employees’ retirement system for 33 earnings and pension information. 34 c. Miscellaneous sources: 35 -3- LSB 1340YH (11) 90 pf/rh 3/ 18

H.F. 3 (1) Any existing real-time database of persons currently 1 receiving benefits in other states, such as the national 2 accuracy clearinghouse. 3 (2) Any databases maintained by the Iowa lottery 4 commission. 5 (3) Any existing real-time eligibility system that includes 6 employment and income information maintained by a consumer 7 reporting agency, as defined by the federal Fair Credit 8 Reporting Act, 15 U.S.C. §1681a, for the purpose of obtaining 9 real-time employment and income information. 10 3. Prior to determining eligibility for SNAP benefits, the 11 department shall access information for every member of the 12 applicant’s household from the following public records: 13 a. A nationwide public records data source of physical asset 14 ownership. The data source may include but is not limited to 15 real property, automobiles, watercraft, aircraft, and luxury 16 vehicles, or any other vehicle owned by the applicant. 17 b. National and state financial institutions in order 18 to locate undisclosed depository accounts or verify account 19 balances of disclosed accounts. 20 4. The department shall enter into a memorandum of 21 understanding with any department, division, bureau, section, 22 unit, or any other subunit of a department to obtain the 23 information specified in this section. 24 5. The provisions of this section shall not apply if every 25 member of the applicant’s household receives supplemental 26 security income. 27 Sec. 4. PROGRAM REPORT. The department of health and human 28 services shall submit a report to the governor and the general 29 assembly by January 15, 2025, and by January 15 annually 30 thereafter through January 15, 2030, detailing the impact of 31 the identity authentication measures taken under this division 32 of this Act. 33 DIVISION II 34 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM AND MEDICAID PROGRAM 35 -4- LSB 1340YH (11) 90 pf/rh 4/ 18

H.F. 3 INTEGRITY AND COOPERATION 1 Sec. 5. Section 234.1, subsection 3, Code 2023, is amended 2 by striking the subsection. 3 Sec. 6. Section 234.1, Code 2023, is amended by adding the 4 following new subsections: 5 NEW SUBSECTION . 3A. “Department” means the department of 6 health and human services. 7 NEW SUBSECTION . 5A. “Supplemental nutrition assistance 8 program” or “SNAP” means the same as defined in section 239.1. 9 Sec. 7. Section 234.12A, Code 2023, is amended to read as 10 follows: 11 234.12A Electronic benefits transfer program. 12 1. The department of human services shall maintain an 13 electronic benefits transfer program utilizing electronic funds 14 transfer systems for the food supplemental nutrition assistance 15 program. The electronic benefits transfer program implemented 16 under this section shall not require a retailer to make cash 17 disbursements or to provide, purchase, or upgrade electronic 18 funds transfer system equipment as a condition of participation 19 in the program. 20 2. A point-of-sale terminal which is used only for purchases 21 from a retailer by electronic benefits transfer utilizing 22 electronic funds transfer systems is not a satellite terminal 23 as defined in section 527.2 . 24 3. For the purposes of this section , “retailer” means 25 a business authorized by the United States department of 26 agriculture to accept food supplemental nutrition assistance 27 program benefits. 28 Sec. 8. NEW SECTION . 234.12B Ensuring integrity in the 29 supplemental nutrition assistance program —— rules. 30 1. State records —— individuals. The department shall 31 receive and review all of the following information concerning 32 individuals enrolled in the supplemental nutrition assistance 33 program that indicates a change in circumstances that may 34 affect eligibility: 35 -5- LSB 1340YH (11) 90 pf/rh 5/ 18

