House File 948 - Introduced HOUSE FILE 948 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 248) A BILL FOR An Act relating to public assistance programs, work 1 requirements for the Iowa health and wellness plan, 2 an information technology fund, the public assistance 3 modernization fund, and the Medicaid for employed people 4 with disabilities program and program review and report. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 1477HV (4) 91 lh/ko

H.F. 948 DIVISION I 1 IOWA HEALTH AND WELLNESS PLAN —— WORK REQUIREMENTS 2 Section 1. IOWA HEALTH AND WELLNESS PLAN —— WORK 3 REQUIREMENTS. 4 1. The department of health and human services shall request 5 any federal approval necessary to include work requirements as 6 a condition of a member maintaining eligibility for the Iowa 7 health and wellness plan. 8 2. The goal of including work requirements is to reduce the 9 dependence of low-income Iowans on public assistance programs 10 through efforts that advance economic stability and mobility. 11 3. The department shall require as a condition of 12 maintaining eligibility for the Iowa health and wellness 13 plan that a member work at least eighty hours each month, as 14 determined by the department. 15 4. The department may exempt an individual from the work 16 requirements under this section if the individual meets any of 17 the following criteria: 18 a. The individual is under nineteen years of age. 19 b. The individual is sixty-five years of age or older. 20 c. The individual is determined to be disabled by the United 21 States social security administration. 22 d. The individual is identified as medically frail or 23 medically exempt under the Medicaid program. 24 e. The individual is a caretaker of a dependent child under 25 six years of age. 26 f. The individual is pregnant and the pregnancy is high 27 risk. 28 g. The individual is receiving unemployment compensation as 29 determined by the department of workforce development. 30 h. The individual is participating in substance use 31 disorder treatment, not to exceed a consecutive six-month 32 period. 33 i. The individual is otherwise exempt for good cause as 34 determined by the director of health and human services. 35 -1- LSB 1477HV (4) 91 lh/ko 1/ 6

H.F. 948 5. To maximize fiscal stability and administrative 1 efficiency, any exemption applied under the Iowa health and 2 wellness plan shall be substantially similar to the exemptions 3 applied under other public assistance programs. 4 6. Upon the department’s receipt of federal approval, 5 and the department’s operationalizing of a real-time system 6 to facilitate evaluation efforts and recipient referrals and 7 reporting, the department shall implement work requirements as 8 a condition of maintaining eligibility for the Iowa health and 9 wellness plan. The department shall adopt rules pursuant to 10 chapter 17A as necessary to administer the work requirements 11 for the Iowa health and wellness plan. 12 7. The department may resubmit a request for federal 13 approval submitted under subsection 1 if the initial request is 14 denied or withdrawn for any reason. 15 Sec. 2. ALTERNATE PLAN. If federal law or regulations 16 affecting work requirements for the Iowa health and wellness 17 plan are modified to exclude work requirements as a basis 18 for maintaining eligibility as provided in this division of 19 this Act, the department of health and human services shall 20 discontinue the Iowa health and wellness plan, subject to 21 federal approval. If, under federal law, the department is not 22 allowed to discontinue the Iowa health and wellness plan, the 23 department may implement an alternative plan as specified in 24 the medical assistance state plan or waiver for coverage of the 25 affected population, subject to prior statutory approval of 26 implementation of the alternative plan. 27 Sec. 3. EFFECTIVE DATE. This division of this Act, being 28 deemed of immediate importance, takes effect upon enactment. 29 DIVISION II 30 WORK RULES AND REQUIREMENTS FOR PUBLIC ASSISTANCE PROGRAMS 31 Sec. 4. PUBLIC ASSISTANCE PROGRAMS —— WORK RULES AND 32 REQUIREMENTS ALIGNMENT. The department of health and human 33 services shall work with the United State department of 34 health and human services and the United States department 35 -2- LSB 1477HV (4) 91 lh/ko 2/ 6

H.F. 948 of agriculture to align the requirements and rules for 1 participants of public assistance programs related to working, 2 including but not limited to rules and requirements related 3 to employment and training for the supplemental nutrition 4 assistance program. 5 DIVISION III 6 INFORMATION TECHNOLOGY 7 Sec. 5. NEW SECTION . 217.25 Information technology fund. 8 1. An information technology fund is created in the state 9 treasury under the control of the department of health and 10 human services. The fund shall consist of moneys appropriated 11 or transferred to, or deposited in, the fund as provided 12 by law. All moneys deposited or paid into the fund are 13 appropriated to the department of health and human services 14 to be used for information technology systems and related 15 modernization initiatives. 16 2. Notwithstanding section 8.33, moneys appropriated in 17 this section that remain unencumbered or unobligated at the 18 close of the fiscal year shall not revert but shall remain 19 available for expenditure for the purposes designated until the 20 close of the succeeding fiscal year. Notwithstanding section 21 12C.7, subsection 2, interest or earnings on moneys in the fund 22 shall be credited to the fund. 23 Sec. 6. TRANSFER OF MONEYS. Any unobligated or unencumbered 24 moneys remaining in the public assistance modernization 25 fund created in section 239.11, on June 30, 2025, shall be 26 transferred to the information technology fund created in 27 section 217.25, as enacted in this division of this Act. 28 Sec. 7. REPEAL. Section 239.11, Code 2025, is repealed. 29 DIVISION IV 30 MEDICAID FOR EMPLOYED PEOPLE WITH DISABILITIES PROGRAM 31 Sec. 8. Section 249A.3, subsection 2, paragraph a, 32 subparagraph (1), subparagraph division (a), Code 2025, is 33 amended to read as follows: 34 (a) As allowed under 42 U.S.C. §1396a(a)(10)(A)(ii)(XIII), 35 -3- LSB 1477HV (4) 91 lh/ko 3/ 6

