H.F. 613 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” means the following assets of the members of the 8 applicant’s household: 9 a. All liquid assets. 10 b. All other personal property excluding one vehicle and 11 the fair market value in excess of ten thousand dollars of an 12 additional vehicle. 13 3. “Asset test” means the comparison of the collective 14 value of all countable assets of the members of the applicant’s 15 household to the maximum allowed household asset limit of 16 fifteen thousand dollars. 17 4. “Department” means the department of health and human 18 services. 19 5. “Public assistance” means the supplemental nutrition 20 assistance program or SNAP, the medical assistance program 21 or Medicaid program as defined in section 249A.2, the family 22 investment program as defined in section 239B.1, and the 23 children’s health insurance program. 24 6. “Real-time eligibility system” means real-time electronic 25 access to a system that allows verification of all applicable 26 public assistance program eligibility information based on the 27 most recent information available to the department through 28 nonmodeled earned and unearned income, such as commercially 29 available wage data. 30 7. “Recipient” means an individual who is receiving public 31 assistance benefits in the state. 32 8. “Supplemental nutrition assistance program” or “SNAP” 33 means benefits provided by the federal program administered 34 through 7 C.F.R. pts. 270 – 283, as amended. 35 -1- LSB 1340HV (5) 90 pf/rh 1/ 18

H.F. 613 Sec. 2. NEW SECTION . 239.2 Supplemental nutrition 1 assistance program —— income eligibility. 2 The department shall establish the gross countable monthly 3 income threshold for the supplemental nutrition assistance 4 program at less than or equal to one hundred sixty percent of 5 the federal poverty level for the household size. 6 Sec. 3. NEW SECTION . 239.3 Identity authentication —— 7 rules. 8 Unless otherwise prohibited by federal law or regulation, 9 prior to the department awarding public assistance benefits, an 10 applicant shall complete a computerized identity authentication 11 process to confirm the identity of the applicant. Identity 12 authentication shall be accomplished through a knowledge-based 13 questionnaire consisting of financial and personal questions. 14 The questionnaire shall contain questions tailored to assist 15 persons without a bank account or those who have poor access 16 to financial and banking services or who do not have an 17 established credit history. The computerized identity 18 authentication process and questionnaire may be completed and 19 submitted online, in person, or via telephone by the applicant 20 or a person authorized by the applicant. The department may 21 adopt rules pursuant to chapter 17A to administer this section. 22 Sec. 4. NEW SECTION . 239.4 Asset test for supplemental 23 nutrition assistance program. 24 1. For the purposes of determining eligibility for receipt 25 of SNAP benefits, the department shall conduct an asset test 26 on all members of the applicant’s household. The allowable 27 financial resources to be included in or excluded from a 28 determination of eligibility for SNAP shall be those specified 29 in 7 U.S.C. §2014(g)(l), to the extent consistent with the term 30 “asset” as defined in this chapter. 31 2. Prior to determining eligibility for SNAP benefits, 32 the department shall access, at a minimum, for every member 33 of the applicant’s household, the following information from 34 the following federal, state, and miscellaneous sources, or 35 -2- LSB 1340HV (5) 90 pf/rh 2/ 18

H.F. 613 successor sources: 1 a. Federal sources and information: 2 (1) Earned and unearned income information maintained by 3 the internal revenue service. 4 (2) The following sources and information maintained by the 5 United States social security administration: 6 (a) Earned income information. 7 (b) Death register information. 8 (c) Prisoner or incarceration status information. 9 (d) Supplemental security income information maintained in 10 the state data exchange database. 11 (e) Beneficiary records and earnings information maintained 12 in the beneficiary and earnings data exchange database. 13 (f) Earnings information maintained in the beneficiary 14 earnings exchange record system database. 15 (3) Income and employment information maintained in the 16 national directory of new hires database by the office of child 17 support enforcement of the administration for children and 18 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 c. Miscellaneous sources: 33 (1) Any existing real-time database of persons currently 34 receiving benefits in other states, such as the national 35 -3- LSB 1340HV (5) 90 pf/rh 3/ 18

