House Study Bill 777 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON APPROPRIATIONS BILL BY CHAIRPERSON MOHR) A BILL FOR An Act relating to and making appropriations to the department 1 of veterans affairs and the department of health and 2 human services, including aging and disability services, 3 behavioral health, public health, and community access 4 and eligibility; the medical assistance program, state 5 supplementary assistance, Hawki, and other health-related 6 programs; family well-being and protection; state-operated 7 specialty care; administration and compliance; transfers, 8 cash flow, and nonreversions; report on nonreversion 9 of moneys; more options for maternal support program; 10 reimbursement rates review; mental diseases exclusion 11 waiver; community health centers reimbursement; full-time 12 equivalent dashboard; comprehensive family support program; 13 federal community mental health services block grant; child 14 welfare and juvenile justice decategorization; commitment 15 or hospitalization of certain persons with substance abuse 16 disorders or mental illness; behavioral health expenditure 17 report; and opioid settlement fund; and including effective 18 date and retroactive applicability provisions. 19 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 20 TLSB 5004YC (17) 91 ak/ko

H.F. _____ DIVISION I 1 DEPARTMENT OF VETERANS AFFAIRS —— FY 2026-2027 2 Section 1. DEPARTMENT OF VETERANS AFFAIRS. There is 3 appropriated from the general fund of the state to the 4 department of veterans affairs for the fiscal year beginning 5 July 1, 2026, and ending June 30, 2027, the following amounts, 6 or so much thereof as is necessary, to be used for the purposes 7 designated: 8 1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION 9 For salaries, support, maintenance, and miscellaneous 10 purposes, and for not more than the following full-time 11 equivalent positions: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 14 2. IOWA VETERANS HOME 15 For salaries, support, maintenance, and miscellaneous 16 purposes: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736 18 a. The Iowa veterans home billings involving the department 19 of health and human services shall be submitted to the 20 department on at least a monthly basis. 21 b. The Iowa veterans home expenditure report shall be 22 submitted monthly to the general assembly. 23 3. HOME OWNERSHIP ASSISTANCE PROGRAM 24 For transfer to the Iowa finance authority for the 25 continuation of the home ownership assistance program for 26 persons who are or were eligible members of the armed forces 27 of the United States or eligible service members pursuant to 28 section 16.54: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 30 DIVISION II 31 AGING AND DISABILITY SERVICES —— FY 2026-2027 32 Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 33 AND DISABILITY SERVICES. There is appropriated from the 34 general fund of the state to the department of health and human 35 -1- LSB 5004YC (17) 91 ak/ko 1/ 42

H.F. _____ services for the fiscal year beginning July 1, 2026, and ending 1 June 30, 2027, the following amount, or so much thereof as is 2 necessary, to be used for the purposes designated: 3 For aging programs for the department of health and human 4 services and area agencies on aging to provide citizens of 5 Iowa who are 60 years of age and older with case management; 6 for Iowa’s aging and disabilities resource centers; for the 7 return to community program; for the purposes of chapter 231E; 8 to administer the prevention of elder abuse, neglect, and 9 exploitation program pursuant to section 231.56A, in accordance 10 with the requirements of the federal Older Americans Act of 11 1965, 42 U.S.C. §3001 et seq., as amended; for the operation 12 of the dependent adult abuse services program pursuant to 13 chapter 235B; for matching funding for programs to enable 14 persons with severe physical or mental disabilities to function 15 more independently; for costs associated with centers for 16 independent living; and for other services which may include 17 but are not limited to adult day care, respite care, chore, 18 information and assistance, and material aid; for information 19 and options counseling for persons with disabilities; and 20 for salaries, support, administration, maintenance, and 21 miscellaneous purposes, and for not more than the following 22 full-time equivalent positions: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,379,531 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 88.00 25 1. Moneys appropriated in this section may be used to 26 supplement federal moneys received under federal regulations. 27 To receive moneys appropriated in this section, a local area 28 agency on aging shall match the moneys with moneys from other 29 sources according to rules adopted by the department. Moneys 30 appropriated in this section may be used for services not 31 specifically enumerated in this section only if approved by the 32 department as part of an area agency on aging’s area plan. 33 2. Of the moneys appropriated in this section, $949,282 34 is allocated to be used for the comprehensive family support 35 -2- LSB 5004YC (17) 91 ak/ko 2/ 42

