Senate Study Bill 3192 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED GOVERNOR BUDGET BILL) A BILL FOR An Act relating to and making appropriations to the department 1 of veterans affairs and the department of health and 2 human services, including aging and disability services, 3 behavioral health, public health, and community access 4 and eligibility; the medical assistance program, state 5 supplementary assistance, Hawki, and other health-related 6 programs; family well-being and protection; state-operated 7 specialty care; administration and compliance; prior 8 appropriations; child welfare and juvenile justice 9 decategorization; commitment or hospitalization of certain 10 persons with mental illness or substance abuse disorders; 11 child abuse prevention; creation of a comprehensive family 12 support program; and repeal of expenditure projections for 13 state child care assistance and adoption subsidy programs; 14 and including effective date and retroactive applicability 15 provisions. 16 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 17 TLSB 5013XG (19) 91 ak/ko

S.F. _____ H.F. _____ DIVISION I 1 DEPARTMENT OF VETERANS AFFAIRS —— FY 2026-2027 2 Section 1. DEPARTMENT OF VETERANS AFFAIRS. There is 3 appropriated from the general fund of the state to the 4 department of veterans affairs for the fiscal year beginning 5 July 1, 2026, and ending June 30, 2027, the following amounts, 6 or so much thereof as is necessary, to be used for the purposes 7 designated: 8 1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION 9 For salaries, support, maintenance, and miscellaneous 10 purposes: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205 12 2. IOWA VETERANS HOME 13 For salaries, support, maintenance, and miscellaneous 14 purposes: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736 16 a. The Iowa veterans home billings involving the department 17 of health and human services shall be submitted to the 18 department on at least a monthly basis. 19 b. The Iowa veterans home expenditure report shall be 20 submitted monthly to the general assembly. 21 3. HOME OWNERSHIP ASSISTANCE PROGRAM 22 For transfer to the Iowa finance authority for the 23 continuation of the home ownership assistance program for 24 persons who are or were eligible members of the armed forces 25 of the United States or eligible service members pursuant to 26 section 16.54: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 28 DIVISION II 29 AGING AND DISABILITY SERVICES —— FY 2026-2027 30 Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 31 AND DISABILITY SERVICES. There is appropriated from the 32 general fund of the state to the department of health and human 33 services for the fiscal year beginning July 1, 2026, and ending 34 June 30, 2027, the following amount, or so much thereof as is 35 -1- LSB 5013XG (19) 91 ak/ko 1/ 37

S.F. _____ H.F. _____ necessary, to be used for the purposes designated: 1 For aging programs for the department of health and human 2 services and area agencies on aging to provide citizens of 3 Iowa who are 60 years of age and older with case management; 4 for Iowa’s aging and disabilities resource centers; for the 5 return to community program; for the purposes of chapter 231E; 6 to administer the prevention of elder abuse, neglect, and 7 exploitation program pursuant to section 231.56A, in accordance 8 with the requirements of the federal Older Americans Act of 9 1965, 42 U.S.C. §3001 et seq., as amended; for the operation 10 of the dependent adult abuse services program pursuant to 11 chapter 235B; for matching funding for programs to enable 12 persons with severe physical or mental disabilities to function 13 more independently; for costs associated with centers for 14 independent living; and for other services which may include 15 but are not limited to adult day care, respite care, chore, 16 information and assistance, and material aid; for information 17 and options counseling for persons with disabilities; and 18 for salaries, support, administration, maintenance, and 19 miscellaneous purposes: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,379,531 21 1. Moneys appropriated in this section may be used to 22 supplement federal moneys received under federal regulations. 23 To receive moneys appropriated in this section, a local area 24 agency on aging shall match the moneys with moneys from other 25 sources according to rules adopted by the department. Moneys 26 appropriated in this section may be used for services not 27 specifically enumerated in this section only if approved by the 28 department as part of an area agency on aging’s area plan. 29 2. Of the moneys appropriated in this section, $949,282 30 is allocated to be used for the comprehensive family support 31 program created in section 231.80 as enacted under this Act. 32 3. Of the moneys appropriated in this section, $33,632 33 is allocated to be used to build community capacity through 34 the coordination and provision of training opportunities in 35 -2- LSB 5013XG (19) 91 ak/ko 2/ 37

