SF 2422 (LSB 6779SV (3) 91)

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 program, the medical assistance program, the Iowa health and wellness plan, and other programs under the purview of the department of health and human services and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
PUBLIC ASSISTANCE PROGRAMS —— ELIGIBILITY AND REPORTING

    Section 1.  Section 239.6, subsection 1, paragraph a, subparagraph (4), Code 2026, is amended to read as follows:
   (4)  Information maintained by the United States citizenship and immigration services of the United States department of homeland security, including but not limited to information accessible through the systematic alien verification for entitlements online service.
    Sec. 2.  Section 239.6, subsection 2, Code 2026, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  g.  The systematic alien verification for entitlements online service maintained by the United States citizenship and immigration services of the United States department of homeland security to verify immigration and United States citizenship information.
DIVISION II
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM

    Sec. 3.  Section 239.1, Code 2026, is amended by adding the following new subsection:
   NEW SUBSECTION.  01.  “Alien” means any person not a citizen or national of the United States.
    Sec. 4.  Section 239.2, Code 2026, is amended to read as follows:
   239.2  Supplemental nutrition assistance program —— income eligibility.
   1.  a.  The department shall establish the gross countable monthly income threshold for the supplemental nutrition assistance program at less than or equal to one hundred sixty percent of the federal poverty level for the household size.
   b.  The department shall consider the income and financial resources of all household members in determining the eligibility and benefit allotment of the household, including all household members determined to be ineligible to participate in SNAP under this section or pursuant to 7 U.S.C. §2015(f). Notwithstanding 7 C.F.R. §273.11(c)(3), the individual’s income, deductible expenses, and resources shall be counted, and none shall be prorated.
   c.  Pursuant to 7 U.S.C. §2015(f), an individual shall be ineligible to participate in SNAP unless the individual is a resident of the United States and meets at least one of the following criteria:
   (1)  The individual is a citizen or national of the United States.
   (2)  The individual is an alien lawfully admitted for permanent residence as an immigrant, as defined in 8 U.S.C. §1101(a)(15) and 1101(a)(20), excluding alien visitors, tourists, diplomats, students, or other individuals admitted temporarily with no intention of abandoning their residence in a foreign country.
   (3)  The individual is an alien who has been granted the status of Cuban and Haitian entrant, as defined in section 501(e) of the federal Refugee Education Assistance Act of 1980, Pub. L. No. 96-422.
   (4)  The individual lawfully resides in the United States in accordance with a compact of free association referred to in 8 U.S.C. §1612(b)(2)(G).
   2.  The department shall comply with federal reporting requirements relating to a household member who is determined to be ineligible to participate in SNAP pursuant to 7 C.F.R. §273.4(b).
DIVISION III
MEDICAID —— MANAGED CARE

    Sec. 5.  NEW SECTION.  249A.5  Delivery of medical assistance.
   1.  For the purposes of this section, “managed care program” means the same as defined in 42 C.F.R. §438.2.
   2.  The department shall deliver all benefits that recipients are entitled to under this chapter utilizing a managed care program in compliance with 42 C.F.R. pt. 438, except for benefits provided on a fee-for-service basis or otherwise excluded from managed care program delivery pursuant to a Medicaid state plan or waiver in effect on or before July 1, 2026.
DIVISION IV
MEDICAID AND IOWA HEALTH AND WELLNESS PLAN —— RETROACTIVE ELIGIBILITY AND REPORTING

    Sec. 6.  NEW SECTION.  249A.3B  Medicaid —— retroactive eligibility.
   1.  Notwithstanding any provision of state law to the contrary, effective January 1, 2027, in compliance with section 71112 of the One Big Beautiful Bill Act, Pub. L. No. 119-21, the department shall adopt rules to provide that the eligibility of a individual who is a pregnant woman, a child, or a resident of a nursing facility licensed under chapter 135C shall be applied retroactively for no more than two months prior to the month in which the individual submits a completed medical assistance program application.
   2.  The department shall not adopt rules, or submit a request for a waiver or state plan amendment to the centers for Medicare and Medicaid services of the United States department of health and human services, to permit the department to provide medical assistance program eligibility retroactively to any other adult individual except as provided in subsection 1.
    Sec. 7.  Section 249N.4, subsection 5, Code 2026, is amended to read as follows:
   5.  A member is eligible for coverage effective the first day of the month following the month of application for enrollment.  The department shall not adopt rules or submit a request for a waiver or state plan amendment to the centers for Medicare and Medicaid services of the United States department of health and human services to permit the department to provide program eligibility prior to the month in which the individual submits a completed application for enrollment.
    Sec. 8.  2017 Iowa Acts, chapter 174, section 12, subsection 15, paragraph a, subparagraph (7), as amended by 2018 Iowa Acts, chapter 1165, section 107, is amended by striking the subparagraph.
    Sec. 9.  MEDICAID RETROACTIVE ELIGIBILITY —— WAIVER.  The department of health and human services shall submit a request for a section 1115 demonstration waiver to the centers for Medicare and Medicaid services of the United States department of health and human services for approval to allow, for purposes of state administration of Medicaid, for implementation by the department of no retroactive eligibility for any adult individual who is not a pregnant woman, a child, or a resident of a nursing facility licensed under chapter 135C, upon the submission of a completed Medicaid application, instead of three months as required under 42 C.F.R. §435.915. The department shall implement the waiver upon receipt of approval of the waiver by the centers for Medicare and Medicaid services of the United States department of health and human services.
DIVISION V
MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— COST NEUTRALITY