H.F. _____ program created in section 231.80 as enacted under this Act. 1 3. Of the moneys appropriated in this section, $33,632 2 is allocated to be used to build community capacity through 3 the coordination and provision of training opportunities in 4 accordance with the consent decree of Conner v. Branstad, No. 5 4-86-CV-30871 (S.D. Iowa, July 15, 1994). 6 DIVISION III 7 BEHAVIORAL HEALTH —— FY 2026-2027 8 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 9 BEHAVIORAL HEALTH. There is appropriated from the general fund 10 of the state to the department of health and human services for 11 the fiscal year beginning July 1, 2026, and ending June 30, 12 2027, the following amount, or so much thereof as is necessary, 13 to be used for the purposes designated: 14 For behavioral health prevention, education, early 15 intervention, treatment, recovery support, and crisis 16 services in order to support statewide access to treatment for 17 behavioral health conditions; stabilization and mitigation of 18 behavioral health crises; and recovery for individuals and 19 families impacted by behavioral health conditions. Activities 20 shall align with accepted best practice guidance standards for 21 behavioral health including those published by the centers for 22 disease control and prevention of the United States department 23 of health and human services, and the substance abuse and 24 mental health services administration of the United States 25 department of health and human services, for health promotion; 26 universal, selective, and indicated prevention; treatment; and 27 recovery services and supports; and shall include a 24-hour 28 helpline, public information resources, professional training, 29 youth prevention, program evaluation, and efforts at the state 30 and local levels, and for not more than the following full-time 31 equivalent positions: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 23,127,121 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 71.00 34 1. Of the moneys appropriated in this section, $300,000 35 -3- LSB 5004YC (17) 91 ak/ko 3/ 42

H.F. _____ is allocated to support the work of the children’s behavioral 1 health system including evidence-based behavioral health 2 prevention, treatment, and recovery services and supports for 3 children and their families. 4 2. Of the moneys appropriated in this section, $950,000 5 is allocated for an integrated substance use disorder managed 6 care system. The department shall maintain the level of mental 7 health and substance use disorder treatment services provided 8 by the managed care contractors, and shall take the steps 9 necessary to continue the federal waivers as needed to maintain 10 the level of services. 11 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 12 WAGERING RECEIPTS FUND. There is appropriated from the 13 sports wagering receipts fund created in section 8.57I, to the 14 department of health and human services for the fiscal year 15 beginning July 1, 2026, and ending June 30, 2027, the following 16 amount, or so much thereof as is necessary, to be used for 17 behavioral health prevention, education, early intervention, 18 treatment, recovery support, and crisis services in order to 19 support statewide access to treatment for behavioral health 20 conditions; stabilization and mitigation of behavioral health 21 crises; and recovery for individuals and families impacted by 22 behavioral health conditions: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 24 DIVISION IV 25 PUBLIC HEALTH —— FY 2026-2027 26 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 27 HEALTH. There is appropriated from the general fund of the 28 state to the department of health and human services for the 29 fiscal year beginning July 1, 2026, and ending June 30, 2027, 30 the following amount, or so much thereof as is necessary, to be 31 used for the purposes designated: 32 For programs that support health promotion, protect the 33 health and safety of the public, conduct disease surveillance 34 and investigation to reduce the incidence of morbidity and 35 -4- LSB 5004YC (17) 91 ak/ko 4/ 42

