H.F. _____ DIVISION I 1 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 2 Section 1. NEW SECTION . 135.16E Supplemental nutrition 3 assistance program error rate —— report. 4 Beginning with the fiscal quarter that starts on October 5 1, 2026, and every fiscal quarter thereafter, within thirty 6 calendar days of the end date of the immediately preceding 7 fiscal quarter, the department shall submit a report to the 8 general assembly detailing payment error rates associated 9 with the supplemental nutrition assistance program for the 10 immediately preceding fiscal quarter. For the purposes of this 11 section, “supplemental nutrition assistance program” has the same 12 meaning as defined in section 239.1. 13 Sec. 2. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 14 —— WAIVER OF EARNED INCOME RULES. 15 1. The department of health and human services shall 16 request a waiver from the food and nutrition services of the 17 United States department of agriculture to provide that, for 18 purposes of state administration of the supplemental nutrition 19 assistance program, the earned income under 20 7 C.F.R. §273.9(c)(7) of household members that meet all of the 21 following criteria shall be excluded from household income: 22 a. Less than twenty-two years of age. 23 b. Enrolled in an elementary or secondary school. 24 c. Resides with a natural parent, adoptive parent, 25 stepparent, or other household member who exercises parental 26 control over the household member described in paragraphs “a” 27 and “b”. 28 2. The department of health and human services shall 29 implement the waiver upon receipt of approval of the waiver 30 from the United States department of agriculture. 31 Sec. 3. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 32 —— WAIVER OF ELIGIBILITY VERIFICATION RULES. 33 1. The department of health and human services shall 34 request a waiver from the food and nutrition services of the 35 -1- LSB 5348YC (15) 91 ak/ko 1/ 18

H.F. _____ United States department of agriculture to provide that, for 1 purposes of state administration of the supplemental nutrition 2 assistance program, information from the following automated 3 sources be considered verified upon receipt for purposes 4 of 7 C.F.R. §272.12(c): 5 a. The United States bureau of labor statistics 6 occupational employment and wage statistics program. 7 b. The national directory of new hires maintained by the 8 office of child support services of the United States office 9 for the administration of children and families. 10 c. The unemployment insurance benefits data released by the 11 Iowa department of workforce development. 12 d. The United States social security administration 13 benefits and death records. 14 e. The residency and identity data released by the United 15 States department of transportation. 16 f. The state incarceration data released by the Iowa 17 department of corrections. 18 g. The national vital statistic report released by the 19 United States centers for disease control and prevention’s 20 national center for health statistics. 21 h. The automated employment verification service known as 22 work number, or equivalent third-party income verification 23 platforms. 24 2. The department of health and human services shall 25 implement the waiver upon receipt of approval of the waiver 26 from the United States department of agriculture. 27 Sec. 4. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 28 —— WAIVER OF EXPUNGEMENT RULES. 29 1. The department of health and human services shall 30 request a waiver from the food and nutrition services of the 31 United States department of agriculture to provide that, for 32 purposes of state administration of the supplemental nutrition 33 assistance program, expungement of benefits on a household’s 34 electronic benefit account under 7 C.F.R. §274.2(i) be 35 -2- LSB 5348YC (15) 91 ak/ko 2/ 18

