Senate Study Bill 3140 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON WARME) 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 6779XC (9) 91 ak/ko

S.F. _____ 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 information accessible through the 7 systematic alien verification for entitlements online service . 8 Sec. 2. Section 239.6, subsection 2, Code 2026, is amended 9 by adding the following new paragraph: 10 NEW PARAGRAPH . g. The systematic alien verification for 11 entitlements online service maintained by the United States 12 citizenship and immigration services of the United States 13 department of homeland security to verify immigration and 14 United States citizenship information. 15 DIVISION II 16 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 17 Sec. 3. Section 239.1, Code 2026, is amended by adding the 18 following new subsection: 19 NEW SUBSECTION . 01. “Alien” means any person not a citizen 20 or national of the United States. 21 Sec. 4. Section 239.2, Code 2026, is amended to read as 22 follows: 23 239.2 Supplemental nutrition assistance program —— income 24 eligibility. 25 1. a. The department shall establish the gross countable 26 monthly income threshold for the supplemental nutrition 27 assistance program at less than or equal to one hundred sixty 28 percent of the federal poverty level for the household size. 29 b. The department shall consider the income and 30 financial resources of all household members in determining 31 the eligibility and benefit allotment of the household, 32 including all household members determined to be ineligible 33 to participate in SNAP under this section or pursuant to 7 34 U.S.C. §2015(f). Notwithstanding 7 C.F.R. §273.11(c)(3), the 35 -1- LSB 6779XC (9) 91 ak/ko 1/ 9

S.F. _____ individual’s income, deductible expenses, and resources shall 1 be counted, and none shall be prorated. 2 c. Pursuant to 7 U.S.C. §2015(f), an individual shall be 3 ineligible to participate in SNAP unless the individual is a 4 resident of the United States and meets at least one of the 5 following criteria: 6 (1) The individual is a citizen or national of the United 7 States. 8 (2) The individual is an alien lawfully admitted for 9 permanent residence as an immigrant, as defined in 8 U.S.C. 10 §1101(a)(15) and 1101(a)(20), excluding alien visitors, 11 tourists, diplomats, students, or other individuals admitted 12 temporarily with no intention of abandoning their residence in 13 a foreign country. 14 (3) The individual is an alien who has been granted the 15 status of Cuban and Haitian entrant, as defined in section 16 501(e) of the federal Refugee Education Assistance Act of 1980, 17 Pub. L. No. 96-422. 18 (4) The individual lawfully resides in the United States in 19 accordance with a compact of free association referred to in 8 20 U.S.C. §1612(b)(2)(G). 21 2. The department shall notify the United States department 22 of agriculture, food and nutrition service, if the department 23 is unable to verify a household member’s eligibility under 24 subsection 1, regardless of whether that household member is 25 applying to participate in SNAP as a member of the household. 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 furnish 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 6779XC (9) 91 ak/ko 2/ 9

S.F. _____ 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 Retroactive eligibility —— 7 limitations. 8 1. Upon request of an individual at the time of the 9 individual’s initial application or interview for the medical 10 assistance program, subject to an independent eligibility 11 determination for the period of retroactive eligibility, the 12 department shall provide for an individual’s eligibility to 13 be applied retroactively for no more than two months prior to 14 the month in which the individual submits a completed medical 15 assistance application. 16 2. The department shall adopt rules as necessary pursuant 17 to chapter 17A to implement and enforce this section. The 18 rules may establish procedures, in compliance with federal 19 requirements relating to notice and due process, to notify 20 affected individuals and providers about retroactive 21 eligibility under this section. 22 Sec. 7. NEW SECTION . 249A.3C Retroactive eligibility —— 23 reporting. 24 1. On or before January 15, the department shall 25 submit an annual report to the general assembly detailing 26 the implementation and impact of retroactive eligibility 27 for Medicaid pursuant to section 249A.3B and retroactive 28 eligibility for the Iowa health and wellness program pursuant 29 to section 249N.4. The report shall include, at minimum, the 30 following information for the immediately preceding fiscal 31 year: 32 a. The number of individuals that applied for medical 33 assistance under section 249A.3B, compared to the number that 34 applied for enrollment in the Iowa health and wellness plan 35 -3- LSB 6779XC (9) 91 ak/ko 3/ 9