H.F. _____ mortality, serve individuals with chronic conditions including 1 but not limited to cancer, support the Iowa donor registry as 2 specified in section 142C.18, and strengthen the health care 3 delivery system and workforce to improve health outcomes for 4 all Iowans, and for not more than the following full-time 5 equivalent positions: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,024,369 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 348.60 8 1. Of the moneys appropriated in this section, $95,000 is 9 allocated for a child vision screening program implemented 10 through the university of Iowa hospitals and clinics in 11 collaboration with early childhood Iowa areas. The program 12 shall submit a report to the department regarding the use 13 of funds allocated under this subsection. The report shall 14 include the objectives and results for the program year 15 including the target population and how the funds allocated 16 assisted the program in meeting the objectives; the number, 17 age, and location within the state of individuals served; 18 the type of services provided to the individuals served; the 19 distribution of moneys based on the services provided; and the 20 continuing needs of the program. 21 2. Of the moneys appropriated in this section, $96,000 shall 22 be used for a grant to a nationally affiliated volunteer eye 23 organization that has an established program for children and 24 adults and that is solely dedicated to preserving sight and 25 preventing blindness through education, nationally certified 26 vision screening and training, and community and patient 27 service programs. The contractor shall submit a report to the 28 general assembly regarding the use of funds allocated under 29 this subsection. The report shall include the objectives and 30 results for the program year including the target population 31 and how the funds allocated assisted the program in meeting the 32 objectives; the number, age, grade level if appropriate, and 33 location within the state of individuals served; the type of 34 services provided to the individuals served; the distribution 35 -5- LSB 5004YC (17) 91 ak/ko 5/ 42

H.F. _____ of moneys based on the services provided; and the continuing 1 needs of the program. 2 3. Of the moneys appropriated in this section, the following 3 amounts are allocated to the department of health and human 4 services to be used as follows to support the goals of 5 increased access, health system integration, and engagement: 6 a. $600,000 for distribution to a nonprofit organization 7 that established the first statewide drug donation repository 8 for continuation of the pharmaceutical infrastructure for 9 safety net providers established as described in 2007 Iowa 10 Acts, chapter 218, section 108, and for the prescription drug 11 donation repository program established in chapter 135M. 12 Moneys under this paragraph shall be distributed in their 13 entirety on July 1, 2026, for the purpose specified. 14 b. $374,000 for distribution to free clinics, as defined in 15 section 135.24, and a nonprofit organization that facilitates 16 the initiation, operation, and collaboration of free clinics 17 for necessary infrastructure, statewide coordination, provider 18 recruitment, service delivery, and provision of assistance to 19 patients in securing a medical home inclusive of oral health 20 care. Of the moneys allocated, $40,000 shall be used to lower 21 fees associated with using an electronic prescribing system. 22 Moneys under this paragraph shall be distributed in their 23 entirety on July 1, 2026, for the purpose specified. 24 c. $25,000 for distribution to an organization that raises 25 awareness about issues related to rural health clinics for 26 necessary infrastructure and service delivery transformation. 27 Moneys under this paragraph shall be distributed in their 28 entirety on July 1, 2026, for the purpose specified. 29 4. Of the moneys appropriated in this section, $600,000 30 is allocated for rural psychiatric residencies for residents 31 selected on or before June 30, 2026. 32 5. Of the moneys appropriated in this section, $20,000 is 33 allocated to make radon test kits available, free of charge, 34 to homeowners and renters in the state. The department shall 35 -6- LSB 5004YC (17) 91 ak/ko 6/ 42

H.F. _____ provide a link on the department’s internet site for homeowners 1 and renters in the state to order radon test kits. 2 6. Of the moneys appropriated in this section, $2,300,000 is 3 allocated for awarding grants for medical residency programs in 4 the state that meet the following criteria: 5 a. The medical residency program is not sponsored by the 6 university of Iowa hospitals and clinics. 7 b. The medical residency program is not related to the 8 practice of family medicine. 9 7. The university of Iowa hospitals and clinics under 10 the control of the state board of regents shall not receive 11 indirect costs from the moneys appropriated in this section. 12 The university of Iowa hospitals and clinics billings to the 13 department shall be, at a minimum, on a quarterly basis. 14 DIVISION V 15 COMMUNITY ACCESS AND ELIGIBILITY —— CHILD SUPPORT SERVICES —— 16 TANF —— FY 2026-2027 17 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 18 ACCESS AND ELIGIBILITY. There is appropriated from the 19 general fund of the state to the department of health and human 20 services for the fiscal year beginning July 1, 2026, and ending 21 June 30, 2027, the following amount, or so much thereof as is 22 necessary, to be used for the purposes designated: 23 To be used for salaries, support, maintenance, and 24 miscellaneous purposes and for family investment program (FIP) 25 assistance in accordance with chapter 239B, and for other costs 26 associated with providing needs-based benefits or assistance 27 including but not limited to maternal and child health, oral 28 health, obesity prevention, the promoting independence and 29 self-sufficiency through employment, job opportunities and the 30 basic skills (PROMISE JOBS) program, supplemental nutrition 31 assistance program (SNAP) employment and training, the FIP 32 diversion program, family planning, rent reimbursement, 33 and eligibility determinations for medical assistance, food 34 assistance, and the children’s health insurance program, and 35 -7- LSB 5004YC (17) 91 ak/ko 7/ 42