H.F. 613 accuracy clearinghouse. 1 (2) Any lottery winner databases maintained by the Iowa 2 1ottery. 3 (3) Any existing real-time eligibility system that includes 4 employment and income information maintained by a consumer 5 reporting agency, as defined by the federal Fair Credit 6 Reporting Act, 15 U.S.C. §1681a, for the purpose of obtaining 7 real-time employment and income information. 8 3. Prior to determining eligibility for SNAP benefits, the 9 department shall access information for every member of the 10 applicant’s household from the following public records: 11 a. A nationwide public records data source of physical asset 12 ownership. The data source may include but is not limited to 13 real property, automobiles, watercraft, aircraft, and luxury 14 vehicles, or any other vehicle owned by the applicant. 15 b. National and state financial institutions in order 16 to locate undisclosed depository accounts or verify account 17 balances of disclosed accounts. 18 4. The department shall enter into a memorandum of 19 understanding with any department, division, bureau, section, 20 unit, or any other subunit of a department to obtain the 21 information specified in this section. 22 5. The provisions of this section shall not apply if every 23 member of the applicant’s household receives supplemental 24 security income. 25 Sec. 5. NEW SECTION . 239.5 Verification and authentication 26 systems —— public assistance programs. 27 1. No later than July 1, 2025, the department shall 28 redesign an existing system; establish a new computerized 29 income, asset, and identity eligibility verification system; 30 or contract with a third-party vendor to provide for identity 31 verification, identity authentication, asset verification, and 32 dual enrollment prevention in order to deter waste, fraud, and 33 abuse in each public assistance program administered by the 34 department. 35 -4- LSB 1340HV (5) 90 pf/rh 4/ 18

H.F. 613 2. The department may contract with a third-party vendor 1 to develop or provide a service for a real-time eligibility 2 system that allows the department to verify or authenticate 3 income, assets, and identity eligibility of applicants and 4 recipients to prevent fraud, misrepresentation, and inadequate 5 documentation when determining eligibility for public 6 assistance programs. The system shall be accessed prior to 7 determining eligibility, periodically between eligibility 8 redeterminations, and during eligibility redeterminations 9 and reviews. The department may also contract with a 10 third-party vendor to provide information to facilitate 11 reviews of recipient eligibility conducted by the department. 12 Specifically, the department may contract with a third-party 13 consumer reporting agency, as defined by the federal Fair 14 Credit Reporting Act, 15 U.S.C. §1681a, for the purpose of 15 obtaining real-time employment and income information. 16 3. A contract entered into under this section shall provide, 17 at a minimum, for all of the following: 18 a. The establishment of the annual savings amount from 19 utilization of the system or service, and a provision that the 20 contract may be terminated contingent upon the savings not 21 exceeding the total yearly cost to the state for utilization of 22 the system or service. 23 b. That the contract shall not preclude the department 24 from continuing to conduct additional eligibility verification 25 or authentication processes, to receive, review, or verify 26 additional information related to the eligibility of an 27 individual, or from contracting with a third-party vendor to 28 provide additional eligibility authentication or verification 29 information. 30 4. The department shall seek federal approval as necessary 31 to implement and administer this section. 32 Sec. 6. PROGRAM REPORT. The department of health and human 33 services shall submit a report to the governor and the general 34 assembly by January 15, 2025, and by January 15 annually 35 -5- LSB 1340HV (5) 90 pf/rh 5/ 18