    Sec. 10.  NEW SECTION.  249A.32C  Medicaid waivers and state plan amendments —— cost neutrality.
   1.  As used in this section, “cost neutral” means federal approval of a waiver submitted by the department to the federal government will not result in a net increase in spending for the administration of the Medicaid program by the state.
   2.  Prior to submitting a request to the centers for Medicare and Medicaid services of the United States department of health and human services for a section 1115 demonstration waiver, a section 1915 home and community-based services waiver, or a state plan amendment to expand coverage under the medical assistance program to additional individuals or a class of individuals, the department shall conduct an analysis to determine if the waiver is cost neutral. For any waiver that is determined to be not cost neutral, the department shall not submit the request for a waiver unless the waiver has been presented to the general assembly and approved by a majority vote of both houses of the general assembly. This subsection shall apply to a section 1115 demonstration waiver, a section 1915 home and community-based services waiver, and a state plan amendment to expand coverage under the medical assistance program to additional individuals or classes of individuals submitted to, or approved by, the centers for Medicare and Medicaid services of the United States department of health and human services prior to the effective date of this division of this Act.
   3.  The department shall annually conduct an analysis to determine the cost neutrality of all approved or implemented cost waivers, and on or before October 1, submit a report to the general assembly detailing the department’s cost neutrality analysis and the department’s compliance with section 7118 of the federal One Big Beautiful Bill Act, Pub. L. No. 119-21, that requires cost neutrality for all Medicaid section 1115 demonstration waivers.
DIVISION VI
EFFECTIVE DATE

    Sec. 11.  EFFECTIVE DATE.  This Act, being deemed of immediate importance, takes effect upon enactment.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the supplemental nutrition assistance program (SNAP), the medical assistance program (Medicaid), the Iowa health and wellness plan (IHAWP), and other programs under the purview of the department of health and human services (HHS).
   DIVISION I —— PUBLIC ASSISTANCE PROGRAMS —— ELIGIBILITY AND REPORTING. The bill requires HHS, prior to determining the initial eligibility of an applicant for, or the ongoing eligibility of a recipient of, public assistance benefits to verify immigration and United States citizenship information of the applicant or recipient through the systematic alien verification for entitlements online service maintained by the United States citizenship and immigration services of the United States department of homeland security.
   DIVISION II —— SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM.  The bill provides that HHS shall consider the income and financial resources of all household members in determining the eligibility and benefit allotment of the household, including household members determined to be ineligible for benefits. An individual shall be ineligible to participate in SNAP unless they have eligible immigration or United States citizenship status as detailed in the bill. HHS is required to notify the United States citizenship and immigration services if HHS is unable to verify the immigration or United States citizenship status of any household member listed on a SNAP application.
   DIVISION III —— MEDICAID —— MANAGED CARE. The bill provides that HHS shall deliver all Medicaid benefits utilizing a managed care program as defined in the bill, except for Medicaid benefits provided on a fee-for-service basis or otherwise excluded from managed care program delivery pursuant to a Medicaid state plan or waiver in effect on or before July 1, 2026.
   DIVISION IV —— MEDICAID AND IOWA HEALTH AND WELLNESS PLAN —— RETROACTIVE ELIGIBILITY AND REPORTING. The bill provides that beginning on January 1, 2027, notwithstanding any provision of state law to the contrary and in compliance with federal law, HHS shall adopt rules to provide for two months of retroactive benefit eligibility for pregnant women, children, and residents of certain nursing facilities who apply for Medicaid. HHS shall not adopt rules or submit a request for a waiver or state plan amendment to CMS for retroactive benefit eligibility for any other adult applying for Medicaid or any individual applying to enroll in IHAWP. The bill strikes a provision related to a prior directive by the general assembly to the department to request a waiver to limit retroactive benefit eligibility. 
   The bill directs HHS to submit a waiver to CMS to allow HHS to deviate from federal law, which provides for three months of retroactive eligibility, and provide for no retroactive eligibility to adults who are not pregnant women, children, or residents of certain nursing facilities. HHS shall implement the waiver upon receipt of approval of the waiver by CMS.
   DIVISION V —— MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— COST NEUTRALITY. The bill requires HHS to conduct an analysis to determine if a waiver or state plan amendment is cost neutral prior to submitting a request for a waiver or state plan amendment to CMS to expand coverage under the medical assistance program to additional individuals or classes of individuals. For any waiver or state plan amendment that is determined not to be cost neutral, HHS shall not submit the request to CMS unless the request has been presented to the general assembly and approved by a majority vote of both houses of the general assembly. HHS is not required to seek legislative approval for waivers or state plan amendments already submitted to, or approved by, CMS prior to the effective date of the bill.
   HHS shall conduct an annual analysis to determine if all approved or implemented Medicaid section 1115 demonstration waivers are cost neutral. On or before October 1, HHS shall submit a report to the general assembly detailing medical assistance program compliance with the federal One Big Beautiful Bill Act, which requires all Medicaid section 1115 demonstration waivers to be cost neutral. The report shall include HHS’s cost neutrality analysis for all demonstration waivers implemented or approved by Medicaid. The bill defines “cost neutral”.
   DIVISION VI —— EFFECTIVE DATE. The bill takes effect upon enactment.