S.F. _____ H.F. _____ accordance with the consent decree of Conner v. Branstad, No. 1 4-86-CV-30871 (S.D. Iowa, July 15, 1994). 2 DIVISION III 3 BEHAVIORAL HEALTH —— FY 2026-2027 4 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 5 BEHAVIORAL HEALTH. There is appropriated from the general fund 6 of the state to the department of health and human services for 7 the fiscal year beginning July 1, 2026, and ending June 30, 8 2027, the following amount, or so much thereof as is necessary, 9 to be used for the purposes designated: 10 For behavioral health prevention, education, early 11 intervention, treatment, recovery support, and crisis 12 services in order to support statewide access to treatment for 13 behavioral health conditions; stabilization and mitigation of 14 behavioral health crises; and recovery for individuals and 15 families impacted by behavioral health conditions. Activities 16 shall align with accepted best practice guidance standards for 17 behavioral health including those published by the centers for 18 disease control and prevention of the United States department 19 of health and human services, and the substance abuse and 20 mental health services administration of the United States 21 department of health and human services, for health promotion; 22 universal, selective, and indicated prevention; treatment; and 23 recovery services and supports; and shall include a 24-hour 24 helpline, public information resources, professional training, 25 youth prevention, program evaluation, and efforts at the state 26 and local levels: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 23,127,121 28 1. Of the moneys appropriated in this section, $300,000 29 is allocated to support the work of the children’s behavioral 30 health system including evidence-based behavioral health 31 prevention, treatment, and recovery services and supports for 32 children and their families. 33 2. Of the moneys appropriated in this section, $950,000 34 is allocated for an integrated substance use disorder managed 35 -3- LSB 5013XG (19) 91 ak/ko 3/ 37

S.F. _____ H.F. _____ care system. The department shall maintain the level of mental 1 health and substance use disorder treatment services provided 2 by the managed care contractors, and shall take the steps 3 necessary to continue the federal waivers as needed to maintain 4 the level of services. 5 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 6 WAGERING RECEIPTS FUND. There is appropriated from the 7 sports wagering receipts fund created in section 8.57I, to the 8 department of health and human services for the fiscal year 9 beginning July 1, 2026, and ending June 30, 2027, the following 10 amount, or so much thereof as is necessary, to be used for 11 behavioral health prevention, education, early intervention, 12 treatment, recovery support, and crisis services in order to 13 support statewide access to treatment for behavioral health 14 conditions; stabilization and mitigation of behavioral health 15 crises; and recovery for individuals and families impacted by 16 behavioral health conditions: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 18 DIVISION IV 19 PUBLIC HEALTH —— FY 2026-2027 20 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 21 HEALTH. There is appropriated from the general fund of the 22 state to the department of health and human services for the 23 fiscal year beginning July 1, 2026, and ending June 30, 2027, 24 the following amount, or so much thereof as is necessary, to be 25 used for the purposes designated: 26 For programs that support health promotion, protect the 27 health and safety of the public, conduct disease surveillance 28 and investigation to reduce the incidence of morbidity and 29 mortality, serve individuals with chronic conditions including 30 but not limited to cancer, support the Iowa donor registry as 31 specified in section 142C.18, and strengthen the health care 32 delivery system and workforce to improve health outcomes for 33 all Iowans: 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 21,833,369 35 -4- LSB 5013XG (19) 91 ak/ko 4/ 37