H.F. _____ permitted after three months or ninety-one days of inactivity, 1 or of benefits remaining, on the electronic benefit account. 2 2. The department of health and human services shall 3 implement the waiver upon receipt of approval of the waiver 4 from the United States department of agriculture. 5 Sec. 5. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 6 —— WAIVER OF PAYMENT QUALITY CONTROL SAMPLING PROCEDURES. 7 1. The department of health and human services shall 8 request a waiver from the food and nutrition services of the 9 United States department of agriculture to provide that, for 10 purposes of state administration of the supplemental nutrition 11 assistance program, when reporting the state’s payment error 12 rate as outlined by 7 C.F.R. §275.14, and food and nutrition 13 services handbooks 310 and 311, the department of health and 14 human services be permitted to report the payment error rate 15 based only on errors directly attributable to the department. 16 2. The department of health and human services shall 17 implement the waiver upon receipt of approval of the waiver 18 from the United States department of agriculture. 19 Sec. 6. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 20 —— WAIVER OF REQUIRED APPLICATION INFORMATION RULES. 21 1. The department of health and human services shall 22 request a waiver from the food and nutrition services of the 23 United States department of agriculture to provide that, for 24 purposes of state administration of the supplemental nutrition 25 assistance program, applications under 7 C.F.R. §273.2 must 26 include all of the following to be considered complete: 27 a. The applicant’s name. 28 b. The applicant’s address. 29 c. The signature of a responsible household member or 30 authorized representative or verbal assent by the applicant to 31 the information provided during the telephonic interview. 32 d. All eligibility information including household 33 composition, household members’ income, expenses, citizenship 34 status, and identity. 35 -3- LSB 5348YC (15) 91 ak/ko 3/ 18

H.F. _____ 2. The department of health and human services shall 1 implement the waiver upon receipt of approval of the waiver. 2 DIVISION II 3 MEDICAL ASSISTANCE PROGRAM 4 Sec. 7. Section 249A.3, subsection 2, paragraph a, 5 subparagraph (1), Code 2026, is amended to read as follows: 6 (1) (a) As allowed under 42 U.S.C. 7 §1396a(a)(10)(A)(ii)(XIII), individuals with disabilities, 8 who are less than sixty-five years of age, who are members of 9 families whose income is less than two hundred fifty three 10 hundred percent of the most recently revised official poverty 11 guidelines published by the United States department of health 12 and human services for the family, who have earned income 13 and who are eligible for mandatory medical assistance or 14 optional medical assistance under this section if earnings are 15 disregarded. As allowed by 42 U.S.C. §1396a(r)(2), unearned 16 income shall also be disregarded in determining whether an 17 individual is eligible for assistance under this subparagraph. 18 For the purposes of determining the amount of an individual’s 19 resources under this subparagraph and as allowed by 42 U.S.C. 20 §1396a(r)(2), a maximum of ten thousand dollars of available 21 resources for an individual and twenty-one thousand dollars 22 of available resources for a couple shall be disregarded, and 23 any additional resources held in a retirement account, in a 24 pension account, in a medical savings account, or in any other 25 account approved under rules adopted by the department shall 26 also be disregarded. 27 (b) Individuals eligible for assistance under this 28 subparagraph, whose individual income exceeds one hundred 29 fifty percent of the official poverty guidelines published 30 by the United States department of health and human services 31 for an individual, shall pay a premium. The amount of the 32 premium shall be based on a sliding fee schedule adopted by 33 rule of the department and shall be based on a percentage of 34 the individual’s income. The maximum premium payable by an 35 -4- LSB 5348YC (15) 91 ak/ko 4/ 18

H.F. _____ individual whose income exceeds one hundred fifty percent of 1 the official poverty guidelines shall be commensurate with 2 the cost of state employees’ group health insurance in this 3 state. The payment to and acceptance by an automated case 4 management system or the department of the premium required 5 under this subparagraph shall not automatically confer initial 6 or continuing program eligibility on an individual. The 7 department shall maintain a page on the department’s internet 8 site where individuals can electronically pay any premium owed 9 by an individual to the department. A premium paid to and 10 accepted by the department’s premium payment process that is 11 subsequently determined to be untimely or to have been paid on 12 behalf of an individual ineligible for the program shall be 13 refunded to the remitter in accordance with rules adopted by 14 the department. Any unpaid premium shall be a debt owed to the 15 department. 16 Sec. 8. Section 249A.4, Code 2026, is amended by adding the 17 following new subsections: 18 NEW SUBSECTION . 15. Submit a quarterly report to the 19 general assembly beginning with the fiscal quarter that starts 20 on October 1, 2026, and every fiscal quarter thereafter, 21 that details payment error rates associated with the medical 22 assistance program for the immediately preceding fiscal 23 quarter. 24 NEW SUBSECTION . 16. Submit an annual report to the general 25 assembly on or before October 1 on petitions for a waiver, also 26 referred to by the department as exceptions to policy, of rules 27 governing the Medicaid program filed pursuant to the rules of 28 the department. The report must include all the following for 29 the immediately preceding fiscal year: 30 a. The total number of exceptions to policy granted. 31 b. The cumulative cost of the exceptions to policy that were 32 granted. 33 c. The types of exceptions to policy that were granted. 34 d. Identifiable trends noted by the department including any 35 -5- LSB 5348YC (15) 91 ak/ko 5/ 18