S.F. _____ under chapter 249N. 1 b. The number of individuals that requested and were denied 2 retroactive benefits pursuant to section 249A.3B and section 3 249N.4. 4 c. The estimated fiscal impact on the state general fund 5 of denials of retroactive benefits under section 249A.3B and 6 section 249N.4. 7 2. The annual report submitted pursuant to this section 8 shall be made publicly available on the department’s internet 9 site. 10 Sec. 8. Section 249N.4, Code 2026, is amended by adding the 11 following new subsection: 12 NEW SUBSECTION . 5A. a. Upon request of an individual 13 at the time of the individual’s initial application or 14 interview for the Iowa health and wellness plan, subject to 15 an independent eligibility determination for the period of 16 retroactive eligibility, the department shall provide for an 17 individual’s eligibility to be applied retroactively for no 18 more than one month prior to the month in which the individual 19 submits a completed application for enrollment. 20 b. The department shall adopt rules as necessary pursuant 21 to chapter 17A to implement and enforce this subsection. 22 The rules may establish procedures, in compliance with all 23 federal requirements relating to notice and due process, to 24 notify affected individuals and providers about retroactive 25 eligibility under this subsection. 26 Sec. 9. MEDICAID RETROACTIVE ELIGIBILITY —— WAIVER. The 27 department of health and human services shall submit a 28 request for a section 1115 demonstration waiver to the centers 29 for Medicare and Medicaid services of the United States 30 department of health and human services for approval to 31 allow, for purposes of state administration of Medicaid, for 32 implementation by the department of a one-month retroactive 33 eligibility period for all applicants, upon the submission 34 of a completed Medicaid application, instead of three months 35 -4- LSB 6779XC (9) 91 ak/ko 4/ 9

S.F. _____ as required under 42 C.F.R. §435.915. The department shall 1 implement the waiver upon receipt of approval of the waiver by 2 the centers for Medicare and Medicaid services of the United 3 States department of health and human services. 4 Sec. 10. IOWA HEALTH AND WELLNESS PLAN RETROACTIVE 5 ELIGIBILITY —— STATE PLAN AMENDMENT. The department of health 6 and human services shall submit a request for a state plan 7 amendment to the centers for Medicare and Medicaid services of 8 the United States department of health and human services to 9 allow, for purposes of state administration of the Iowa health 10 and wellness plan, for implementation by the department of a 11 two-month retroactive eligibility period for all applicants 12 upon the submission of a completed application, instead 13 of three months as required under 42 C.F.R. §435.915. The 14 department shall implement the waiver upon receipt of approval 15 of the waiver by the centers for Medicare and Medicaid services 16 of the United States department of health and human services. 17 Sec. 11. CONTINGENT EFFECTIVE DATE. 18 1. The following takes effect upon federal approval of 19 the department of health and human services request for a 20 section 1115 demonstration waiver to allow implementation by 21 the department of a one-month retroactive eligibility period 22 for Medicaid: 23 The section of this division of this Act enacting section 24 249A.3B. 25 2. The following takes effect upon federal approval of the 26 department of health and human services request for a state 27 plan amendment to allow implementation by the department of a 28 two-month retroactive eligibility period for the Iowa health 29 and wellness plan: 30 The section of this division of this Act amending section 31 249N.4. 32 DIVISION V 33 MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— COST NEUTRALITY 34 Sec. 12. NEW SECTION . 249A.32C Medicaid waivers and state 35 -5- LSB 6779XC (9) 91 ak/ko 5/ 9

S.F. _____ plan amendments —— cost neutrality. 1 1. As used in this section, “cost neutral” means federal 2 approval of a waiver submitted by the department to the federal 3 government will not result in a net increase in spending for 4 the administration of the Medicaid program by the state. 5 2. Prior to submitting a request to the centers for Medicare 6 and Medicaid services of the United States department of health 7 and human services for a section 1115 demonstration waiver, 8 a section 1915 home and community-based services waiver, or 9 a state plan amendment to expand coverage under the medical 10 assistance program to additional individuals or a class of 11 individuals, the department shall conduct an analysis to 12 determine if the waiver is cost neutral. For any waiver that 13 is determined to be not cost neutral, the department shall not 14 submit the request for a waiver unless the waiver has been 15 presented to the general assembly and approved by a majority 16 vote of both houses of the general assembly. This subsection 17 shall apply to a section 1115 demonstration waiver, a section 18 1915 home and community-based services waiver, and a state 19 plan amendment to expand coverage under the medical assistance 20 program to additional individuals or classes of individuals 21 submitted to, or approved by, the centers for Medicare and 22 Medicaid services of the United States department of health and 23 human services prior to the effective date of this division of 24 this Act. 25 3. The department shall annually conduct an analysis to 26 determine the cost neutrality of all approved or implemented 27 cost waivers, and on or before October 1, submit a report to 28 the general assembly detailing the department’s cost neutrality 29 analysis and the department’s compliance with section 7118 of 30 the federal One Big Beautiful Bill Act, Pub. L. No. 119-21, 31 that requires cost neutrality for all Medicaid section 1115 32 demonstration waivers. 33 DIVISION VI 34 EFFECTIVE DATE 35 -6- LSB 6779XC (9) 91 ak/ko 6/ 9