S.F. _____ H.F. _____ 1. Of the moneys appropriated in this section, the following 1 amounts are allocated to the department of health and human 2 services to be used as follows to support the goals of 3 increased access, health system integration, and engagement: 4 a. $600,000 for distribution to a nonprofit organization 5 that established the first statewide drug donation repository 6 for continuation of the pharmaceutical infrastructure for 7 safety net providers established as described in 2007 Iowa 8 Acts, chapter 218, section 108, and for the prescription drug 9 donation repository program established in chapter 135M. 10 Moneys under this paragraph shall be distributed in their 11 entirety on July 1, 2026, for the purpose specified. 12 b. $374,000 for distribution to free clinics, as defined in 13 section 135.24, and a nonprofit organization that facilitates 14 the initiation, operation, and collaboration of free clinics 15 for necessary infrastructure, statewide coordination, provider 16 recruitment, service delivery, and provision of assistance to 17 patients in securing a medical home inclusive of oral health 18 care. Of the moneys allocated, $40,000 shall be used to lower 19 fees associated with using an electronic prescribing system. 20 Moneys under this paragraph shall be distributed in their 21 entirety on July 1, 2026, for the purpose specified. 22 c. $25,000 for distribution to an organization that raises 23 awareness about issues related to rural health clinics for 24 necessary infrastructure and service delivery transformation. 25 Moneys under this paragraph shall be distributed in their 26 entirety on July 1, 2026, for the purpose specified. 27 2. Of the moneys appropriated in this section, $400,000 28 is allocated for rural psychiatric residencies for residents 29 selected on or before June 30, 2026. 30 3. Of the moneys appropriated in this section, $20,000 is 31 allocated to make radon test kits available, free of charge, 32 to homeowners and renters in the state. The department shall 33 provide a link on the department’s internet site for homeowners 34 and renters in the state to order radon test kits. 35 -5- LSB 5013XG (19) 91 ak/ko 5/ 37

S.F. _____ H.F. _____ 4. Of the moneys appropriated in this section, $2,500,000 1 is allocated for Medicaid graduate medical education efforts 2 and consistent with the purpose of the department’s request for 3 approval to the centers of Medicare and Medicaid services of 4 the United States department of health and human services for 5 a Medicaid supplemental enhanced payment for the purposes of 6 maximizing federal funding opportunities for graduate medical 7 education as described in 2025 Iowa Acts, chapter 120, section 8 13. 9 5. The university of Iowa hospitals and clinics under 10 the control of the state board of regents shall not receive 11 indirect costs from the moneys appropriated in this section. 12 The university of Iowa hospitals and clinics billings to the 13 department shall be, at a minimum, on a quarterly basis. 14 DIVISION V 15 COMMUNITY ACCESS AND ELIGIBILITY —— CHILD SUPPORT SERVICES —— 16 TANF —— FY 2026-2027 17 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 18 ACCESS AND ELIGIBILITY. There is appropriated from the 19 general fund of the state to the department of health and human 20 services for the fiscal year beginning July 1, 2026, and ending 21 June 30, 2027, the following amount, or so much thereof as is 22 necessary, to be used for the purposes designated: 23 To be used for salaries, support, maintenance, and 24 miscellaneous purposes and for family investment program (FIP) 25 assistance in accordance with chapter 239B, and for other costs 26 associated with providing needs-based benefits or assistance 27 including but not limited to maternal and child health, oral 28 health, obesity prevention, the promoting independence and 29 self-sufficiency through employment, job opportunities and the 30 basic skills (PROMISE JOBS) program, supplemental nutrition 31 assistance program (SNAP) employment and training, the FIP 32 diversion program, family planning, rent reimbursement, 33 and eligibility determinations for medical assistance, food 34 assistance, and the children’s health insurance program: 35 -6- LSB 5013XG (19) 91 ak/ko 6/ 37

S.F. _____ H.F. _____ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 76,312,642 1 1. Of the child support collections assigned under FIP, 2 the federal share of the child support collections shall be 3 credited to the child support services appropriation made in 4 this division of this Act. Of the remainder of the child 5 support collections assigned under FIP, a portion shall be 6 credited to community access and eligibility, and the remaining 7 moneys may be used to increase recoveries, to sustain cash flow 8 in the collection services center refund account as provided in 9 section 252B.13A, or for technology needs. If child support 10 collections assigned under FIP are greater than estimated or 11 are otherwise determined not to be required for maintenance of 12 efforts, the state share of either amount is appropriated to 13 the department for child support services as described in this 14 division of this Act, or may be transferred to or retained in 15 the collection services center refund account. 16 2. Of the moneys appropriated in this section, $3,075,000 is 17 allocated for continuation of the department’s initiative to 18 provide for adequate developmental surveillance and screening 19 during a child’s first five years. The moneys shall first be 20 used to fully fund the current participating counties to ensure 21 that those counties are fully operational, with the remaining 22 moneys to be used for expanding participation to additional 23 counties. Full implementation and expansion shall include 24 enhancing the scope of the initiative through collaboration 25 with child health specialty clinics to promote the use of 26 developmental surveillance and screening to support healthy 27 child development through early identification and response to 28 biomedical and social determinants of healthy development by 29 providing practitioner consultation and continuous improvement 30 through training and education, particularly for children 31 with behavioral conditions and needs. The department shall 32 also collaborate with the Medicaid program and child health 33 specialty clinics to assist in coordinating the activities 34 of the first five initiative into the establishment of 35 -7- LSB 5013XG (19) 91 ak/ko 7/ 37