H.F. _____ of the following: 1 (1) The number of exceptions to policy granted in a 2 particular geographic location. 3 (2) The types of Medicaid services that were the basis for 4 exceptions to policy. 5 (3) The Medicaid program eligibility classification of 6 individuals granted Medicaid program exceptions to policy. 7 Sec. 9. NEW SECTION . 249A.32C Home and community-based 8 service waivers —— rural provider rate increase. 9 1. For the purposes of this section, unless context 10 otherwise requires: 11 a. “Consumer” means the same as defined in section 249A.29. 12 b. “Rural area” means a geographical area that is not part 13 of a metropolitan statistical area as designated by the United 14 States office of management and budget. 15 c. “Waiver” means the same as defined in section 249A.29. 16 2. The base reimbursement rate for a provider of services 17 under a medical assistance program home and community-based 18 services waiver shall be increased to cover the travel time 19 and expenses incurred by the provider to provide services to a 20 consumer who resides in a rural area. 21 Sec. 10. NEW SECTION . 249A.32D Waivers —— cost neutrality. 22 1. As used in this section, “cost neutral” means federal 23 approval of a waiver related to the medical assistance program 24 submitted by the department to the federal government will not 25 result in a net increase in spending for state administration 26 of the medical assistance program. 27 2. Prior to submitting a request for a waiver to the United 28 States department of health and human services related to 29 the medical assistance program, the department shall conduct 30 an analysis to determine if the waiver is cost neutral. For 31 any waiver that is determined to be not cost neutral, the 32 department shall not submit the request for a waiver unless the 33 waiver has been presented to the general assembly and approved 34 by a majority vote of both houses of the general assembly. 35 -6- LSB 5348YC (15) 91 ak/ko 6/ 18

H.F. _____ Sec. 11. MEDICAID EXCEPTIONS TO POLICY REVIEW —— REPORT 1 TO GENERAL ASSEMBLY. The department of health and human 2 services shall conduct a review of petitions for a waiver, 3 also referred to by the department as exceptions to policy, of 4 rules governing the Medicaid program granted by the department 5 between January 1, 2020, and January 1, 2026, and shall submit 6 a report on or before December 15, 2026, of the findings of the 7 review. The report shall include all of the following: 8 1. The total number of exceptions to policy granted. 9 2. The cumulative cost of the exceptions to policy that were 10 granted. 11 3. The types of exceptions to policy that were granted. 12 4. Identifiable trends noted by the department including 13 any of the following: 14 a. The number of exceptions to policy granted in a 15 particular geographic location. 16 b. The types of Medicaid services that were the basis for 17 the waiver. 18 c. The Medicaid program classification of individuals 19 granted exception to policy. 20 DIVISION III 21 ELIGIBILITY FOR CERTAIN PROGRAMS 22 Sec. 12. NEW SECTION . 234.6A Program eligibility —— 23 residency. 24 1. As used in this section, “public assistance program” 25 means any of the following: 26 a. The state child care assistance program under section 27 237A.13. 28 b. The family investment program under chapter 239B. 29 c. The medical assistance program under chapter 249A. 30 d. The supplemental nutrition assistance program 31 administered by the state pursuant to 7 C.F.R. pts. 270 – 283, 32 as amended. 33 e. The special supplemental nutrition program for women, 34 infants, and children as provided in 42 U.S.C. §1786 et seq. 35 -7- LSB 5348YC (15) 91 ak/ko 7/ 18