H.F. 3 a. Death records. On at least a monthly basis, information 1 from the department including but not limited to death records. 2 b. Employment information. On at least a quarterly basis, 3 information from the department of workforce development 4 including but not limited to changes in employment or wages. 5 c. Residency information. On at least a monthly basis, 6 information including but not limited to potential changes in 7 residency as identified by out-of-state electronic benefit 8 transfer transactions. 9 d. Incarceration information. On at least a monthly basis, 10 information from the department of corrections. 11 2. State records —— households. The department shall 12 receive and review all of the following information concerning 13 individuals in households enrolled in the supplemental 14 nutrition assistance program that indicates a change in 15 circumstances that may affect eligibility: 16 a. Tax information. On at least a quarterly basis, 17 information from the department of revenue including but not 18 limited to potential changes in income, wages, or residency as 19 identified by tax records. 20 b. Unemployment information. On at least a semi-monthly 21 basis, information from the department of workforce development 22 including but not limited to potential changes in employment, 23 income, or assets. 24 3. Federal records —— households. The department shall 25 cross-check information relating to individuals in households 26 enrolled in the supplemental nutrition assistance program with 27 federal databases including but not limited to all of the 28 following, on at least a monthly basis: 29 a. Earned income information, death register information, 30 incarceration records, supplemental security income 31 information, beneficiary records, earnings information, and 32 pension information maintained by the United States social 33 security administration. 34 b. Income and employment information maintained in the 35 -6- LSB 1340YH (11) 90 pf/rh 6/ 18

H.F. 3 national directory of new hires database and child support 1 enforcement data maintained by the United States department of 2 health and human services. 3 c. Payment and earnings information maintained by the United 4 States department of housing and urban development. 5 d. National fleeing felon information maintained by the 6 United States federal bureau of investigation. 7 4. Rules. The department may adopt rules pursuant to 8 chapter 17A to administer this section. 9 Sec. 9. NEW SECTION . 234.12C Cooperation with child support 10 enforcement. 11 An applicant for supplemental nutrition assistance program 12 benefits shall be required to cooperate with the child support 13 recovery unit as a condition of eligibility as specified in 7 14 C.F.R. §273.11(o). 15 Sec. 10. NEW SECTION . 234.12D Required employment 16 and training for supplemental nutrition assistance program 17 eligibility. 18 The department shall not exercise the state option to 19 provide any exemptions from the employment and training 20 requirements as specified in 7 U.S.C. §2015(o)(6)(E). 21 Sec. 11. NEW SECTION . 249A.58 Ensuring integrity in the 22 medical assistance program —— recipient and applicant information 23 reviewed —— rules. 24 1. State records —— recipients. The department shall 25 receive and review all of the following information concerning 26 recipients that indicates a change in circumstances that may 27 affect eligibility: 28 a. Death records. On at least a monthly basis, information 29 from the department including but not limited to death records. 30 b. Employment information. On at least a quarterly basis, 31 information from the department of workforce development 32 including but not limited to changes in employment or wages. 33 c. Residency information. On at least a monthly basis, 34 information including but not limited to potential changes in 35 -7- LSB 1340YH (11) 90 pf/rh 7/ 18

H.F. 3 residency as identified by out-of-state electronic benefit 1 transfer transactions. 2 d. Tax records. On at least a quarterly basis, information 3 from the department of revenue including but not limited to 4 potential changes in income, wages, or residency as identified 5 by tax records. 6 e. Unemployment information. On at least a semi-monthly 7 basis, information from the department of workforce development 8 including but not limited to potential changes in employment, 9 income, or assets. 10 2. Federal records —— recipients. The department shall 11 cross-check information relating to recipients with federal 12 databases including but not limited to all of the following, on 13 at least a monthly basis: 14 a. Earned income information, death register information, 15 incarceration records, supplemental security income 16 information, beneficiary records, earnings information, and 17 pension information maintained by the United States social 18 security administration. 19 b. Income and employment information maintained by the 20 national directory of new hires database and child support 21 enforcement data maintained by the United States department of 22 health and human services. 23 c. Payment and earnings information maintained by the United 24 States department of housing and urban development. 25 d. National fleeing felon information maintained by the 26 United States federal bureau of investigation. 27 3. Real-time record review —— applicants. Prior to 28 determining the eligibility of an applicant for Medicaid, the 29 department shall access information for every member of the 30 applicant’s household from the data sources specified in this 31 section and shall conduct a review of nationwide public records 32 data sources of physical asset ownership. The nationwide 33 public records data sources may include but are not limited to 34 records of real property and automobiles, watercraft, aircraft, 35 -8- LSB 1340YH (11) 90 pf/rh 8/ 18