H.F. 613 thereafter through January 15, 2030, detailing the impact of 1 the identity authentication measures taken under this division 2 of this Act. 3 DIVISION II 4 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM AND MEDICAID PROGRAM 5 INTEGRITY AND COOPERATION 6 Sec. 7. Section 234.1, subsection 3, Code 2023, is amended 7 by striking the subsection. 8 Sec. 8. Section 234.1, Code 2023, is amended by adding the 9 following new subsections: 10 NEW SUBSECTION . 3A. “Department” means the department of 11 health and human services. 12 NEW SUBSECTION . 5A. “Supplemental nutrition assistance 13 program” or “SNAP” means the same as defined in section 239.1. 14 Sec. 9. Section 234.12A, Code 2023, is amended to read as 15 follows: 16 234.12A Electronic benefits transfer program. 17 1. The department of human services shall maintain an 18 electronic benefits transfer program utilizing electronic funds 19 transfer systems for the food supplemental nutrition assistance 20 program. The electronic benefits transfer program implemented 21 under this section shall not require a retailer to make cash 22 disbursements or to provide, purchase, or upgrade electronic 23 funds transfer system equipment as a condition of participation 24 in the program. 25 2. A point-of-sale terminal which is used only for purchases 26 from a retailer by electronic benefits transfer utilizing 27 electronic funds transfer systems is not a satellite terminal 28 as defined in section 527.2 . 29 3. For the purposes of this section , “retailer” means 30 a business authorized by the United States department of 31 agriculture to accept food supplemental nutrition assistance 32 program benefits. 33 Sec. 10. NEW SECTION . 234.12B Ensuring integrity in the 34 supplemental nutrition assistance program —— rules. 35 -6- LSB 1340HV (5) 90 pf/rh 6/ 18

H.F. 613 1. State records —— individuals. The department shall 1 receive and review all of the following information concerning 2 individuals enrolled in the supplemental nutrition assistance 3 program that indicates a change in circumstances that may 4 affect eligibility: 5 a. Death records. On at least a daily basis, information 6 from the department including but not limited to death records. 7 b. Employment information. On at least a semimonthly 8 basis, information from the department of workforce development 9 including but not limited to changes in employment or wages. 10 c. Residency information. On at least a monthly basis, 11 information to confirm Iowa residency or to identify potential 12 changes in Iowa residency as identified through an automated 13 search process of a database of addresses. 14 d. Incarceration information. On at least a monthly basis, 15 information from the department of corrections. 16 2. State records —— households —— unemployment 17 information. The department shall receive and review on at 18 least a semimonthly basis, information from the department of 19 workforce development including but not limited to potential 20 changes in employment, income, or assets that indicate a change 21 in circumstances that may affect eligibility. 22 3. Federal records —— households. The department shall 23 cross-check information relating to individuals in households 24 enrolled in the supplemental nutrition assistance program with 25 federal databases including but not limited to all of the 26 following, on at least a monthly basis: 27 a. Earned income information, death register information, 28 incarceration records, supplemental security income 29 information, beneficiary records, and earnings information 30 maintained by the United States social security administration. 31 b. Income and employment information maintained in the 32 national directory of new hires database and child support 33 enforcement data maintained by the United States department of 34 health and human services. 35 -7- LSB 1340HV (5) 90 pf/rh 7/ 18

H.F. 613 c. National fleeing felon information maintained by the 1 United States federal bureau of investigation. 2 4. Rules. The department may adopt rules pursuant to 3 chapter 17A to administer this section. 4 Sec. 11. NEW SECTION . 234.12C Required employment 5 and training for supplemental nutrition assistance program 6 eligibility. 7 The department shall require all able-bodied adults without 8 dependents to participate in mandatory employment and training 9 as a condition of eligibility for supplemental nutrition 10 assistance program benefits. 11 Sec. 12. NEW SECTION . 249A.58 Ensuring integrity in the 12 medical assistance program —— recipient and applicant information 13 reviewed —— rules. 14 1. State records —— recipients. The department shall 15 receive and review all of the following information concerning 16 recipients that indicates a change in circumstances that may 17 affect eligibility: 18 a. Death records. On at least a daily basis, information 19 from the department including but not limited to death records. 20 b. Employment information. On at least a semimonthly 21 basis, information from the department of workforce development 22 including but not limited to changes in employment or wages. 23 c. Residency information. On at least a monthly basis, 24 information to confirm Iowa residency or to identify potential 25 changes in Iowa residency as identified through an automated 26 search process of a database of addresses. 27 d. Unemployment information. On at least a semimonthly 28 basis, information from the department of workforce development 29 including but not limited to potential changes in employment, 30 income, or assets. 31 2. Federal records —— recipients. The department shall 32 cross-check information relating to recipients with federal 33 databases including but not limited to all of the following, on 34 at least a monthly basis: 35 -8- LSB 1340HV (5) 90 pf/rh 8/ 18