H.F. _____ 2. a. Unless prohibited under federal law, the department 1 may require from an applicant to a public assistance program 2 proof of at least twelve months of continuous residency within 3 the state including any of the following: 4 (1) A statement from the applicant attesting to the 5 applicant’s reasons for being in the state and length of 6 residency within the state. 7 (2) A statement from the applicant’s employer confirming 8 the applicant’s employment in the state. 9 (3) Any other statement from other persons with knowledge 10 who can attest to the applicant’s reasons for being in the 11 state and length of residency within the state. 12 (4) A copy of the applicant’s most recently filed Iowa state 13 income tax return. 14 b. Paragraph “a” shall not apply to applicants who receive 15 benefits under the federal Social Security Act, 42 U.S.C. §423 16 et seq. 17 Sec. 13. Section 239.6, subsection 1, paragraph a, 18 subparagraph (4), Code 2026, is amended to read as follows: 19 (4) Information maintained by the United States citizenship 20 and immigration services of the United States department of 21 homeland security , including information accessible through the 22 systematic alien verification for entitlements online service . 23 Sec. 14. Section 239.6, subsection 2, Code 2026, is amended 24 by adding the following new paragraph: 25 NEW PARAGRAPH . g. The systematic alien verification for 26 entitlements online service maintained by the United States 27 citizenship and immigration services of the United States 28 department of homeland security to verify immigration and 29 United States citizenship information. 30 DIVISION IV 31 MISCELLANEOUS PUBLIC ASSISTANCE PROGRAMS 32 Sec. 15. NEW SECTION . 135.16E Special supplemental 33 nutrition program for women, infants, and children —— citizens 34 and qualified aliens. 35 -8- LSB 5348YC (15) 91 ak/ko 8/ 18

H.F. _____ The department shall restrict participation in the special 1 supplemental nutrition program for women, infants, and children 2 to citizens and qualified aliens pursuant to section 742 of 3 the federal Personal Responsibility and Work Opportunity 4 Reconciliation Act of 1996, Pub. L. No. 104-193. 5 Sec. 16. Section 249N.6, subsection 5, Code 2026, is amended 6 by adding the following new paragraph: 7 NEW PARAGRAPH . c. Notwithstanding any other provision of 8 law to the contrary, an Iowa health and wellness plan provider 9 may impose a fee of no more than five dollars on a member based 10 on the member’s failure to attend a scheduled appointment with 11 the provider. 12 Sec. 17. Section 249N.7, subsection 1, Code 2026, is amended 13 to read as follows: 14 1. Membership in the Iowa health and wellness plan shall 15 require payment of monthly contributions for members whose 16 household income is at or above fifty one hundred percent 17 of the federal poverty level. Members shall be subject 18 to an eight dollar copayment amounts applicable only to 19 for nonemergency use of a hospital emergency department. 20 Total member cost-sharing, annually, shall align with the 21 cost-sharing limitations requirements for the American health 22 benefits exchanges under the Affordable Care Act One Big 23 Beautiful Bill Act, Pub. L. No. 119-21 . Contributions Monthly 24 contributions and copayment amounts for members shall be 25 established by rule of the department. 26 Sec. 18. Section 249N.7, Code 2026, is amended by adding the 27 following new subsections: 28 NEW SUBSECTION . 3. Notwithstanding subsection 1, a member 29 who fails to complete all required preventative care services 30 and wellness activities specified during the prior annual 31 membership period shall be subject to a monthly five dollar fee 32 during the subsequent year of membership. 33 NEW SUBSECTION . 4. Notwithstanding subsection 1, a member 34 whose household income is at or above one hundred percent of 35 -9- LSB 5348YC (15) 91 ak/ko 9/ 18