H.F. _____ for not more than the following full-time equivalent positions: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 74,610,079 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 870.40 3 1. Of the child support collections assigned under FIP, 4 the federal share of the child support collections shall be 5 credited to the child support services appropriation made in 6 this division of this Act. Of the remainder of the child 7 support collections assigned under FIP, a portion shall be 8 credited to community access and eligibility, and the remaining 9 moneys may be used to increase recoveries, to sustain cash flow 10 in the collection services center refund account as provided in 11 section 252B.13A, or for technology needs. If child support 12 collections assigned under FIP are greater than estimated or 13 are otherwise determined not to be required for maintenance of 14 efforts, the state share of either amount is appropriated to 15 the department for child support services as described in this 16 division of this Act, or may be transferred to or retained in 17 the collection services center refund account. 18 2. Of the moneys appropriated in this section, $3,075,000 is 19 allocated for continuation of the department’s initiative to 20 provide for adequate developmental surveillance and screening 21 during a child’s first five years. The moneys shall first be 22 used to fully fund the current participating counties to ensure 23 that those counties are fully operational, with the remaining 24 moneys to be used for expanding participation to additional 25 counties. Full implementation and expansion shall include 26 enhancing the scope of the initiative through collaboration 27 with child health specialty clinics to promote the use of 28 developmental surveillance and screening to support healthy 29 child development through early identification and response to 30 biomedical and social determinants of healthy development by 31 providing practitioner consultation and continuous improvement 32 through training and education, particularly for children 33 with behavioral conditions and needs. The department shall 34 also collaborate with the Medicaid program and child health 35 -8- LSB 5004YC (17) 91 ak/ko 8/ 42

H.F. _____ specialty clinics to assist in coordinating the activities 1 of the first five initiative into the establishment of 2 patient-centered medical homes developed to improve health 3 quality and population health while reducing health care costs. 4 To the maximum extent possible, moneys allocated in this 5 subsection shall be utilized as matching moneys for Medicaid 6 program reimbursement. 7 3. Of the moneys appropriated in this section, $1,145,102 is 8 allocated to the Iowa commission on volunteer service created 9 in section 15H.2 for programs and grants. 10 4. Of the moneys appropriated in this section, $127,500 11 is allocated to the Iowa food bank association, as defined 12 in section 190B.201, to operate a supplemental nutrition 13 assistance program hotline. 14 5. The university of Iowa hospitals and clinics under 15 the control of the state board of regents shall not receive 16 indirect costs from the moneys appropriated in this section. 17 The university of Iowa hospitals and clinics billings to the 18 department shall be, at a minimum, on a quarterly basis. 19 Sec. 7. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CHILD 20 SUPPORT SERVICES. There is appropriated from the general fund 21 of the state to the department of health and human services for 22 the fiscal year beginning July 1, 2026, and ending June 30, 23 2027, the following amount, or so much thereof as is necessary, 24 to be used for the purposes designated: 25 For child support services, including salaries, support, 26 maintenance, and miscellaneous purposes, and for not more than 27 the following full-time equivalent positions: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,644,114 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 464.00 30 1. Federal access and visitation grant moneys shall be used 31 for services designed to increase compliance with the child 32 access provisions of court orders, including but not limited to 33 neutral visitation sites and mediation services. 34 2. Moneys appropriated in this section may be used 35 -9- LSB 5004YC (17) 91 ak/ko 9/ 42