H.F. 613 a. Earned income information, death register information, 1 incarceration records, supplemental security income 2 information, beneficiary records, and earnings information 3 maintained by the United States social security administration. 4 b. Income and employment information maintained by the 5 national directory of new hires database and child support 6 enforcement data maintained by the United States department of 7 health and human services. 8 c. National fleeing felon information maintained by the 9 United States federal bureau of investigation. 10 3. Real-time record review —— applicants. Prior to 11 determining the eligibility of an applicant subject to an asset 12 test for Medicaid, the department shall access information 13 for every member of the applicant’s household from the data 14 sources specified in this section and shall conduct a review 15 of nationwide public records data sources of physical asset 16 ownership. The nationwide public records data sources may 17 include but are not limited to records of real property and 18 automobiles, watercraft, aircraft, luxury vehicles, and any 19 other vehicles owned by the applicant. 20 4. Rules. The department may adopt rules pursuant to 21 chapter 17A to administer this section. 22 Sec. 13. NEW SECTION . 249A.59 Cooperation with child 23 support services. 24 1. Unless exempt pursuant to state or federal law or 25 regulation, an applicant for or recipient of medical assistance 26 shall be required to cooperate with child support services as a 27 condition of eligibility. 28 2. The department shall adopt rules pursuant to chapter 17A 29 to administer this section. 30 Sec. 14. MEDICAID —— REASONABLE COMPATIBILITY STANDARD 31 INCOME THRESHOLD —— DETERMINATION OF ELIGIBILITY. The 32 department of health and human services shall reduce the 33 reasonable compatibility income threshold standard from ten 34 percent to five percent when the department is determining 35 -9- LSB 1340HV (5) 90 pf/rh 9/ 18

H.F. 613 eligibility for medical assistance, and shall continue to 1 utilize income data sources as a tool in the eligibility 2 determination process. The department of health and human 3 services shall request any federal approval necessary, 4 including any Medicaid state plan amendment or waiver, to 5 administer this section. 6 DIVISION III 7 IOWA HEALTH AND WELLNESS PLAN —— REENROLLMENT 8 Sec. 15. IOWA HEALTH AND WELLNESS PLAN —— MEMBER 9 REENROLLMENT FOLLOWING TERMINATION FOR NONPAYMENT OF MONTHLY 10 CONTRIBUTIONS. The department of health and human services 11 shall seek approval of an amendment to the section 1115 12 demonstration waiver for the Iowa health and wellness plan from 13 the centers for Medicare and Medicaid services of the United 14 States department of health and human services to provide the 15 following: 16 1. 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 21 of monthly contributions, shall be allowed to subsequently 22 reenroll in the program without first paying any outstanding 23 monthly contributions, if the member has not been terminated 24 from the program previously for nonpayment of monthly 25 contributions. 26 2. Following an initial termination from the Iowa health 27 and wellness plan pursuant to subsection 1, if an Iowa health 28 and wellness plan member is subsequently terminated from the 29 program pursuant to subsection 1 for nonpayment of monthly 30 contributions, the member shall be subject to payment of any 31 outstanding monthly contributions accrued since the subsequent 32 termination not to exceed the aggregate annual copayment and 33 monthly contribution limits prior to reenrollment in the 34 program. 35 -10- LSB 1340HV (5) 90 pf/rh 10/ 18

