S.F. 530 DIVISION I 1 DIRECT CARE WORKFORCE SUPPORT PROGRAMS 2 Section 1. NEW SECTION . 84A.22 Direct care workers —— wage 3 survey. 4 Beginning January 1, 2027, and each odd-numbered year 5 thereafter, the department of workforce development shall 6 replicate the survey entitled “Direct Care Workers of Iowa 7 2019 Wage & Benefit Survey”, released in June 2019, to survey 8 wages and benefits for direct care workers. The survey shall 9 measure the wages and benefits of direct care workers employed 10 through temporary staffing agencies separately from direct care 11 workers employed directly by a facility or employer, and shall 12 measure wages and benefits delineated by direct care workers’ 13 years of experience to determine the effect of seniority on 14 current wages and benefits. A report containing the results of 15 the survey shall be published on the department of workforce 16 development’s internet site no later than December 15. 17 Sec. 2. NURSING FACILITY FUNDING —— REVIEW AND 18 REPORTING. The department of health and human services shall 19 do all of the following: 20 1. Review the appropriation made pursuant to 2023 Iowa 21 Acts, chapter 112, section 30, subsection 1, paragraph “a”, 22 subparagraph (1), subparagraph division (a), for the fiscal 23 period beginning July 1, 2023, and ending June 30, 2025, for 24 rebasing of case-mix nursing facilities including the fifteen 25 million dollars provided for this purpose, to identify how the 26 additional funding was utilized by the nursing facilities and 27 the extent to which the wages of direct care workers as defined 28 in section 249L.2 were increased as a result of the additional 29 funding. The department shall report initial findings and 30 recommendations by December 15, 2025, and final findings and 31 recommendations by December 15, 2026, to the governor and the 32 general assembly. 33 2. Review the outcomes of initiatives funded through the 34 federal American Rescue Plan Act of 2021, Pub. L. No. 117-2, to 35 -1- LSB 1469XS (3) 91 lh/ko 1/ 4

S.F. 530 support the health care workforce including use of the funds to 1 increase the pay and benefits of direct support professionals, 2 and train, recruit, retain, and expand the direct support 3 professional workforce, to determine if the initiatives 4 should be continued. The department shall report findings and 5 recommendations to the governor and the general assembly by 6 December 15, 2025. 7 DIVISION II 8 DIRECT CARE WORKER MINIMUM WAGE REQUIREMENTS —— MEDICAID 9 PROGRAM 10 Sec. 3. DIRECT CARE WORKER MINIMUM WAGE REQUIREMENTS —— 11 MEDICAID PROGRAM. 12 1. a. Notwithstanding section 91D.1, the state hourly wage 13 for an employee employed as a direct care worker by a provider 14 reimbursed under the Medicaid program shall be at least $15.00 15 beginning July 1, 2026; at least $16.00 beginning July 1, 16 2027; at least $17.00 beginning July 1, 2028; at least $18.00 17 beginning July 1, 2029; at least $19.00 beginning July 1, 2030; 18 and at least $20.00 beginning July 1, 2031. On or after July 19 1, 2032, the state hourly wage for an employee employed as a 20 direct care worker by a provider reimbursed under the Medicaid 21 program shall be increased by a cost-of-living adjustment as 22 determined by applying the percent change in the consumer price 23 index for urban wage earners and clerical workers, United 24 States city average, as published annually in October in the 25 federal register by the federal department of labor, bureau of 26 labor statistics. 27 b. Paragraph “a” shall not be construed to authorize a 28 provider that employs a direct care worker whose current hourly 29 wage is above the minimum wage pursuant to paragraph “a”, to 30 decrease the direct care worker’s current hourly wage. 31 2. For the purposes of this section, “direct care worker” 32 means an individual who provides supportive services and care 33 in home-based, community-based, or facility settings to people 34 experiencing health conditions, illness, or a disability, 35 -2- LSB 1469XS (3) 91 lh/ko 2/ 4

S.F. 530 and who receives compensation for such services. “Direct 1 care worker” includes but is not limited to direct support 2 professionals, supported community living workers, home health 3 aides, universal workers, hospice aides, personal assistants, 4 patient care technicians, consumer directed attendant care 5 providers, senior helpers or companions, and certified nursing 6 assistants. 7 Sec. 4. CONTINGENT EFFECTIVE DATE. This division of this 8 Act takes effect upon the effective date of an increased 9 appropriation to the department of health and human services 10 for the Medicaid program to provide a reimbursement rate 11 increase to Medicaid providers who are subject to payment of 12 the required minimum wage for direct care workers under this 13 division of this Act in an amount that offsets the increase in 14 the required minimum wage paid by such Medicaid providers. 15 EXPLANATION 16 The inclusion of this explanation does not constitute agreement with 17 the explanation’s substance by the members of the general assembly. 18 This bill includes measures to support direct care services 19 and the direct care workforce. 20 DIVISION I. Division I of the bill includes provisions 21 relating to support of the direct care workforce. 22 Beginning January 1, 2027, and each odd-numbered year 23 thereafter, Iowa workforce development shall replicate the 24 survey entitled “Direct Care Workers of Iowa 2019 Wage & 25 Benefit Survey”, released in June 2019, to survey wages and 26 benefits for direct care workers, and publish the results of 27 the survey on Iowa workforce development’s internet site no 28 later than December 15. 29 The bill requires the department of health and human 30 services (HHS) to review the funding appropriated for the 31 fiscal period beginning July 1, 2023, and ending June 30, 2025, 32 for rebasing of case-mix nursing facilities to identify how the 33 additional funding was utilized, and the extent to which direct 34 care worker wages were increased as a result of the additional 35 -3- LSB 1469XS (3) 91 lh/ko 3/ 4

S.F. 530 funding. HHS must report initial and final findings and 1 recommendations to the governor and the general assembly. HHS 2 is also required to review the outcomes of initiatives funded 3 through the federal American Rescue Plan Act to support the 4 health care workforce and report findings and recommendations 5 to the governor and the general assembly by December 15, 2025. 6 DIVISION II. Division II of the bill requires Medicaid 7 providers to comply with direct care worker minimum wage 8 requirements. The bill provides that notwithstanding Code 9 section 91D.1 (minimum wage requirements —— exceptions), the 10 state hourly wage for an employee employed as a direct care 11 worker, as defined in the bill, by a Medicaid provider shall 12 be at least $15.00 beginning July 1, 2026, and the minimum 13 shall increase by $1.00 per year to at least $20.00 beginning 14 July 1, 2031. The bill does not authorize a Medicaid provider 15 who is paying a direct care worker an hourly wage above the 16 required minimum to decrease the direct care worker’s current 17 hourly wage. On or after July 1, 2032, this state hourly 18 wage shall be increased by a cost-of-living adjustment amount 19 as determined by applying the percent change in the consumer 20 price index for urban wage earners and clerical workers, United 21 States city average, as published annually in October in the 22 federal register by the federal department of labor, bureau of 23 labor statistics. This division of the bill takes effect upon 24 the effective date of an increased appropriation to HHS for the 25 Medicaid program to provide a reimbursement rate increase to 26 Medicaid providers who are subject to payment of the required 27 minimum wage for direct care workers in an amount that offsets 28 the increase in the required minimum wage paid by such Medicaid 29 providers. 30 -4- LSB 1469XS (3) 91 lh/ko 4/ 4