H.F. 3 luxury vehicles, and any other vehicles owned by the applicant. 1 4. Residency information —— applicants. Prior to determining 2 the eligibility of an applicant for Medicaid, the department 3 shall require proof of residency from the applicant. 4 5. Rules. The department may adopt rules pursuant to 5 chapter 17A to administer this section. 6 Sec. 12. MEDICAID PROGRAM WAIVER FROM USE OF AUTOMATIC 7 RENEWAL AND PREPOPULATED FORMS. The department of health 8 and human services shall request a Medicaid section 1115 9 demonstration waiver from the centers for Medicare and Medicaid 10 services of the United States department of health and human 11 services to enable the department to suspend the requirements 12 to use prepopulated eligibility renewal forms and to renew 13 eligibility automatically based on available information. 14 DIVISION III 15 IOWA HEALTH AND WELLNESS PLAN —— REENROLLMENT 16 Sec. 13. IOWA HEALTH AND WELLNESS PLAN —— MEMBER 17 REENROLLMENT FOLLOWING TERMINATION FOR NONPAYMENT OF MONTHLY 18 CONTRIBUTIONS. The department of health and human services 19 shall seek approval of an amendment to the section 1115 20 demonstration waiver for the Iowa health and wellness plan from 21 the centers for Medicare and Medicaid services of the United 22 States department of health and human services to provide the 23 following: 24 1. An Iowa health and wellness plan member who is not 25 otherwise exempt from payment of a monthly contribution, who 26 is subject to payment of a monthly contribution as the result 27 of failure to complete required healthy behaviors, and whose 28 eligibility for the program is terminated due to nonpayment 29 of monthly contributions, shall be allowed to subsequently 30 reenroll in the program without first paying any outstanding 31 monthly contributions, if the member has not been terminated 32 from the program previously for nonpayment of monthly 33 contributions. 34 2. Following an initial termination from the Iowa health 35 -9- LSB 1340YH (11) 90 pf/rh 9/ 18

H.F. 3 and wellness plan pursuant to subsection 1, if an Iowa health 1 and wellness plan member is subsequently terminated from the 2 program pursuant to subsection 1 for nonpayment of monthly 3 contributions, the member shall be subject to payment of any 4 outstanding monthly contributions accrued since the subsequent 5 termination not to exceed the aggregate annual copayment and 6 monthly contribution limits prior to reenrollment in the 7 program. 8 3. This section shall not apply to an Iowa health and 9 wellness plan member who is deemed to be in substantial 10 compliance with the healthy behaviors requirement to complete a 11 wellness examination by providing proof of a scheduled wellness 12 examination appointment, if the appointment is scheduled 13 no later than ninety days beyond the end of the applicable 14 enrollment period. 15 DIVISION IV 16 MEDICAID DEMONSTRATION WAIVER REQUEST —— IOWA HEALTH AND 17 WELLNESS PLAN 18 Sec. 14. MEDICAID DEMONSTRATION WAIVER REQUEST —— COMMUNITY 19 ENGAGEMENT REQUIREMENTS FOR IOWA HEALTH AND WELLNESS PLAN 20 MEMBERS. 21 1. The department of health and human services shall submit 22 a request by July 1, 2023, and annually by July 1 thereafter 23 until federal approval is received from the centers for 24 Medicare and Medicaid services of the United States department 25 of health and human services, for a section 1115 demonstration 26 waiver to require that as a condition of eligibility, Iowa 27 health and wellness plan members participate in community 28 engagement activities. 29 2. The waiver request submitted by the department shall 30 require that, unless an individual is exempt pursuant to 31 subsection 3, as a condition of eligibility for the Iowa health 32 and wellness plan, a recipient shall do one of the following: 33 a. Work twenty hours or more per week, averaged on a monthly 34 basis. 35 -10- LSB 1340YH (11) 90 pf/rh 10/ 18