S.F. _____ H.F. _____ patient-centered medical homes developed to improve health 1 quality and population health while reducing health care costs. 2 To the maximum extent possible, moneys allocated in this 3 subsection shall be utilized as matching moneys for Medicaid 4 program reimbursement. 5 3. Of the moneys appropriated in this section, $1,145,102 is 6 allocated to the Iowa commission on volunteer service created 7 in section 15H.2 for programs and grants. 8 4. The university of Iowa hospitals and clinics under 9 the control of the state board of regents shall not receive 10 indirect costs from the moneys appropriated in this section. 11 The university of Iowa hospitals and clinics billings to the 12 department shall be, at a minimum, on a quarterly basis. 13 Sec. 7. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CHILD 14 SUPPORT SERVICES. There is appropriated from the general fund 15 of the state to the department of health and human services for 16 the fiscal year beginning July 1, 2026, and ending June 30, 17 2027, the following amount, or so much thereof as is necessary, 18 to be used for the purposes designated: 19 For child support services, including salaries, support, 20 maintenance, and miscellaneous purposes: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,644,114 22 1. Federal access and visitation grant moneys shall be used 23 for services designed to increase compliance with the child 24 access provisions of court orders, including but not limited to 25 neutral visitation sites and mediation services. 26 2. Moneys appropriated in this section may be used 27 throughout the fiscal year in the manner necessary for 28 cash flow management. For cash flow management under this 29 subsection, the department may temporarily draw more than the 30 amount appropriated provided the amount appropriated is not 31 exceeded at the close of the fiscal year. 32 Sec. 8. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 33 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT. There is 34 appropriated from the special fund created in section 8.41 to 35 -8- LSB 5013XG (19) 91 ak/ko 8/ 37

S.F. _____ H.F. _____ the department of health and human services for the fiscal year 1 beginning July 1, 2026, and ending June 30, 2027, from moneys 2 received under the federal temporary assistance for needy 3 families (TANF) block grant pursuant to the federal Personal 4 Responsibility and Work Opportunity Reconciliation Act of 1996, 5 Pub. L. No. 104-193, and successor legislation, including TANF 6 block grant moneys received in any prior fiscal year that 7 were deposited in the special fund and remain unencumbered 8 or unobligated on June 30, 2026, the following amounts, or 9 so much thereof as is necessary, to be used for the purposes 10 designated: 11 1. For community access and eligibility: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,566,312 13 2. For community access and eligibility to provide 14 pregnancy prevention grants on the condition that family 15 planning services are funded: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 17 Pregnancy prevention grants shall be awarded to programs 18 in existence on or before July 1, 2026, if the programs have 19 demonstrated positive outcomes. Grants shall be awarded 20 to pregnancy prevention programs developed after July 1, 21 2026, if the programs are based on existing models that have 22 demonstrated positive outcomes. Grants must comply with the 23 requirements provided in 1997 Iowa Acts, chapter 208, section 24 14, subsections 1 and 2, including the requirement that a 25 program awarded a grant must emphasize sexual abstinence. 26 Priority in awarding grants shall be given to programs 27 that serve areas of the state which demonstrate the highest 28 percentage of unplanned pregnancies of females of childbearing 29 age within the geographic area to be served by the grant. 30 3. To meet one of the four purposes of TANF as specified 31 in 45 C.F.R. §260.20, including by modernizing the program 32 to promote economic mobility and self-sufficiency, ensuring 33 that families are able to overcome benefit cliffs, encouraging 34 healthy families, and streamlining service delivery to reduce 35 -9- LSB 5013XG (19) 91 ak/ko 9/ 37

