Senate File 2422 - Introduced SENATE FILE 2422 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO SSB 3140) A BILL FOR An Act relating to the supplemental nutrition assistance 1 program, the medical assistance program, the Iowa health 2 and wellness plan, and other programs under the purview of 3 the department of health and human services and including 4 effective date provisions. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 6779SV (3) 91 ak/ko
S.F. 2422 DIVISION I 1 PUBLIC ASSISTANCE PROGRAMS —— ELIGIBILITY AND REPORTING 2 Section 1. Section 239.6, subsection 1, paragraph a, 3 subparagraph (4), Code 2026, is amended to read as follows: 4 (4) Information maintained by the United States citizenship 5 and immigration services of the United States department of 6 homeland security , including but not limited to information 7 accessible through the systematic alien verification for 8 entitlements online service . 9 Sec. 2. Section 239.6, subsection 2, Code 2026, is amended 10 by adding the following new paragraph: 11 NEW PARAGRAPH . g. The systematic alien verification for 12 entitlements online service maintained by the United States 13 citizenship and immigration services of the United States 14 department of homeland security to verify immigration and 15 United States citizenship information. 16 DIVISION II 17 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 18 Sec. 3. Section 239.1, Code 2026, is amended by adding the 19 following new subsection: 20 NEW SUBSECTION . 01. “Alien” means any person not a citizen 21 or national of the United States. 22 Sec. 4. Section 239.2, Code 2026, is amended to read as 23 follows: 24 239.2 Supplemental nutrition assistance program —— income 25 eligibility. 26 1. a. The department shall establish the gross countable 27 monthly income threshold for the supplemental nutrition 28 assistance program at less than or equal to one hundred sixty 29 percent of the federal poverty level for the household size. 30 b. The department shall consider the income and 31 financial resources of all household members in determining 32 the eligibility and benefit allotment of the household, 33 including all household members determined to be ineligible 34 to participate in SNAP under this section or pursuant to 7 35 -1- LSB 6779SV (3) 91 ak/ko 1/ 7
S.F. 2422 U.S.C. §2015(f). Notwithstanding 7 C.F.R. §273.11(c)(3), the 1 individual’s income, deductible expenses, and resources shall 2 be counted, and none shall be prorated. 3 c. Pursuant to 7 U.S.C. §2015(f), an individual shall be 4 ineligible to participate in SNAP unless the individual is a 5 resident of the United States and meets at least one of the 6 following criteria: 7 (1) The individual is a citizen or national of the United 8 States. 9 (2) The individual is an alien lawfully admitted for 10 permanent residence as an immigrant, as defined in 8 U.S.C. 11 §1101(a)(15) and 1101(a)(20), excluding alien visitors, 12 tourists, diplomats, students, or other individuals admitted 13 temporarily with no intention of abandoning their residence in 14 a foreign country. 15 (3) The individual is an alien who has been granted the 16 status of Cuban and Haitian entrant, as defined in section 17 501(e) of the federal Refugee Education Assistance Act of 1980, 18 Pub. L. No. 96-422. 19 (4) The individual lawfully resides in the United States in 20 accordance with a compact of free association referred to in 8 21 U.S.C. §1612(b)(2)(G). 22 2. The department shall comply with federal reporting 23 requirements relating to a household member who is determined 24 to be ineligible to participate in SNAP pursuant to 7 C.F.R. 25 §273.4(b). 26 DIVISION III 27 MEDICAID —— MANAGED CARE 28 Sec. 5. NEW SECTION . 249A.5 Delivery of medical assistance. 29 1. For the purposes of this section, “managed care program” 30 means the same as defined in 42 C.F.R. §438.2. 31 2. The department shall deliver all benefits that 32 recipients are entitled to under this chapter utilizing a 33 managed care program in compliance with 42 C.F.R. pt. 438, 34 except for benefits provided on a fee-for-service basis or 35 -2- LSB 6779SV (3) 91 ak/ko 2/ 7