H.F. 3 b. Participate in and comply with the requirements of a work 1 program for twenty hours or more per week, as determined by the 2 department. 3 c. Volunteer twenty hours or more per week, as determined 4 by the department. 5 d. Meet a combination of work and work program participation 6 requirements for a total of twenty hours or more per week, as 7 determined by the department. 8 e. Participate in and comply with the PROMISE JOBS program 9 pursuant to chapter 239B. 10 3. The following individuals shall be exempt from the 11 requirements specified in subsection 2: 12 a. An individual medically certified as physically or 13 mentally unfit for employment. 14 b. A woman who is pregnant. 15 c. A parent or caretaker responsible for the care of a 16 dependent child under one year of age. 17 d. A parent or caretaker personally providing the care for a 18 dependent child with a serious medical condition or disability, 19 as determined by the department. 20 e. An individual receiving unemployment compensation and 21 complying with work requirements of the federal or state 22 unemployment compensation system. 23 f. An individual participating in a substance use disorder 24 treatment and rehabilitation program. 25 4. The department shall implement the Medicaid waiver upon 26 receipt of federal approval and shall adopt rules pursuant to 27 chapter 17A to administer the waiver provisions. 28 DIVISION V 29 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— ELIGIBLE FOODS 30 Sec. 15. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— 31 ELIGIBLE FOODS. 32 1. The department of health and human services shall 33 request a waiver from the food and nutrition service of the 34 United States department of agriculture to provide that, for 35 -11- LSB 1340YH (11) 90 pf/rh 11/ 18

H.F. 3 the purposes of state administration of the supplemental 1 nutrition assistance program, eligible foods as defined in 7 2 C.F.R. §271.2 include only those items defined as supplemental 3 foods in 7 C.F.R. §246.2 as specified in the most current Iowa 4 special supplemental nutrition program for women, infants, and 5 children approved foods list. 6 2. The department of health and human services shall 7 implement the waiver upon receipt of approval of the waiver. 8 Sec. 16. DEPARTMENT OF AGRICULTURE AND LAND STEWARDSHIP 9 —— DOUBLE UP FOOD BUCKS PROGRAM —— SUPPLEMENTAL 10 APPROPRIATION. There is appropriated from the general fund of 11 the state to the department of agriculture and land stewardship 12 for the fiscal year beginning July 1, 2023, and ending June 13 30, 2024, in addition to any other funding appropriated for 14 such purpose for the same fiscal year, the following amount, 15 or so much thereof as is necessary, to be used for the purposes 16 designated: 17 To provide grants to support the double up food bucks 18 program administered by the Iowa healthiest state initiative 19 to make fresh fruits and vegetables sold at farmers markets, 20 grocery stores, and other participating locations accessible 21 to individuals and families who reside in this state and 22 receive assistance through the federal supplemental nutrition 23 assistance program: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 25 A grant recipient that receives funding pursuant to this 26 section shall provide at least a dollar-for-dollar match of the 27 grant assistance. 28 Notwithstanding section 8.33, moneys appropriated under this 29 section shall not revert at the close of the fiscal year, but 30 shall remain available for the purposes designated. 31 Sec. 17. CONTINGENT EFFECTIVE DATE. The following takes 32 effect on the date the department of health and human services 33 receives federal approval of the waiver request relating to 34 supplemental nutrition assistance program eligible foods as 35 -12- LSB 1340YH (11) 90 pf/rh 12/ 18

