SSB 3140 (LSB 6779XC (9) 91)

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 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 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 notify the United States department of agriculture, food and nutrition service, if the department is unable to verify a household member’s eligibility under subsection 1, regardless of whether that household member is applying to participate in SNAP as a member of the household.
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 furnish 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  Retroactive eligibility —— limitations.
   1.  Upon request of an individual at the time of the individual’s initial application or interview for the medical assistance program, subject to an independent eligibility determination for the period of retroactive eligibility, the department shall provide for an individual’s eligibility to be applied retroactively for no more than two months prior to the month in which the individual submits a completed medical assistance application.
   2.  The department shall adopt rules as necessary pursuant to chapter 17A to implement and enforce this section. The rules may establish procedures, in compliance with federal requirements relating to notice and due process, to notify affected individuals and providers about retroactive eligibility under this section.
    Sec. 7.  NEW SECTION.  249A.3C  Retroactive eligibility —— reporting.
   1.  On or before January 15, the department shall submit an annual report to the general assembly detailing the implementation and impact of retroactive eligibility for Medicaid pursuant to section 249A.3B and retroactive eligibility for the Iowa health and wellness program pursuant to section 249N.4. The report shall include, at minimum, the following information for the immediately preceding fiscal year:
   a.  The number of individuals that applied for medical assistance under section 249A.3B, compared to the number that applied for enrollment in the Iowa health and wellness plan under chapter 249N.
   b.  The number of individuals that requested and were denied retroactive benefits pursuant to section 249A.3B and section 249N.4.
   c.  The estimated fiscal impact on the state general fund of denials of retroactive benefits under section 249A.3B and section 249N.4.
   2.  The annual report submitted pursuant to this section shall be made publicly available on the department’s internet site.
    Sec. 8.  Section 249N.4, Code 2026, is amended by adding the following new subsection:
   NEW SUBSECTION.  5A.  a.  Upon request of an individual at the time of the individual’s initial application or interview for the Iowa health and wellness plan, subject to an independent eligibility determination for the period of retroactive eligibility, the department shall provide for an individual’s eligibility to be applied retroactively for no more than one month prior to the month in which the individual submits a completed application for enrollment.
   b.  The department shall adopt rules as necessary pursuant to chapter 17A to implement and enforce this subsection. The rules may establish procedures, in compliance with all federal requirements relating to notice and due process, to notify affected individuals and providers about retroactive eligibility under this subsection.
    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 a one-month retroactive eligibility period for all applicants, 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.
    Sec. 10.  IOWA HEALTH AND WELLNESS PLAN RETROACTIVE ELIGIBILITY —— STATE PLAN AMENDMENT.  The department of health and human services shall submit a request for a state plan amendment to the centers for Medicare and Medicaid services of the United States department of health and human services to allow, for purposes of state administration of the Iowa health and wellness plan, for implementation by the department of a two-month retroactive eligibility period for all applicants upon the submission of a completed 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.
    Sec. 11.  CONTINGENT EFFECTIVE DATE.
   1.  The following takes effect upon federal approval of the department of health and human services request for a section 1115 demonstration waiver to allow implementation by the department of a one-month retroactive eligibility period for Medicaid:
   The section of this division of this Act enacting section 249A.3B.
   2.  The following takes effect upon federal approval of the department of health and human services request for a state plan amendment to allow implementation by the department of a two-month retroactive eligibility period for the Iowa health and wellness plan:
   The section of this division of this Act amending section 249N.4.
DIVISION V
MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— COST NEUTRALITY

    Sec. 12.  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. 13.  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 PROGRAM. The bill provides for additional requirements when HHS is determining the initial eligibility of a household for SNAP within the state. 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 an eligible immigration or United States citizenship status as detailed in the bill. HHS is required to notify the United States department of agriculture 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 furnish 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 HHS shall request a section 1115 demonstration waiver from the centers for Medicare and Medicaid services of the United States department of health and human services (CMS) to provide for two months of retroactive eligibility under Medicaid as described in the bill. Contingent upon the approval such waiver by CMS, HHS shall provide for a retroactive eligibility period of no more than two months upon request by a Medicaid-eligible applicant. HHS shall only provide retroactive eligibility if it determines that the person was eligible during the period of retroactive eligibility. HHS shall adopt rules as necessary pursuant to Code chapter 17A to implement and enforce retroactive eligibility. HHS may establish procedures, in compliance with federal requirements relating to notice and due process, to notify affected individuals and providers about retroactive Medicaid eligibility.
   The bill provides that HHS shall submit a request for a state plan amendment from CMS to provide for one month of retroactive eligibility under IHAWP as detailed in the bill. Contingent upon the approval of such state plan amendment by CMS, HHS shall provide for a retroactive eligibility period of no more than one month upon request by eligible IHAWP applicants. HHS shall only provide retroactive eligibility if it determines that the applicants were eligible during the period of retroactive eligibility. HHS shall adopt rules as necessary pursuant to Code chapter 17A to implement and enforce retroactive eligibility. HHS may establish procedures, in compliance with federal requirements relating to notice and due process, to notify affected individuals and providers about retroactive IHAWP eligibility.
   On or before January 15, HHS shall submit annually a report to the general assembly detailing specific data and the costs to the state related to retroactive eligibility under both Medicaid and IHAWP. HHS shall make the report available on HHS’s internet site.
   DIVISION V —— MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— COST NEUTRALITY. The bill requires HHS to conduct an analysis, prior to a request for a waiver or state plan amendment being submitted to CMS to expand coverage under the medical assistance program to additional individuals or classes of individuals, to determine if the waiver or state plan amendment is cost neutral. For any such waiver or state plan amendment that is determined to not be cost neutral, HHS shall not submit the request for a waiver to CMS unless the waiver 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.
   HHS shall conduct an 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.