S.F. _____ Sec. 13. EFFECTIVE DATE. This Act, being deemed of 1 immediate importance, takes effect upon enactment. 2 EXPLANATION 3 The inclusion of this explanation does not constitute agreement with 4 the explanation’s substance by the members of the general assembly. 5 This bill relates to the supplemental nutrition assistance 6 program (SNAP), the medical assistance program (Medicaid), the 7 Iowa health and wellness plan (IHAWP), and other programs under 8 the purview of the department of health and human services 9 (HHS). 10 DIVISION I —— PUBLIC ASSISTANCE PROGRAMS —— ELIGIBILITY 11 AND REPORTING. The bill requires HHS, prior to determining 12 the initial eligibility of an applicant for, or the ongoing 13 eligibility of a recipient of, public assistance benefits to 14 verify immigration and United States citizenship information 15 of 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 II —— SUPPLEMENTAL NUTRITION PROGRAM. The bill 20 provides for additional requirements when HHS is determining 21 the initial eligibility of a household for SNAP within the 22 state. HHS shall consider the income and financial resources 23 of all household members in determining the eligibility and 24 benefit allotment of the household, including household members 25 determined to be ineligible for benefits. An individual shall 26 be ineligible to participate in SNAP unless they have an 27 eligible immigration or United States citizenship status as 28 detailed in the bill. HHS is required to notify the United 29 States department of agriculture if HHS is unable to verify 30 the immigration or United States citizenship status of any 31 household member listed on a SNAP application. 32 DIVISION III —— MEDICAID —— MANAGED CARE. The bill provides 33 that HHS shall furnish all Medicaid benefits utilizing a 34 managed care program as defined in the bill, except for 35 -7- LSB 6779XC (9) 91 ak/ko 7/ 9

S.F. _____ Medicaid benefits provided on a fee-for-service basis or 1 otherwise excluded from managed care program delivery pursuant 2 to a Medicaid state plan or waiver in effect on or before July 3 1, 2026. 4 DIVISION IV —— MEDICAID AND IOWA HEALTH AND WELLNESS 5 PLAN —— RETROACTIVE ELIGIBILITY AND REPORTING. The bill 6 provides that HHS shall request a section 1115 demonstration 7 waiver from the centers for Medicare and Medicaid services 8 of the United States department of health and human services 9 (CMS) to provide for two months of retroactive eligibility 10 under Medicaid as described in the bill. Contingent upon 11 the approval such waiver by CMS, HHS shall provide for a 12 retroactive eligibility period of no more than two months 13 upon request by a Medicaid-eligible applicant. HHS shall 14 only provide retroactive eligibility if it determines that 15 the person was eligible during the period of retroactive 16 eligibility. HHS shall adopt rules as necessary pursuant 17 to Code chapter 17A to implement and enforce retroactive 18 eligibility. HHS may establish procedures, in compliance with 19 federal requirements relating to notice and due process, to 20 notify affected individuals and providers about retroactive 21 Medicaid eligibility. 22 The bill provides that HHS shall submit a request for a 23 state plan amendment from CMS to provide for one month of 24 retroactive eligibility under IHAWP as detailed in the bill. 25 Contingent upon the approval of such state plan amendment by 26 CMS, HHS shall provide for a retroactive eligibility period 27 of no more than one month upon request by eligible IHAWP 28 applicants. HHS shall only provide retroactive eligibility 29 if it determines that the applicants were eligible during the 30 period of retroactive eligibility. HHS shall adopt rules as 31 necessary pursuant to Code chapter 17A to implement and enforce 32 retroactive eligibility. HHS may establish procedures, in 33 compliance with federal requirements relating to notice and due 34 process, to notify affected individuals and providers about 35 -8- LSB 6779XC (9) 91 ak/ko 8/ 9

S.F. _____ retroactive IHAWP eligibility. 1 On or before January 15, HHS shall submit annually a report 2 to the general assembly detailing specific data and the costs 3 to the state related to retroactive eligibility under both 4 Medicaid and IHAWP. HHS shall make the report available on 5 HHS’s internet site. 6 DIVISION V —— MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— 7 COST NEUTRALITY. The bill requires HHS to conduct an analysis, 8 prior to a request for a waiver or state plan amendment 9 being submitted to CMS to expand coverage under the medical 10 assistance program to additional individuals or classes of 11 individuals, to determine if the waiver or state plan amendment 12 is cost neutral. For any such waiver or state plan amendment 13 that is determined to not be cost neutral, HHS shall not submit 14 the request for a waiver to CMS unless the waiver has been 15 presented to the general assembly and approved by a majority 16 vote of both houses of the general assembly. HHS is not 17 required to seek legislative approval for waivers or state plan 18 amendments already submitted to, or approved by, CMS. 19 HHS shall conduct an analysis to determine if all approved 20 or implemented Medicaid section 1115 demonstration waivers 21 are cost neutral. On or before October 1, HHS shall submit a 22 report to the general assembly detailing medical assistance 23 program compliance with the federal One Big Beautiful Bill Act, 24 which requires all Medicaid section 1115 demonstration waivers 25 to be cost neutral. The report shall include HHS’s cost 26 neutrality analysis for all demonstration waivers implemented 27 or approved by Medicaid. The bill defines “cost neutral”. 28 DIVISION VI —— EFFECTIVE DATE. The bill takes effect upon 29 enactment. 30 -9- LSB 6779XC (9) 91 ak/ko 9/ 9