H.F. 3 specified under this division of this Act, if the waiver is 1 approved: 2 The section of this division of this Act making a 3 supplemental appropriation to the department of agriculture 4 and land stewardship to provide grants to support the double 5 up food bucks program. 6 DIVISION VI 7 IMPLEMENTATION PROVISIONS 8 Sec. 18. IMPLEMENTATION PROVISIONS. 9 1. The department of health and human services shall request 10 federal approval including for any state plan amendment or 11 waiver necessary to administer this Act. 12 2. If the department of health and human services determines 13 that any provision of this Act would result in the denial 14 of funds or services from the federal government that would 15 otherwise be available or would be inconsistent with the 16 requirements of federal law or regulation, such provision shall 17 be suspended, but only to the extent necessary to eliminate the 18 inconsistency with federal requirements. 19 3. Unless otherwise provided in a division of this Act, the 20 department of health and human services shall implement the 21 provisions of this Act in an incremental fashion, beginning 22 July 1, 2023, with a goal of full implementation no later 23 than June 30, 2025, to minimize duplication of efforts and to 24 maximize coordination with the implementation time frames of 25 other departmental resource enhancements. 26 4. The provisions of this Act requiring federal approval 27 shall be implemented upon receipt of federal approval. 28 5. The provisions of this Act not requiring federal approval 29 shall be implemented as specified in this Act, or if not 30 specified in this Act, no later than June 30, 2025. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill relates to various public assistance programs. 35 -13- LSB 1340YH (11) 90 pf/rh 13/ 18

H.F. 3 DIVISION I. This division requires that prior to the 1 department of health and human services (HHS) awarding public 2 assistance benefits to an applicant, the applicant shall 3 complete a computerized identity authentication process to 4 confirm the identity of the applicant through the use of a 5 knowledge-based questionnaire consisting of financial and 6 personal questions tailored to assist persons without a bank 7 account or those who have poor access to financial and banking 8 services or who do not have an established credit history. 9 The identity authentication process and questionnaire may be 10 submitted online, in person, or via telephone by the applicant 11 or a person authorized by the applicant. The bill also 12 requires HHS to conduct an asset test on all members of the 13 household of an applicant for supplemental nutrition assistance 14 program (SNAP) benefits. The bill specifies the minimum 15 information, federal, state, and other data sources, and public 16 records that HHS must access prior to determining eligibility 17 for an applicant’s SNAP benefits. The bill requires HHS to 18 enter into a memorandum of understanding with any department or 19 subunit of a department to obtain the information specified. 20 The bill’s provisions do not apply if every member of the 21 applicant’s household receives supplemental security income. 22 The bill authorizes HHS to adopt administrative rules to 23 administer the bill and requires HHS to submit an annual report 24 to the governor and the general assembly to assess the impact 25 of the bill. 26 DIVISION II. This division relates to SNAP and Medicaid 27 program integrity by requiring HHS to, within specified time 28 frames, receive and review state and federal information 29 from various entities concerning individuals or individuals 30 in households enrolled in the SNAP or the Medicaid program 31 that indicates a change in circumstances that may affect 32 eligibility. The information relates to death, employment, 33 residency, incarceration, tax, and unemployment information 34 and involves the provision of such information to HHS by the 35 -14- LSB 1340YH (11) 90 pf/rh 14/ 18

H.F. 3 departments of workforce development, corrections, and revenue, 1 and information identified by out-of-state electronic benefit 2 transfer transactions. Additionally, the bill requires HHS to, 3 on at least a monthly basis, cross-check information relating 4 to individuals in households enrolled in SNAP or the Medicaid 5 program, as applicable, with specified federal databases 6 maintained by the United States social security administration, 7 the United States department of health and human services, the 8 United States department of housing and urban development, and 9 the United States federal bureau of investigation. With regard 10 to the Medicaid program only, the bill also requires that prior 11 to determining eligibility for the Medicaid program, HHS shall 12 access information for every member of an applicant’s household 13 from the data sources outlined in the bill and conduct a review 14 of nationwide public records data sources of physical asset 15 ownership. The data sources may include but are not limited to 16 records of real property and automobiles, watercraft, aircraft, 17 luxury vehicles, and any other vehicles owned by the applicant. 18 An applicant for Medicaid must also provide proof of residency. 19 The bill also requires an applicant for SNAP benefits to 20 cooperate with the child support recovery unit as a condition 21 of eligibility as specified under federal law. 22 The bill also directs HHS to request federal approval 23 for a Medicaid section 1115 demonstration waiver to suspend 24 requirements to use prepopulated eligibility renewal forms 25 and to renew eligibility automatically based on available 26 information. 27 DIVISION III. This division requires HHS to seek federal 28 approval of an amendment to the section 1115 demonstration 29 waiver for the Iowa health and wellness plan to provide both 30 of the following: (1) that an Iowa health and wellness 31 plan member who is not otherwise exempt from payment of a 32 monthly contribution, who is subject to payment of a monthly 33 contribution as the result of failure to complete required 34 healthy behaviors, and whose eligibility for the program is 35 -15- LSB 1340YH (11) 90 pf/rh 15/ 18