H.F. _____ the federal poverty level shall be subject to the following 1 copay amounts: 2 a. A five dollar copay for a diagnostic dental procedure. 3 As used in this paragraph, “diagnostic dental procedure” means 4 a dental procedure that is not performed for preventative 5 purposes. 6 b. A one dollar copay for a prescription drug when a 7 suitable generic equivalent drug approved by the United States 8 food and drug administration is available to the member. 9 Sec. 19. 2023 Iowa Acts, chapter 104, section 12, subsection 10 3, is amended to read as follows: 11 3. Unless otherwise provided in this Act, the department 12 of health and human services shall implement the provisions of 13 this Act in an incremental fashion, beginning July 1, 2023, 14 with a goal of full implementation no later than July 1, 2025 15 completed by January 1, 2027 , to minimize duplication of 16 efforts and to maximize coordination with the implementation 17 time frames of other departmental resource enhancements. 18 Sec. 20. IOWA HEALTH AND WELLNESS PLAN —— MEMBER 19 REENROLLMENT FOLLOWING TERMINATION FOR NONPAYMENT OF MONTHLY 20 CONTRIBUTIONS. The department of human services shall seek 21 approval of an amendment to the section 1115 demonstration 22 waiver for the Iowa health and wellness plan from the centers 23 for Medicare and Medicaid services of the United States 24 department of health and human services to provide the 25 following: 26 1. An Iowa health and wellness plan member who is subject 27 to payment of a monthly contribution as the result of failure 28 to complete required preventative care services and wellness 29 activities, and whose eligibility for the program is terminated 30 due to nonpayment of monthly contributions, shall be allowed 31 to subsequently reenroll in the program without first paying 32 any outstanding monthly contributions, if the member has not 33 been terminated from the program previously for nonpayment of 34 monthly contributions. 35 -10- LSB 5348YC (15) 91 ak/ko 10/ 18

H.F. _____ 2. If an Iowa health and wellness plan member has been 1 terminated from the program previously for nonpayment of 2 monthly contributions, and is subsequently terminated from 3 the program for nonpayment of monthly contributions owed as 4 a result of failure to complete required preventative care 5 services and wellness activities, the member shall be subject 6 to payment of any outstanding monthly contributions prior to 7 reenrollment in the program. 8 Sec. 21. ADMINISTRATIVE RULES —— SPECIAL POPULATION NURSING 9 FACILITY REIMBURSEMENT RATES. The department of health and 10 human services shall amend the department’s rules establishing 11 the rate component limits for the direct care rate and the 12 nondirect care rate patient-day-weighted medians and modified 13 price-base reimbursement rates to apply the same rates provided 14 to special population nursing facilities enrolled in Medicare 15 on or after June 1, 1993, to those enrolled on or after July 1, 16 2023. 17 DIVISION V 18 PUBLIC ASSISTANCE FRAUD —— REPORT 19 Sec. 22. NEW SECTION . 10A.404 Fraud in public assistance 20 —— report. 21 On or before October 1, 2026, and every fiscal year 22 thereafter, the department shall submit a report to the general 23 assembly concerning the department’s activities relative 24 to fraud in public assistance programs for the immediately 25 preceding fiscal year. The report shall include but is not 26 limited to a summary of the number of cases investigated, 27 case outcomes, overpayment dollars identified, amount of cost 28 avoidance, and actual dollars recovered. 29 DIVISION VI 30 HIGH-ACUITY PEDIATRIC WORK GROUP —— REPORT 31 Sec. 23. HIGH-ACUITY PEDIATRIC WORK GROUP —— REPORT TO 32 GENERAL ASSEMBLY. 33 1. The department of health and human services shall convene 34 a work group to examine the unique service needs of high-acuity 35 -11- LSB 5348YC (15) 91 ak/ko 11/ 18