H.F. 613 3. This section shall not apply to an Iowa health and 1 wellness plan member who is deemed to be in substantial 2 compliance with the healthy behaviors requirement to complete a 3 wellness examination by providing proof of a scheduled wellness 4 examination appointment, if the appointment is scheduled 5 no later than ninety days beyond the end of the applicable 6 enrollment period. 7 DIVISION IV 8 MEDICAID DEMONSTRATION WAIVER REQUEST —— IOWA HEALTH AND 9 WELLNESS PLAN 10 Sec. 16. MEDICAID DEMONSTRATION WAIVER REQUEST —— COMMUNITY 11 ENGAGEMENT REQUIREMENTS FOR IOWA HEALTH AND WELLNESS PLAN 12 MEMBERS. 13 1. The department of health and human services shall submit 14 a request by July 1, 2023, and annually by July 1 thereafter 15 until federal approval is received from the centers for 16 Medicare and Medicaid services of the United States department 17 of health and human services, for a section 1115 demonstration 18 waiver to require that as a condition of eligibility, Iowa 19 health and wellness plan members participate in community 20 engagement activities. 21 2. The waiver request submitted by the department shall 22 require that, unless an individual is exempt pursuant to 23 subsection 3, as a condition of eligibility for the Iowa health 24 and wellness plan, a recipient shall do one of the following: 25 a. Work twenty hours or more per week, averaged on a monthly 26 basis. 27 b. Participate in and comply with the requirements of a work 28 program for twenty hours or more per week, as determined by the 29 department. 30 c. Volunteer twenty hours or more per week, as determined 31 by the department. 32 d. Meet a combination of work and work program participation 33 requirements for a total of twenty hours or more per week, as 34 determined by the department. 35 -11- LSB 1340HV (5) 90 pf/rh 11/ 18

H.F. 613 e. Participate in and comply with the PROMISE JOBS program 1 pursuant to chapter 239B. 2 3. The following individuals shall be exempt from the 3 requirements specified in subsection 2: 4 a. An individual medically certified as physically or 5 mentally unfit for employment. 6 b. A woman who is pregnant. 7 c. A parent or caretaker responsible for the care of a 8 dependent child under six years of age. 9 d. A parent or caretaker personally providing the care for a 10 dependent child with a serious medical condition or disability, 11 as determined by the department. 12 e. An individual receiving unemployment compensation and 13 complying with work requirements of the federal or state 14 unemployment compensation system. 15 f. An individual participating in a substance use disorder 16 treatment and rehabilitation program. 17 4. The department shall implement the Medicaid waiver upon 18 receipt of federal approval and shall adopt rules pursuant to 19 chapter 17A to administer the waiver provisions. 20 DIVISION V 21 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— ELIGIBLE FOODS 22 Sec. 17. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— 23 INELIGIBLE FOODS. The department of health and human services 24 shall request a waiver from the food and nutrition service of 25 the United States department of agriculture to provide that 26 for the purposes of state administration of the supplemental 27 food and nutrition program, eligible foods as defined in 7 28 C.F.R. §271.2 do not include candy and non-sugar-free soda. 29 The department of health and human services shall implement the 30 waiver upon receipt of approval of the waiver. 31 Sec. 18. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— DOUBLE 32 UP FOOD BUCKS PROGRAM —— SUPPLEMENTAL APPROPRIATION. There 33 is appropriated from the general fund of the state to the 34 department of health and human services for the fiscal year 35 -12- LSB 1340HV (5) 90 pf/rh 12/ 18

H.F. 613 beginning July 1, 2023, and ending June 30, 2024, in addition 1 to any other funding appropriated for such purposes for the 2 same fiscal year, the following amount or so much thereof as is 3 necessary, to be used for the purposes designated: 4 To provide grants to support the double up food bucks 5 program administered by the Iowa healthiest state initiative 6 to make fresh fruits and vegetables sold at farmers markets, 7 grocery stores, and other participating locations accessible 8 to individuals and families who reside in this state and 9 receive assistance through the federal supplemental nutrition 10 assistance program: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 12 A grant recipient that receives funding pursuant to this 13 section shall provide at least a dollar-for-dollar match of the 14 grant assistance. 15 Notwithstanding section 8.33, moneys appropriated under this 16 section shall not revert at the close of the fiscal year, but 17 shall remain available for the purposes designated. 18 Sec. 19. CONTINGENT EFFECTIVE DATE. The following takes 19 effect on the date the department of health and human services 20 receives federal approval of the waiver request relating to 21 supplemental nutrition assistance program ineligible foods as 22 specified under this division of this Act, if the waiver is 23 approved: 24 The section of this division of this Act making a 25 supplemental appropriation to the department of health and 26 human services to provide grants to support the double up food 27 bucks program. 28 DIVISION VI 29 IMPLEMENTATION PROVISIONS 30 Sec. 20. IMPLEMENTATION PROVISIONS. 31 1. The department of health and human services shall request 32 federal approval including for any state plan amendment or 33 waiver necessary to administer this Act. 34 2. If the department of health and human services determines 35 -13- LSB 1340HV (5) 90 pf/rh 13/ 18