S.F. 2422 otherwise excluded from managed care program delivery pursuant 1 to a Medicaid state plan or waiver in effect on or before July 2 1, 2026. 3 DIVISION IV 4 MEDICAID AND IOWA HEALTH AND WELLNESS PLAN —— RETROACTIVE 5 ELIGIBILITY AND REPORTING 6 Sec. 6. NEW SECTION . 249A.3B Medicaid —— retroactive 7 eligibility. 8 1. Notwithstanding any provision of state law to the 9 contrary, effective January 1, 2027, in compliance with 10 section 71112 of the One Big Beautiful Bill Act, Pub. L. No. 11 119-21, the department shall adopt rules to provide that the 12 eligibility of a individual who is a pregnant woman, a child, 13 or a resident of a nursing facility licensed under chapter 135C 14 shall be applied retroactively for no more than two months 15 prior to the month in which the individual submits a completed 16 medical assistance program application. 17 2. The department shall not adopt rules, or submit a 18 request for a waiver or state plan amendment to the centers for 19 Medicare and Medicaid services of the United States department 20 of health and human services, to permit the department to 21 provide medical assistance program eligibility retroactively to 22 any other adult individual except as provided in subsection 1. 23 Sec. 7. Section 249N.4, subsection 5, Code 2026, is amended 24 to read as follows: 25 5. A member is eligible for coverage effective the first day 26 of the month following the month of application for enrollment. 27 The department shall not adopt rules or submit a request for 28 a waiver or state plan amendment to the centers for Medicare 29 and Medicaid services of the United States department of health 30 and human services to permit the department to provide program 31 eligibility prior to the month in which the individual submits 32 a completed application for enrollment. 33 Sec. 8. 2017 Iowa Acts, chapter 174, section 12, subsection 34 15, paragraph a, subparagraph (7), as amended by 2018 Iowa 35 -3- LSB 6779SV (3) 91 ak/ko 3/ 7
S.F. 2422 Acts, chapter 1165, section 107, is amended by striking the 1 subparagraph. 2 Sec. 9. MEDICAID RETROACTIVE ELIGIBILITY —— WAIVER. The 3 department of health and human services shall submit a 4 request for a section 1115 demonstration waiver to the centers 5 for Medicare and Medicaid services of the United States 6 department of health and human services for approval to 7 allow, for purposes of state administration of Medicaid, for 8 implementation by the department of no retroactive eligibility 9 for any adult individual who is not a pregnant woman, a child, 10 or a resident of a nursing facility licensed under chapter 11 135C, upon the submission of a completed Medicaid application, 12 instead of three months as required under 42 C.F.R. §435.915. 13 The department shall implement the waiver upon receipt of 14 approval of the waiver by the centers for Medicare and Medicaid 15 services of the United States department of health and human 16 services. 17 DIVISION V 18 MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— COST NEUTRALITY 19 Sec. 10. NEW SECTION . 249A.32C Medicaid waivers and state 20 plan amendments —— cost neutrality. 21 1. As used in this section, “cost neutral” means federal 22 approval of a waiver submitted by the department to the federal 23 government will not result in a net increase in spending for 24 the administration of the Medicaid program by the state. 25 2. Prior to submitting a request to the centers for Medicare 26 and Medicaid services of the United States department of health 27 and human services for a section 1115 demonstration waiver, 28 a section 1915 home and community-based services waiver, or 29 a state plan amendment to expand coverage under the medical 30 assistance program to additional individuals or a class of 31 individuals, the department shall conduct an analysis to 32 determine if the waiver is cost neutral. For any waiver that 33 is determined to be not cost neutral, the department shall not 34 submit the request for a waiver unless the waiver has been 35 -4- LSB 6779SV (3) 91 ak/ko 4/ 7
S.F. 2422 presented to the general assembly and approved by a majority 1 vote of both houses of the general assembly. This subsection 2 shall apply to a section 1115 demonstration waiver, a section 3 1915 home and community-based services waiver, and a state 4 plan amendment to expand coverage under the medical assistance 5 program to additional individuals or classes of individuals 6 submitted to, or approved by, the centers for Medicare and 7 Medicaid services of the United States department of health and 8 human services prior to the effective date of this division of 9 this Act. 10 3. The department shall annually conduct an analysis to 11 determine the cost neutrality of all approved or implemented 12 cost waivers, and on or before October 1, submit a report to 13 the general assembly detailing the department’s cost neutrality 14 analysis and the department’s compliance with section 7118 of 15 the federal One Big Beautiful Bill Act, Pub. L. No. 119-21, 16 that requires cost neutrality for all Medicaid section 1115 17 demonstration waivers. 18 DIVISION VI 19 EFFECTIVE DATE 20 Sec. 11. EFFECTIVE DATE. This Act, being deemed of 21 immediate importance, takes effect upon enactment. 22 EXPLANATION 23 The inclusion of this explanation does not constitute agreement with 24 the explanation’s substance by the members of the general assembly. 25 This bill relates to the supplemental nutrition assistance 26 program (SNAP), the medical assistance program (Medicaid), the 27 Iowa health and wellness plan (IHAWP), and other programs under 28 the purview of the department of health and human services 29 (HHS). 30 DIVISION I —— PUBLIC ASSISTANCE PROGRAMS —— ELIGIBILITY 31 AND REPORTING. The bill requires HHS, prior to determining 32 the initial eligibility of an applicant for, or the ongoing 33 eligibility of a recipient of, public assistance benefits to 34 verify immigration and United States citizenship information 35 -5- LSB 6779SV (3) 91 ak/ko 5/ 7