H.F. _____ throughout the fiscal year in the manner necessary for 1 cash flow management. For cash flow management under this 2 subsection, the department may temporarily draw more than the 3 amount appropriated provided the amount appropriated is not 4 exceeded at the close of the fiscal year. 5 Sec. 8. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 6 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT. There is 7 appropriated from the special fund created in section 8.41 to 8 the department of health and human services for the fiscal year 9 beginning July 1, 2026, and ending June 30, 2027, from moneys 10 received under the federal temporary assistance for needy 11 families (TANF) block grant pursuant to the federal Personal 12 Responsibility and Work Opportunity Reconciliation Act of 1996, 13 Pub. L. No. 104-193, and successor legislation, including TANF 14 block grant moneys received in any prior fiscal year that 15 were deposited in the special fund and remain unencumbered 16 or unobligated on June 30, 2026, the following amounts, or 17 so much thereof as is necessary, to be used for the purposes 18 designated: 19 1. For community access and eligibility: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,566,312 21 2. For community access and eligibility to provide 22 pregnancy prevention grants on the condition that family 23 planning services are funded: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 25 Pregnancy prevention grants shall be awarded to programs 26 in existence on or before July 1, 2026, if the programs have 27 demonstrated positive outcomes. Grants shall be awarded 28 to pregnancy prevention programs developed after July 1, 29 2026, if the programs are based on existing models that have 30 demonstrated positive outcomes. Grants must comply with the 31 requirements provided in 1997 Iowa Acts, chapter 208, section 32 14, subsections 1 and 2, including the requirement that a 33 program awarded a grant must emphasize sexual abstinence. 34 Priority in awarding grants shall be given to programs 35 -10- LSB 5004YC (17) 91 ak/ko 10/ 42

H.F. _____ that serve areas of the state which demonstrate the highest 1 percentage of unplanned pregnancies of females of childbearing 2 age within the geographic area to be served by the grant. 3 3. To meet one of the four purposes of TANF as specified 4 in 45 C.F.R. §260.20, including by modernizing the program 5 to promote economic mobility and self-sufficiency, ensuring 6 that families are able to overcome benefit cliffs, encouraging 7 healthy families, and streamlining service delivery to reduce 8 duplication: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000,000 10 4. For early intervention and supports for child abuse 11 prevention and the family development and self-sufficiency 12 (FaDSS) grant program in accordance with section 216A.107: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,013,980 14 5. For accountability, compliance, program integrity, 15 technology needs, and other resources necessary to meet 16 federal and state reporting, tracking, and case management 17 requirements, and other departmental needs: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 19 6. For state child care assistance: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 42,281,826 21 7. For child protective services: 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 67,249,100 23 a. Of the moneys appropriated in this subsection, 24 $1,658,000 shall be allocated for child protection centers 25 located in Iowa pursuant to the child protection center grant 26 program under section 135.118. The grant amounts under the 27 program shall be equalized so that each center receives a 28 uniform base amount of $245,000, and the remaining moneys 29 are awarded through a funding formula based upon the volume 30 of children served by a center. To increase access to child 31 protection center services for children in rural areas, the 32 funding formula for awarding the remaining moneys shall provide 33 for awarding an enhanced amount to eligible grantees to develop 34 and maintain satellite centers in underserved regions of the 35 -11- LSB 5004YC (17) 91 ak/ko 11/ 42