H.F. 948 individuals with disabilities, who are less than sixty-five 1 years of age, who are members of families whose income is 2 less than two hundred fifty percent of the most recently 3 revised official poverty guidelines published by the United 4 States department of health and human services for the family, 5 who have earned income and who are eligible for mandatory 6 medical assistance or optional medical assistance under this 7 section if earnings are disregarded. As allowed by 42 U.S.C. 8 §1396a(r)(2), unearned income shall also be disregarded in 9 determining whether an individual is eligible for assistance 10 under this subparagraph. For the purposes of determining the 11 amount of an individual’s resources under this subparagraph and 12 as allowed by 42 U.S.C. §1396a(r)(2), a maximum of ten thousand 13 dollars of available resources for an individual and twenty-one 14 thousand dollars of available resources for a couple shall be 15 disregarded, and any additional resources held in a retirement 16 account, in a medical savings account, or in any other account 17 approved under rules adopted by the department shall also be 18 disregarded. 19 Sec. 9. MEDICAID FOR EMPLOYED PEOPLE WITH DISABILITIES 20 PROGRAM REVIEW AND REPORT. 21 1. During the 2025 legislative interim, the department 22 of health and human services shall review the Medicaid for 23 employed people with disabilities program in other states 24 for eligibility criteria, asset limits, and cost-sharing 25 requirements. 26 2. By December 15, 2025, the department of health and 27 human services shall submit a report to the general assembly 28 containing the results of the review, and recommendations to 29 expand employment opportunities for people with disabilities 30 under the Medicaid for employed people with disabilities 31 program and the fiscal information for each recommendation. 32 EXPLANATION 33 The inclusion of this explanation does not constitute agreement with 34 the explanation’s substance by the members of the general assembly. 35 -4- LSB 1477HV (4) 91 lh/ko 4/ 6

H.F. 948 This bill relates to work requirements for the Iowa health 1 and wellness plan (IHAWP), public assistance programs, 2 an information technology fund, the public assistance 3 modernization fund, and the Medicaid for employed people with 4 disabilities program and program review and report. 5 DIVISION I. This division requires the department of health 6 and human services (HHS) to request any federal approval 7 necessary to include work requirements as a condition of 8 maintaining eligibility for IHAWP. 9 HHS shall require as a condition of eligibility for IHAWP 10 that a member work at least 80 hours each month. HHS may exempt 11 certain individuals from the work requirement who are under 12 19 years of age, 65 years of age or older, medically frail or 13 medically exempt under Medicaid, a caretaker of a child under 14 6 years of age, experiencing a high-risk pregnancy, receiving 15 unemployment compensation, participating in substance use 16 disorder treatment, or exempt for good cause as determined by 17 the director of HHS. The division requires that any exemption 18 applied under IHAWP shall be substantially similar to the 19 exemptions applied under other public assistance programs. 20 The division requires that upon HHS’s receipt of federal 21 approval and HHS’s operationalizing of a system to facilitate 22 evaluation, and recipient referrals and reporting, HHS shall 23 implement and adopt rules to administer work requirements as a 24 condition of maintaining eligibility for IHAWP. 25 HHS may resubmit a request for federal approval under the 26 division if the initial request is denied or withdrawn for any 27 reason. 28 If federal law or regulations exclude work requirements for 29 IHAWP, HHS shall discontinue IHAWP or implement an alternative 30 plan as described in the bill. 31 The division takes effect upon enactment. 32 DIVISION II. This division requires HHS to work with the 33 United States department of health and human services and 34 the United States department of agriculture to align the 35 -5- LSB 1477HV (4) 91 lh/ko 5/ 6

H.F. 948 department’s work rules and requirements for participants of 1 public assistance programs, including but not limited to rules 2 and requirements related to employment and training for the 3 supplemental nutrition assistance program. 4 DIVISION III. This division creates a information 5 technology fund in the state treasury under the control of HHS. 6 All moneys in the fund shall be appropriated to HHS to be used 7 for information technology systems and related modernization 8 initiatives. 9 The division repeals the public assistance modernization 10 fund, and transfers any unobligated and unencumbered moneys in 11 the fund on June 30, 2025, to the information technology fund 12 created in the division. 13 DIVISION IV. Currently, for the purposes of determining the 14 resources of an individual to meet the eligibility requirements 15 for the Medicaid for employed people with disabilities program 16 (MEPD) program, a maximum of $10,000 of available resources is 17 disregarded, in addition to any additional resources held in 18 a retirement account, in a medical savings account, or in any 19 other account approved under rules adopted by HHS. The bill 20 maintains the maximum amount of $10,000 in available resources 21 disregarded for an individual, but provides that for the 22 purposes of determining the resources of a couple, a maximum 23 amount of $21,000 of available resources is disregarded. 24 The division requires, during the 2025 interim, that HHS 25 review the MEPD program in other states and submit a report 26 to the general assembly by December 15, 2025, containing the 27 results of the review and recommendations to expand employment 28 opportunities for people with disabilities under the MEPD 29 program. 30 -6- LSB 1477HV (4) 91 lh/ko 6/ 6