H.F. _____ pediatric recipients of medical assistance under chapter 249A, 1 and high-acuity pediatric members of the healthy and well kids 2 in Iowa program under chapter 514I. The work group shall do 3 all of the following: 4 a. Identify the barriers that prevent the high-acuity 5 pediatric recipients and members from remaining in the least 6 restrictive environment possible. 7 b. Develop a proposal for a tiered reimbursement 8 methodology to provide high-acuity home health services 9 tailored to meet the allowable medical and nonmedical support 10 needs of high-acuity pediatric recipients and members. 11 2. The work group shall be comprised of at least one 12 representative of a provider of high-acuity home health 13 services, one representative of the Iowa chapter of the 14 American academy of pediatrics, one representative of the 15 Iowa association of community providers, one representative 16 of the Iowa health care association, and other individuals or 17 organizations deemed appropriate by the department. 18 3. On or before December 1, 2026, the department shall 19 submit a report to the general assembly that includes all of 20 the following: 21 a. The barriers identified by the work group that prevent 22 high-acuity pediatric recipients and members from remaining in 23 the least restrictive environment possible. 24 b. The working group’s proposed tiered reimbursement 25 methodology and the estimated fiscal impact on affected 26 providers and health care facilities. 27 4. The department of health and human services shall provide 28 administrative support, including scheduling meetings of the 29 work group as necessary to complete the work of the work group. 30 EXPLANATION 31 The inclusion of this explanation does not constitute agreement with 32 the explanation’s substance by the members of the general assembly. 33 This bill relates to public assistance programs, including 34 the supplemental nutrition assistance program, the medical 35 -12- LSB 5348YC (15) 91 ak/ko 12/ 18

H.F. _____ assistance program, and other public assistance programs under 1 the purview of the department of health and human services 2 (HHS). 3 DIVISION I —— SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM. 4 Beginning October 1, 2026, the bill requires HHS to submit a 5 report to the general assembly every fiscal quarter detailing 6 the payment error rates associated with the supplemental 7 nutrition assistance program (SNAP) for the immediately 8 preceding fiscal quarter; it must be submitted within 30 9 calendar days of the immediately preceding fiscal quarter. 10 The bill requires that HHS request an appropriate waiver 11 of specific federal SNAP regulations regarding earned income, 12 independent verification of eligibility, expungement of 13 benefits from certain electronic benefit accounts, calculations 14 by HHS of the program payment error rate, and required program 15 application information. HHS shall implement any requested 16 waiver upon receipt of approval of the waiver by the federal 17 government. 18 DIVISION II —— MEDICAL ASSISTANCE PROGRAM. Code section 19 249A.3 sets forth program eligibility criteria for Medicaid 20 for employed persons with disabilities (MEPD) pursuant to 42 21 U.S.C. §1396a. The bill amends current eligibility provisions 22 requiring the department to cap premiums for individuals 23 whose income falls below 250 percent of the federal poverty 24 level (FPL), and that any acceptance by the department of the 25 payment of a premium does not automatically confer initial or 26 continuing MEPD eligibility on an individual. Code section 27 249A.3 also requires HHS to not consider certain assets when 28 determining asset eligibility under MEPD. 29 The bill requires that HHS extend MEPD eligibility to those 30 with household incomes up to 300 percent of the FPL. Moneys in 31 a pension fund are not to be considered by HHS for purposes of 32 determining asset eligibility under MEPD. The bill provides 33 that HHS must allow for the electronic payment of MEPD premiums 34 through a page maintained on the department’s internet site. 35 -13- LSB 5348YC (15) 91 ak/ko 13/ 18