S.F. _____ H.F. _____ duplication: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000,000 2 4. For early intervention and supports for child abuse 3 prevention and the family development and self-sufficiency 4 (FaDSS) grant program in accordance with section 216A.107: 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,013,980 6 5. For accountability, compliance, program integrity, 7 technology needs, and other resources necessary to meet 8 federal and state reporting, tracking, and case management 9 requirements, and other departmental needs: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 11 6. For state child care assistance: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 42,281,826 13 7. For child protective services: 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 67,249,100 15 a. Of the moneys appropriated in this subsection, 16 $1,658,000 shall be allocated for child protection centers 17 located in Iowa pursuant to the child protection center grant 18 program under section 135.118. The grant amounts under the 19 program shall be equalized so that each center receives a 20 uniform base amount of $245,000, and the remaining moneys 21 are awarded through a funding formula based upon the volume 22 of children served by a center. To increase access to child 23 protection center services for children in rural areas, the 24 funding formula for awarding the remaining moneys shall provide 25 for awarding an enhanced amount to eligible grantees to develop 26 and maintain satellite centers in underserved regions of the 27 state. 28 b. Of the moneys appropriated in this subsection, up to 29 $227,000 shall be used for the public purpose of continuing a 30 grant to a nonprofit human services organization that provides 31 services to individuals and families in multiple locations in 32 southwest Iowa and Nebraska, for support of a project providing 33 immediate, sensitive support and forensic interviews, medical 34 exams, needs assessments, and referrals for victims of child 35 -10- LSB 5013XG (19) 91 ak/ko 10/ 37

S.F. _____ H.F. _____ abuse and their nonoffending family members. 1 DIVISION VI 2 MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— 3 HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 4 PROGRAMS —— FY 2026-2027 5 Sec. 9. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— MEDICAL 6 ASSISTANCE PROGRAM, STATE SUPPLEMENTARY ASSISTANCE, AND HEALTHY 7 AND WELL KIDS IN IOWA PROGRAM. There is appropriated from the 8 general fund of the state to the department of health and human 9 services for the fiscal year beginning July 1, 2026, and ending 10 June 30, 2027, the following amount, or so much thereof as is 11 necessary, to be used for the purposes designated: 12 For medical assistance program reimbursement and associated 13 costs as specifically provided in the reimbursement 14 methodologies in effect on June 30, 2026, except as otherwise 15 expressly authorized by law, consistent with options under 16 federal law and regulations, and contingent upon receipt of 17 approval from the office of the governor of reimbursement for 18 each abortion performed under the medical assistance program; 19 for the state supplementary assistance program; for the health 20 insurance premium payment program; and for maintenance of 21 the healthy and well kids in Iowa (Hawki) program pursuant 22 to chapter 514I, including supplemental dental services, 23 for receipt of federal financial participation under Tit. 24 XXI of the federal Social Security Act, which creates the 25 children’s health insurance program; and for other specified 26 health-related programs: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,992,550,706 28 1. Of the moneys appropriated in this section, $3,383,880 29 shall be used for program administration, outreach, and 30 enrollment activities of the state family planning services 31 program pursuant to section 217.41B, and of this amount, the 32 department may use up to $200,000 for administrative expenses. 33 2. Iowans support reducing the number of abortions 34 performed in this state. Moneys appropriated under this 35 -11- LSB 5013XG (19) 91 ak/ko 11/ 37