H.F. 3 terminated due to nonpayment of monthly contributions shall be 1 allowed to subsequently reenroll in the program without first 2 paying any outstanding monthly contributions, if the member has 3 not been terminated from the program previously for nonpayment 4 of monthly contributions, and (2) following an initial 5 termination from the Iowa health and wellness plan, if an Iowa 6 health and wellness plan member is subsequently terminated 7 from the program for nonpayment of monthly contributions, the 8 member shall be subject to payment of any outstanding monthly 9 contributions accrued since the subsequent termination and not 10 to exceed program limits prior to reenrollment in the program. 11 The bill does not apply to an Iowa health and wellness plan 12 member who is deemed to be in substantial compliance with the 13 requirement to complete a wellness examination by providing 14 proof of a scheduled examination appointment if the appointment 15 is scheduled no later than 90 days beyond the end of the 16 applicable enrollment period. 17 DIVISION IV. This division requires HHS to submit a request 18 for federal approval by July 1, 2023, and annually by July 1, 19 thereafter until federal approval is received, for a waiver 20 to require that as a condition of eligibility, Iowa health 21 and wellness plan members participate in community engagement 22 activities. The bill specifies the types of community 23 engagement activities to be required under the waiver submitted 24 and provides exceptions to required participation in community 25 engagement activities. The bill directs HHS to implement 26 the waiver upon receipt of federal approval and to adopt 27 administrative rules to administer the waiver provisions. 28 DIVISION V. This division requires HHS to request a waiver 29 from the United States department of agriculture, food and 30 nutrition service, to provide that the eligible foods under 31 the state administration of SNAP only include those items 32 defined as supplemental foods in the most current Iowa special 33 supplemental nutrition program for women, infants, and children 34 (WIC) approved food list. The department is directed to 35 -16- LSB 1340YH (11) 90 pf/rh 16/ 18

H.F. 3 implement the waiver upon receipt of approval of the waiver. 1 The division also relates to the double up food bucks 2 program by making a supplemental appropriation from the general 3 fund of the state to the department of agriculture and land 4 stewardship for fiscal year 2023-2024, in addition to any other 5 funding appropriated for such purpose for the same fiscal 6 year, to provide grants to support the double up food bucks 7 program administered by the Iowa healthiest state initiative 8 to make fresh fruits and vegetables sold at farmers markets, 9 grocery stores, and other participating locations accessible to 10 individuals and families who reside in this state and receive 11 assistance through SNAP. The division requires a double 12 up food bucks program grant recipient to provide at least 13 a dollar-for-dollar match of the grant assistance. Moneys 14 appropriated under the division do not revert at the close of 15 the fiscal year but remain available for the purposes of the 16 double up food bucks program. 17 The supplemental appropriation for the double up food bucks 18 program takes effect on the date HHS receives federal approval 19 of the SNAP waiver, if the waiver is approved. 20 DIVISION VI. This division provides implementation 21 provisions for the bill. The bill requires HHS to request 22 federal approval including for any state plan amendment or 23 waiver necessary to administer the bill. If HHS determines 24 that any provision of the bill would result in the denial 25 of funds or services from the federal government that would 26 otherwise be available or would be inconsistent with the 27 requirements of federal law or regulation, such provision shall 28 be suspended, but only to the extent necessary to eliminate 29 the inconsistency with federal requirements. Unless otherwise 30 provided in a division of the bill, HHS shall implement the 31 provisions of the bill in an incremental fashion, beginning 32 July 1, 2023, with a goal of full implementation no later 33 than June 30, 2025, to minimize duplication of efforts and to 34 maximize coordination with the implementation time frames of 35 -17- LSB 1340YH (11) 90 pf/rh 17/ 18