H.F. _____ Beginning October 1, 2026, the bill requires the director 1 of HHS to submit a report every fiscal quarter to the general 2 assembly detailing payment error rates associated with the 3 medical assistance program for the preceding fiscal quarter. 4 The bill also requires the director of HHS to submit an 5 annual report to the general assembly on or before October 1, 6 2026, with specific information as detailed in the bill related 7 to petitions for a waiver, which the department refers to as 8 exceptions to policy, to rules governing the Medicaid program 9 granted by HHS during the immediately preceding fiscal year. 10 Under current law, the reimbursement rate set by HHS for 11 providers under the home and community-based waivers does not 12 cover the provider’s travel time and other expenses associated 13 with providing care to a resident in a rural area of the state. 14 The bill requires HHS to cover such costs for those providers. 15 The bill requires HHS to conduct an analysis to determine 16 if a waiver related to the medical assistance program is cost 17 neutral prior to submission of a request for the waiver to 18 the United States department of health and human services. 19 Prior to submitting a waiver request related to the medical 20 assistance program that is not cost neutral, HHS must seek 21 the approval of the general assembly by majority vote of both 22 houses of the general assembly. “Cost neutral” is defined to 23 mean that approval of a waiver by the federal government will 24 not result in a net increase in spending on the administration 25 of the program by the state. 26 HHS is required to conduct a review of petitions for a 27 waiver, also referred to by the department as exceptions to 28 policy, of rules governing the Medicaid program granted by the 29 department between January 1, 2020, and January 1, 2026. On or 30 before December 15, 2026, the department shall submit a report 31 to the general assembly with specific information as detailed 32 in the bill. 33 DIVISION III —— ELIGIBILITY FOR CERTAIN PROGRAMS. The bill 34 permits HHS, unless prohibited by federal law, for purposes 35 -14- LSB 5348YC (15) 91 ak/ko 14/ 18

H.F. _____ of determining eligibility for assistance from certain public 1 assistance programs under the purview of HHS, to require proof 2 of 12 months of continuous residency through documentation that 3 attests to employment within the state and other reasons for 4 being in the state, as well as the length of residency of the 5 applicant. HHS may not require proof of residency for people 6 who are receiving social security benefits. “Public assistance 7 program” is defined as the family investment program, medical 8 assistance program, supplemental nutrition assistance program, 9 and the special nutrition assistance program for women, 10 infants, and children. 11 The bill requires HHS, prior to determining the initial 12 eligibility of an applicant for, or the ongoing eligibility 13 of a recipient of, public assistance benefits to verify 14 immigration and United States citizenship information of 15 the applicant or recipient through the systematic alien 16 verification for entitlements online service maintained by 17 the United States citizenship and immigration services of the 18 United States department of homeland security. 19 DIVISION IV —— MISCELLANEOUS PUBLIC ASSISTANCE PROGRAM 20 PROVISIONS. Section 742 of the federal Personal Responsibility 21 and Work Opportunity Reconciliation Act of 1996 neither 22 prohibits a state from providing nor requires a state to 23 provide food assistance to a person who is not a citizen or 24 qualified alien under certain programs, including the special 25 supplemental nutrition program for women, infants, and children 26 (WIC). The bill provides that HHS shall restrict participation 27 in WIC to citizens and qualified aliens pursuant to federal 28 law. 29 Under current law, a provider under the Iowa health and 30 wellness plan (IHAWP) cannot charge a member a nonattendance 31 fee. Under the bill, a provider can charge a member a 32 nonattendance fee. HHS has established monthly member 33 contributions and copayment amounts for IHAWP members by 34 rule. Under the bill, IHAWP providers may charge a member 35 -15- LSB 5348YC (15) 91 ak/ko 15/ 18