H.F. 613 that any provision of this Act would result in the denial 1 of funds or services from the federal government that would 2 otherwise be available or would be inconsistent with the 3 requirements of federal law or regulation, such provision shall 4 be suspended, but only to the extent necessary to eliminate the 5 inconsistency with federal requirements. 6 3. Unless otherwise provided in a division of this Act, the 7 department of health and human services shall implement the 8 provisions of this Act in an incremental fashion, beginning 9 July 1, 2023, with a goal of full implementation no later 10 than June 30, 2025, to minimize duplication of efforts and to 11 maximize coordination with the implementation time frames of 12 other departmental resource enhancements. 13 4. The provisions of this Act requiring federal approval 14 shall be implemented upon receipt of federal approval. 15 5. The provisions of this Act not requiring federal approval 16 shall be implemented as specified in this Act, or if not 17 specified in this Act, no later than June 30, 2025. 18 EXPLANATION 19 The inclusion of this explanation does not constitute agreement with 20 the explanation’s substance by the members of the general assembly. 21 This bill relates to various public assistance programs. 22 DIVISION I. This division establishes the income threshold 23 for the supplemental nutrition assistance program (SNAP) at 24 less than or equal to 160 percent of the federal poverty level. 25 The division also requires that prior to the department of 26 health and human services (HHS) awarding public assistance 27 benefits to an applicant, the applicant shall complete a 28 computerized identity authentication process to confirm the 29 identity of the applicant through the use of a knowledge-based 30 questionnaire consisting of financial and personal questions 31 tailored to assist persons without a bank account or those 32 who have poor access to financial and banking services or who 33 do not have an established credit history. The computerized 34 identity authentication process and questionnaire may be 35 -14- LSB 1340HV (5) 90 pf/rh 14/ 18

H.F. 613 submitted online, in person, or via telephone by the applicant 1 or a person authorized by the applicant. The bill also 2 requires HHS to conduct an asset test on all members of 3 the household of an applicant for SNAP benefits. The bill 4 specifies the minimum information, federal, state, and other 5 data sources, and public records that HHS must access prior to 6 determining eligibility for an applicant’s SNAP benefits. The 7 bill requires HHS to enter into a memorandum of understanding 8 with any department or subunit of a department to obtain the 9 information specified. The bill’s provisions do not apply if 10 every member of the applicant’s household receives supplemental 11 security income. 12 The bill provides that no later than July 1, 2025, HHS 13 shall redesign an existing system, establish a new identity 14 eligibility verification system, or contract with a third-party 15 vendor to provide verification, authentication, and dual 16 enrollment prevention systems for public assistance programs. 17 The department may also contract with a third-party vendor 18 to develop or provide a real-time eligibility system. All 19 contracts are subject to minimum requirements specified in the 20 bill. 21 The bill authorizes HHS to adopt administrative rules to 22 administer the bill and requires HHS to submit an annual report 23 to the governor and the general assembly to assess the impact 24 of the bill. 25 DIVISION II. This division relates to SNAP and Medicaid 26 program integrity by requiring HHS to, within specified time 27 frames, receive and review state and federal information 28 from various entities concerning individuals or individuals 29 in households enrolled in SNAP or the Medicaid program 30 that indicates a change in circumstances that may affect 31 eligibility. The information relates to death, employment, 32 residency, incarceration, and unemployment information. 33 Additionally, the bill requires HHS to cross-check information 34 relating to individuals in households enrolled in SNAP or 35 -15- LSB 1340HV (5) 90 pf/rh 15/ 18