H.F. _____ state. 1 b. Of the moneys appropriated in this subsection, up to 2 $227,000 shall be used for the public purpose of continuing a 3 grant to a nonprofit human services organization that provides 4 services to individuals and families in multiple locations in 5 southwest Iowa and Nebraska, for support of a project providing 6 immediate, sensitive support and forensic interviews, medical 7 exams, needs assessments, and referrals for victims of child 8 abuse and their nonoffending family members. 9 DIVISION VI 10 MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— 11 HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 12 PROGRAMS —— FY 2026-2027 13 Sec. 9. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— MEDICAL 14 ASSISTANCE PROGRAM, STATE SUPPLEMENTARY ASSISTANCE, AND HEALTHY 15 AND WELL KIDS IN IOWA PROGRAM. There is appropriated from the 16 general fund of the state to the department of health and human 17 services for the fiscal year beginning July 1, 2026, and ending 18 June 30, 2027, the following amount, or so much thereof as is 19 necessary, to be used for the purposes designated: 20 For medical assistance program reimbursement and associated 21 costs as specifically provided in the reimbursement 22 methodologies in effect on June 30, 2026, except as otherwise 23 expressly authorized by law, consistent with options under 24 federal law and regulations, and contingent upon receipt of 25 approval from the office of the governor of reimbursement for 26 each abortion performed under the medical assistance program; 27 for the state supplementary assistance program; for the health 28 insurance premium payment program; and for maintenance of 29 the healthy and well kids in Iowa (Hawki) program pursuant 30 to chapter 514I, including supplemental dental services, 31 for receipt of federal financial participation under Tit. 32 XXI of the federal Social Security Act, which creates the 33 children’s health insurance program; and for other specified 34 health-related programs: 35 -12- LSB 5004YC (17) 91 ak/ko 12/ 42

H.F. _____ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,995,889,295 1 1. Of the moneys appropriated in this section, 2 $1,930,142,662 is allocated for medical assistance program 3 reimbursement and associated costs. Of the moneys allocated 4 in this subsection, $3,383,880 shall be used for program 5 administration, outreach, and enrollment activities of the 6 state family planning services program pursuant to section 7 217.41B , and of this amount, the department may use $200,000 8 for administrative expenses. 9 2. Iowans support reducing the number of abortions 10 performed in our state. Moneys appropriated under this section 11 shall not be used for abortions, unless otherwise authorized 12 under this section. 13 3. The provisions of this section relating to abortions 14 shall also apply to the Iowa health and wellness plan created 15 pursuant to chapter 249N . 16 4. Of the moneys appropriated in this section, $4,479,762 is 17 allocated for the state supplementary assistance program. 18 5. Of the moneys appropriated in this section, $61,266,871 19 is allocated for maintenance of the Hawki program pursuant 20 to chapter 514I , including supplemental dental services, for 21 receipt of federal financial participation under Tit. XXI of 22 the federal Social Security Act, which creates the children’s 23 health insurance program. 24 Sec. 10. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HEALTH 25 PROGRAM OPERATIONS. There is appropriated from the general 26 fund of the state to the department of health and human 27 services for the fiscal year beginning July 1, 2026, and ending 28 June 30, 2027, the following amount, or so much thereof as is 29 necessary, to be used for the purposes designated: 30 For health program operations and the autism support program 31 under section 225D.2, and for not more than the following 32 full-time equivalent positions: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 41,129,136 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 82.00 35 -13- LSB 5004YC (17) 91 ak/ko 13/ 42

H.F. _____ 1. The department of inspections, appeals, and licensing 1 shall provide all state matching moneys for survey and 2 certification activities performed by the department of 3 inspections, appeals, and licensing. The department of health 4 and human services shall be solely responsible for distributing 5 the federal matching moneys for such activities. 6 2. Of the moneys appropriated in this section, a sufficient 7 amount is allocated for the administration of the health 8 insurance premium payment program, including salaries, support, 9 maintenance, and miscellaneous purposes. 10 3. Of the moneys appropriated in this section, $750,000 is 11 allocated for a nonprofit organization that provides access 12 to emergency poison information and treatment. Pursuant to 13 the directive under 2014 Iowa Acts, chapter 1140, section 14 102, the federal matching moneys available to the nonprofit 15 organization from the department under the federal Children’s 16 Health Insurance Program Reauthorization Act of 2009 shall be 17 subject to the federal administrative cap rule of 10 percent 18 applicable to moneys provided under Tit. XXI of the federal 19 Social Security Act, and shall be included in the department’s 20 calculations of the cap. 21 4. Unless otherwise provided by law, if a contract for 22 services provided under this section initially entered into 23 during the fiscal year beginning July 1, 2026, and ending 24 June 30, 2027, provides for an annual increase of the cost of 25 services provided under the contract, the annual increase shall 26 not exceed the amount by which the consumer price index for 27 all urban consumers increased during the immediately preceding 28 calendar year. This subsection does not affect a contract 29 entered into on or before June 30, 2026, that is for a term of 30 more than one year. 31 Sec. 11. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 32 PHARMACEUTICAL SETTLEMENT ACCOUNT. There is appropriated 33 from the pharmaceutical settlement account created in section 34 249A.33 to the department of health and human services for the 35 -14- LSB 5004YC (17) 91 ak/ko 14/ 42