H.F. _____ a $5 nonattendance fee and all IHAWP members must pay an $8 1 copayment for each nonemergency use of a hospital emergency 2 department. 3 Under current law, IHAWP members with household incomes 4 above 50 percent and not in excess of 100 percent of the 5 FPL who fail to complete the required preventative services 6 and wellness services annually are required to pay a monthly 7 contribution of $5, while those members with household incomes 8 in excess of 100 percent of the FPL that fail to complete the 9 required preventative services and wellness services annually 10 are required to pay a monthly contribution of $10. The bill 11 instead requires any member that fails to complete the required 12 preventative services and wellness services annually to pay a 13 monthly fee of $5 during the subsequent membership year. 14 The bill requires an IHAWP member whose household income 15 is at or above 100 percent of the FPL to pay a $5 copay when 16 receiving diagnostic dental procedures, and a $1 copay when 17 buying a prescription drug when an equivalent generic drug is 18 available. The bill defines “diagnostic dental procedure”. 19 Current Code chapter 239 sets forth specific requirements 20 for specifically defined public assistance programs under the 21 purview of HHS. Under current law, HHS set a goal of fully 22 implementing the requirements for public assistance programs 23 pursuant to Code chapter 239 by July 1, 2025. Under the bill, 24 the department must fully implement the requirements pursuant 25 to Code chapter 239 by January 1, 2027. 26 The bill requires HHS to seek approval of an amendment 27 to the section 1115 demonstration waiver for the Iowa health 28 and wellness plan from the centers for Medicare and Medicaid 29 services of the United States department of health and human 30 services to provide that an IHAWP member whose eligibility 31 for the program is terminated due to nonpayment of monthly 32 contributions owed as a result of an IHAWP member’s failure 33 to complete required preventative care services and wellness 34 activities shall be allowed to subsequently reenroll in 35 -16- LSB 5348YC (15) 91 ak/ko 16/ 18

H.F. _____ the program without first paying any outstanding monthly 1 contributions, if the member has not been terminated from the 2 program previously for nonpayment of monthly contributions; 3 if the IHAWP member has previously been terminated from 4 the program for nonpayment of monthly contributions, the 5 member shall be subject to payment of any outstanding monthly 6 contributions prior to reenrollment in the program. 7 Currently, HHS has established by rule certain reimbursement 8 rate limits for special population nursing facilities enrolled 9 in the Medicare program on or after June 1, 1993. The bill 10 requires HHS to apply these same reimbursement rate limits to 11 special population nursing facilities enrolled in the federal 12 Medicare program on or after July 1, 2023. 13 DIVISION V —— PUBLIC ASSISTANCE FRAUD —— REPORT. The bill 14 requires the department of inspections, appeals, and licensing 15 to submit a report on or before October 1, 2026, to the general 16 assembly concerning the department’s activities relative 17 to fraud in public assistance programs for the immediately 18 preceding fiscal year. The report shall include but is not 19 limited to a summary of the number of cases investigated, 20 case outcomes, overpayment dollars identified, amount of cost 21 avoidance, and actual dollars recovered. 22 DIVISION VI —— HIGH-ACUITY WORK GROUP —— REPORT. Under 23 the bill, HHS is required to convene a work group to identify 24 barriers to the ability of high-acuity Medicaid recipients 25 and members of Iowa health and wellness kids in Iowa (Hawki) 26 to remain in the least restrictive environment possible, and 27 develop a proposal for a tiered reimbursement methodology 28 to provide high-acuity home health services tailored to 29 meet the allowable medical and nonmedical support needs of 30 such individuals. The work group shall be composed of at 31 least one representative from providers of high-acuity home 32 health services, the Iowa chapter of the American academy 33 of pediatrics, the Iowa association of community providers, 34 the Iowa health care association, and other individuals or 35 -17- LSB 5348YC (15) 91 ak/ko 17/ 18

H.F. _____ organizations deemed appropriate by HHS. The work group 1 shall submit a report to the general assembly on or before 2 December 1, 2026, that outlines barriers identified by the work 3 group to high-acuity pediatric members remaining in the least 4 restrictive environment possible, and provides the estimated 5 fiscal impact of the work group’s proposed tiered reimbursement 6 methodology on affected providers and health care facilities. 7 HHS shall provide administrative support to the work group. 8 -18- LSB 5348YC (15) 91 ak/ko 18/ 18