H.F. 613 the Medicaid program, as applicable, with specified federal 1 databases. With regard to the Medicaid program only, the bill 2 also requires that prior to determining eligibility for the 3 Medicaid program, HHS shall access information for every member 4 of an applicant’s household from the data sources outlined in 5 the bill and conduct a review of nationwide public records data 6 sources of physical asset ownership. The bill also requires 7 an applicant for Medicaid benefits to cooperate with child 8 support services as a condition of eligibility as specified 9 under federal law. 10 The bill requires HHS to use a reasonable compatibility 11 standard threshold of 5 percent rather than 10 percent in 12 determining eligibility for Medicaid. 13 DIVISION III. This division requires HHS to seek federal 14 approval of an amendment to the section 1115 demonstration 15 waiver for the Iowa health and wellness plan to provide both 16 of the following: (1) that an Iowa health and wellness 17 plan member who is not otherwise exempt from payment of a 18 monthly contribution, who is subject to payment of a monthly 19 contribution as the result of failure to complete required 20 healthy behaviors, and whose eligibility for the program is 21 terminated due to nonpayment of monthly contributions, shall be 22 allowed to subsequently reenroll in the program without first 23 paying any outstanding monthly contributions, if the member has 24 not been terminated from the program previously for nonpayment 25 of monthly contributions, and (2) following an initial 26 termination from the Iowa health and wellness plan, if an Iowa 27 health and wellness plan member is subsequently terminated 28 from the program for nonpayment of monthly contributions, the 29 member shall be subject to payment of any outstanding monthly 30 contributions accrued since the subsequent termination not to 31 exceed program limits prior 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 -16- LSB 1340HV (5) 90 pf/rh 16/ 18

H.F. 613 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. This division requires HHS to submit a 4 request for federal approval by July 1, 2023, and annually 5 by July 1 thereafter until federal approval is received, for 6 a waiver to require that as a condition of eligibility, Iowa 7 health and wellness plan members participate in community 8 engagement activities. The bill specifies the types of 9 community engagement activities to be required under the waiver 10 submitted and provides exceptions to required participation 11 in community engagement activities. The bill directs HHS to 12 implement the waiver upon receipt of federal approval and to 13 adopt administrative rules to administer the waiver provisions. 14 DIVISION V. This division requires HHS to request a waiver 15 from the United States department of agriculture, food and 16 nutrition service, to provide that eligible foods under 17 the state administration of SNAP do not include candy and 18 non-sugar-free soda. The department is directed to implement 19 the waiver upon receipt of approval of the waiver. 20 The division also relates to the double up food bucks program 21 by making a supplemental appropriation from the general fund of 22 the state to HHS for fiscal year 2023-2024, in addition to any 23 other funding appropriated for such purpose for the same fiscal 24 year, to provide grants to support the double up food bucks 25 program administered by the Iowa healthiest state initiative 26 to make fresh fruits and vegetables sold at farmers markets, 27 grocery stores, and other participating locations accessible to 28 individuals and families who reside in this state and receive 29 assistance through SNAP. The division requires a double 30 up food bucks program grant recipient to provide at least 31 a dollar-for-dollar match of the grant assistance. Moneys 32 appropriated under the division do not revert at the close of 33 the fiscal year but remain available for the purposes of the 34 double up food bucks program. 35 -17- LSB 1340HV (5) 90 pf/rh 17/ 18

H.F. 613 The supplemental appropriation for the double up food bucks 1 program takes effect on the date HHS receives federal approval 2 of the SNAP waiver, if the waiver is approved. 3 DIVISION VI. This division provides implementation 4 provisions for the bill. The bill requires HHS to request 5 federal approval including for any state plan amendment or 6 waiver necessary to administer the bill. If HHS 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 12 the inconsistency with federal requirements. Unless otherwise 13 provided in the bill, HHS shall implement the provisions of the 14 bill in an incremental fashion, beginning July 1, 2023, with 15 a goal of full implementation no later than June 30, 2025, to 16 minimize duplication of efforts and to maximize coordination 17 with the implementation time frames of other departmental 18 resource enhancements. The provisions of the bill requiring 19 federal approval shall be implemented upon receipt of federal 20 approval. The provisions of the bill not requiring federal 21 approval shall be implemented as specified in the bill, and 22 if it not specified in the bill, then not later than June 30, 23 2025. 24 -18- LSB 1340HV (5) 90 pf/rh 18/ 18