H.F. _____ fiscal year beginning July 1, 2026, and ending June 30, 2027, 1 the following amount, or so much thereof as is necessary, to be 2 used for the purposes designated: 3 Notwithstanding any provision of law to the contrary, to 4 supplement the appropriation made in this Act from the general 5 fund of the state for health program operations under the 6 medical assistance program for the same fiscal year: 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 8 Sec. 12. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— QUALITY 9 ASSURANCE TRUST FUND. Notwithstanding any provision of law 10 to the contrary, and subject to the availability of moneys, 11 there is appropriated from the quality assurance trust fund 12 created in section 249L.4 to the department of health and human 13 services for the fiscal year beginning July 1, 2026, and ending 14 June 30, 2027, the following amount, or so much thereof as is 15 necessary, for the purposes designated: 16 To supplement the appropriation made in this Act from the 17 general fund of the state to the department of health and human 18 services for medical assistance for the same fiscal year: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 20 Sec. 13. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HOSPITAL 21 HEALTH CARE ACCESS TRUST FUND. Notwithstanding any provision 22 of law to the contrary, and any subject to the availability of 23 moneys, there is appropriated from the hospital health care 24 access trust fund created in section 249M.4 to the department 25 of health and human services for the fiscal year beginning July 26 1, 2026, and ending June 30, 2027, the following amount, or so 27 much thereof as is necessary, for the purposes designated: 28 To supplement the appropriation made in this Act from the 29 general fund of the state to the department of health and human 30 services for medical assistance for the same fiscal year: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 32 Sec. 14. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 33 BEHAVIORAL HEALTH FUND. Notwithstanding section 225A.7, 34 subsection 2, and subject to the availability of moneys, there 35 -15- LSB 5004YC (17) 91 ak/ko 15/ 42

H.F. _____ is appropriated from the behavioral health fund established in 1 section 225A.7, to the department of health and human services 2 for the fiscal year beginning July 1, 2026, and ending June 30, 3 2027, the following amount, or so much thereof as is necessary, 4 for the purposes designated: 5 To supplement the appropriation made in this Act from the 6 general fund of the state to the department of health and human 7 services for medical assistance for the fiscal year beginning 8 July 1, 2026, and ending June 30, 2027: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,771,589 10 Sec. 15. REIMBURSEMENT RATES. 11 1. Reimbursement for medical assistance, state 12 supplementary assistance, and social service providers and 13 services reimbursed under the purview of the department of 14 health and human services shall remain at the reimbursement 15 rate in effect on June 30, 2026, or shall be determined 16 pursuant to the reimbursement methodology in effect on June 30, 17 2026, with the exception of the following: 18 a. If reimbursement is otherwise negotiated by contract or 19 pursuant to an updated fee schedule. 20 b. As otherwise provided in this section. 21 2. a. (1) Notwithstanding any provision of law to the 22 contrary, for the fiscal year beginning July 1, 2026, and 23 ending June 30, 2027, the department of health and human 24 services shall reimburse case-mix nursing facility rates based 25 on the methodology in effect on June 30, 2026. 26 (2) July 1, 2025, through December 31, 2025, the department 27 of health and human services shall calculate each nursing 28 facility’s case-mix index for rates effective July 1, 2026. 29 (3) January 1, 2026, through June 30, 2026, the department 30 of health and human services shall calculate each nursing 31 facility’s case-mix index for rates effective January 1, 2027. 32 (4) (a) Medicaid managed care organizations shall adjust 33 the following rates based upon payment rate listings issued by 34 the department of health and human services: 35 -16- LSB 5004YC (17) 91 ak/ko 16/ 42