S.F. 2422 of the applicant or recipient through the systematic alien 1 verification for entitlements online service maintained by 2 the United States citizenship and immigration services of the 3 United States department of homeland security. 4 DIVISION II —— SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM. 5 The bill provides that HHS shall consider the income and 6 financial resources of all household members in determining the 7 eligibility and benefit allotment of the household, including 8 household members determined to be ineligible for benefits. An 9 individual shall be ineligible to participate in SNAP unless 10 they have eligible immigration or United States citizenship 11 status as detailed in the bill. HHS is required to notify the 12 United States citizenship and immigration services if HHS is 13 unable to verify the immigration or United States citizenship 14 status of any household member listed on a SNAP application. 15 DIVISION III —— MEDICAID —— MANAGED CARE. The bill provides 16 that HHS shall deliver all Medicaid benefits utilizing a 17 managed care program as defined in the bill, except for 18 Medicaid benefits provided on a fee-for-service basis or 19 otherwise excluded from managed care program delivery pursuant 20 to a Medicaid state plan or waiver in effect on or before July 21 1, 2026. 22 DIVISION IV —— MEDICAID AND IOWA HEALTH AND WELLNESS PLAN —— 23 RETROACTIVE ELIGIBILITY AND REPORTING. The bill provides that 24 beginning on January 1, 2027, notwithstanding any provision of 25 state law to the contrary and in compliance with federal law, 26 HHS shall adopt rules to provide for two months of retroactive 27 benefit eligibility for pregnant women, children, and residents 28 of certain nursing facilities who apply for Medicaid. HHS 29 shall not adopt rules or submit a request for a waiver or state 30 plan amendment to CMS for retroactive benefit eligibility 31 for any other adult applying for Medicaid or any individual 32 applying to enroll in IHAWP. The bill strikes a provision 33 related to a prior directive by the general assembly to the 34 department to request a waiver to limit retroactive benefit 35 -6- LSB 6779SV (3) 91 ak/ko 6/ 7
S.F. 2422 eligibility. 1 The bill directs HHS to submit a waiver to CMS to allow HHS 2 to deviate from federal law, which provides for three months 3 of retroactive eligibility, and provide for no retroactive 4 eligibility to adults who are not pregnant women, children, or 5 residents of certain nursing facilities. HHS shall implement 6 the waiver upon receipt of approval of the waiver by CMS. 7 DIVISION V —— MEDICAID WAIVERS AND STATE PLAN AMENDMENTS 8 —— COST NEUTRALITY. The bill requires HHS to conduct an 9 analysis to determine if a waiver or state plan amendment 10 is cost neutral prior to submitting a request for a waiver 11 or state plan amendment to CMS to expand coverage under the 12 medical assistance program to additional individuals or classes 13 of individuals. For any waiver or state plan amendment that 14 is determined not to be cost neutral, HHS shall not submit 15 the request to CMS unless the request has been presented to 16 the general assembly and approved by a majority vote of both 17 houses of the general assembly. HHS is not required to seek 18 legislative approval for waivers or state plan amendments 19 already submitted to, or approved by, CMS prior to the 20 effective date of the bill. 21 HHS shall conduct an annual analysis to determine if all 22 approved or implemented Medicaid section 1115 demonstration 23 waivers are cost neutral. On or before October 1, HHS shall 24 submit a report to the general assembly detailing medical 25 assistance program compliance with the federal One Big 26 Beautiful Bill Act, which requires all Medicaid section 1115 27 demonstration waivers to be cost neutral. The report shall 28 include HHS’s cost neutrality analysis for all demonstration 29 waivers implemented or approved by Medicaid. The bill defines 30 “cost neutral”. 31 DIVISION VI —— EFFECTIVE DATE. The bill takes effect upon 32 enactment. 33 -7- LSB 6779SV (3) 91 ak/ko 7/ 7