House Study Bill 248 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON NORDMAN) 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 1477YC (7) 91 lh/ko

H.F. _____ 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 subsection 3 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 qualified as exempt for 34 good cause as determined by the director of health and human 35 -1- LSB 1477YC (7) 91 lh/ko 1/ 6

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may resubmit a request for federal 14 approval submitted under subsection 1 if the initial request is 15 denied or withdrawn for any reason. 16 Sec. 2.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

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

H.F. _____ amended to read as follows: 1 (a) As allowed under 42 U.S.C. §1396a(a)(10)(A)(ii)(XIII), 2 individuals with disabilities, who are less than sixty-five 3 years of age, who are members of families whose income is 4 less than two hundred fifty percent of the most recently 5 revised official poverty guidelines published by the United 6 States department of health and human services for the family, 7 who have earned income and who are eligible for mandatory 8 medical assistance or optional medical assistance under this 9 section if earnings are disregarded. As allowed by 42 U.S.C. 10 §1396a(r)(2), unearned income shall also be disregarded in 11 determining whether an individual is eligible for assistance 12 under this subparagraph. For the purposes of determining the 13 amount of an individual’s resources under this subparagraph and 14 as allowed by 42 U.S.C. §1396a(r)(2), a maximum of ten thousand 15 dollars of available resources for an individual and twenty-one 16 thousand dollars of available resources for a couple shall be 17 disregarded, and any additional resources held in a retirement 18 account, in a medical savings account, or in any other account 19 approved under rules adopted by the department shall also be 20 disregarded. 21 Sec. 9. MEDICAID FOR EMPLOYED PEOPLE WITH DISABILITIES 22 PROGRAM REVIEW AND REPORT. 23 1. During the 2025 legislative interim, the department 24 of health and human services shall review the Medicaid for 25 employed people with disabilities program in other states 26 for eligibility criteria, asset limits, and cost-sharing 27 requirements. 28 2. By December 15, 2025, the department of health and 29 human services shall submit a report to the general assembly 30 containing the results of the review, and recommendations to 31 expand employment opportunities for people with disabilities 32 under the Medicaid for employed people with disabilities 33 program and the fiscal information for each recommendation. 34 EXPLANATION 35 -4- LSB 1477YC (7) 91 lh/ko 4/ 6

H.F. _____ The inclusion of this explanation does not constitute agreement with 1 the explanation’s substance by the members of the general assembly. 2 This bill relates to public assistance programs, work 3 requirements for the Iowa health and wellness plan (IHAWP), 4 an information technology fund, the public assistance 5 modernization fund, and the Medicaid for employed people with 6 disabilities program and program review and report. 7 DIVISION I. This division requires the department of health 8 and human services (HHS) to request any federal approval 9 necessary to include work requirements as a condition of 10 maintaining eligibility for IHAWP. 11 HHS shall require as a condition of eligibility for IHAWP 12 that a member work at least 80 hours each month. HHS may exempt 13 certain individuals from the work requirement who are under 14 19 years of age, 65 years of age or older, medically frail or 15 medically exempt under Medicaid, a caretaker of a child under 16 6 years of age, experiencing a high-risk pregnancy, receiving 17 unemployment compensation, participating in substance use 18 disorder treatment, or exempt for good cause as determined by 19 the director of HHS. The division requires that any exemption 20 applied under IHAWP shall be substantially similar to the 21 exemptions applied under other public assistance programs. 22 The division requires that upon HHS’s receipt of federal 23 approval and HHS’s implementation of a system to facilitate 24 referrals, reporting, and evaluation, HHS shall implement and 25 adopt rules to administer work requirements as a condition of 26 eligibility for IHAWP. 27 HHS may resubmit a request for federal approval under the 28 division if the initial request is denied or withdrawn for any 29 reason. 30 If federal law or regulations exclude work requirements for 31 IHAWP, HHS shall discontinue IHAWP or implement an alternative 32 plan as described in the bill. 33 The division takes effect upon enactment. 34 DIVISION II. This division requires HHS to work with the 35 -5- LSB 1477YC (7) 91 lh/ko 5/ 6

H.F. _____ United States department of health and human services and 1 the United States department of agriculture to align the 2 department’s work rules and requirements for participants of 3 public assistance programs, including but not limited to rules 4 and requirements related to employment and training for the 5 supplemental nutrition assistance program. 6 DIVISION III. This division creates a information 7 technology fund in the state treasury under the control of HHS. 8 All moneys in the fund shall be appropriated to HHS to be used 9 for information technology systems and related modernization 10 initiatives. 11 The division repeals the public assistance modernization 12 fund, and transfers any unobligated and unencumbered moneys in 13 the fund on June 30, 2025, to the information technology fund 14 created in the division. 15 DIVISION IV. Currently, for the purposes of determining the 16 resources of an individual to meet the eligibility requirements 17 for the Medicaid for employed people with disabilities program 18 (MEPD) program, a maximum of $10,000 of available resources is 19 disregarded, in addition to any additional resources held in 20 a retirement account, in a medical savings account, or in any 21 other account approved under rules adopted by HHS. The bill 22 maintains the maximum amount of $10,000 in available resources 23 disregarded for an individual, but provides that for the 24 purposes of determining the resources of a couple, a maximum 25 amount of $21,000 of available resources is disregarded. 26 The division requires during the 2025 interim for HHS to 27 review the MEPD program in other states and submit a report 28 to the general assembly by December 15, 2025, containing the 29 results of the review and recommendations to expand employment 30 opportunities for people with disabilities under the MEPD 31 program. 32 -6- LSB 1477YC (7) 91 lh/ko 6/ 6