S.F. _____ H.F. _____ section shall not be used for abortions, unless otherwise 1 authorized under this section. 2 3. The provisions of this section relating to abortions also 3 apply to the Iowa health and wellness plan established pursuant 4 to chapter 249N. 5 Sec. 10. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HEALTH 6 PROGRAM OPERATIONS. There is appropriated from the general 7 fund of the state to the department of health and human 8 services for the fiscal year beginning July 1, 2026, and ending 9 June 30, 2027, the following amount, or so much thereof as is 10 necessary, to be used for the purposes designated: 11 For health program operations and the autism support program 12 under section 225D.2: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,672,433 14 1. The department of inspections, appeals, and licensing 15 shall provide all state matching moneys for survey and 16 certification activities performed by the department of 17 inspections, appeals, and licensing. The department of health 18 and human services shall be solely responsible for distributing 19 the federal matching moneys for such activities. 20 2. Of the moneys appropriated in this section, a sufficient 21 amount is allocated for the administration of the health 22 insurance premium payment program, including salaries, support, 23 maintenance, and miscellaneous purposes. 24 3. Of the moneys appropriated in this section, $750,000 is 25 allocated for a nonprofit organization that provides access 26 to emergency poison information and treatment. Pursuant to 27 the directive under 2014 Iowa Acts, chapter 1140, section 28 102, the federal matching moneys available to the nonprofit 29 organization from the department under the federal Children’s 30 Health Insurance Program Reauthorization Act of 2009 shall be 31 subject to the federal administrative cap rule of 10 percent 32 applicable to moneys provided under Tit. XXI of the federal 33 Social Security Act, and shall be included in the department’s 34 calculations of the cap. 35 -12- LSB 5013XG (19) 91 ak/ko 12/ 37

S.F. _____ H.F. _____ 4. Unless otherwise provided by law, if a contract for 1 services provided under this section initially entered into 2 during the fiscal year beginning July 1, 2026, and ending 3 June 30, 2027, provides for an annual increase of the cost of 4 services provided under the contract, the annual increase shall 5 not exceed the amount by which the consumer price index for 6 all urban consumers increased during the immediately preceding 7 calendar year. This subsection does not affect a contract 8 entered into on or before June 30, 2026, that is for a term of 9 more than one year. 10 Sec. 11. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 11 PHARMACEUTICAL SETTLEMENT ACCOUNT. Notwithstanding section 12 249A.33, subsection 2, there is appropriated from the 13 pharmaceutical settlement account created in section 249A.33 14 any moneys remaining in the account for the fiscal year 15 beginning July 1, 2026, and ending June 30, 2027, to the 16 department of health and human services to supplement the 17 appropriation made in this Act from the general fund of the 18 state for the medical assistance program for the same fiscal 19 year. 20 Sec. 12. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 21 QUALITY ASSURANCE TRUST FUND. Notwithstanding section 249L.4, 22 subsection 2, there is appropriated from the quality assurance 23 trust fund created in section 249L.4 any moneys remaining in 24 the fund for the fiscal year beginning July 1, 2026, and ending 25 June 30, 2027, to the department of health and human services 26 to supplement the appropriation made in this Act from the 27 general fund of the state for the medical assistance program 28 for the same fiscal year. 29 Sec. 13. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HOSPITAL 30 HEALTH CARE ACCESS TRUST FUND. Notwithstanding section 249M.4, 31 subsection 2, there is appropriated from the hospital health 32 care access trust fund created in section 249M.4 any moneys 33 remaining in the fund for the fiscal year beginning July 1, 34 2026, and ending June 30, 2027, to the department of health and 35 -13- LSB 5013XG (19) 91 ak/ko 13/ 37

S.F. _____ H.F. _____ human services to supplement the appropriation made in this Act 1 from the general fund of the state for the medical assistance 2 program for the same fiscal year. 3 Sec. 14. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 4 BEHAVIORAL HEALTH FUND. Notwithstanding section 225A.7, 5 subsection 2, and subject to the availability of moneys, there 6 is appropriated from the behavioral health fund established in 7 section 225A.7, to the department of health and human services 8 for the fiscal year beginning July 1, 2026, and ending June 30, 9 2027, the following amount, or so much thereof as is necessary, 10 for the purposes designated: 11 To supplement the appropriation made in this Act from the 12 general fund of the state to the department of health and human 13 services for medical assistance for the fiscal year beginning 14 July 1, 2026, and ending June 30, 2027: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,053,449 16 Sec. 15. REIMBURSEMENT RATES. 17 1. Reimbursement for medical assistance, state 18 supplementary assistance, and social service providers and 19 services reimbursed under the purview of the department of 20 health and human services shall remain at the reimbursement 21 rate in effect on June 30, 2026, or shall be determined 22 pursuant to the reimbursement methodology in effect on June 30, 23 2026, with the exception of the following: 24 a. If reimbursement is otherwise negotiated by contract or 25 pursuant to an updated fee schedule. 26 b. As otherwise provided in this section. 27 2. a. (1) Notwithstanding any provision of law to the 28 contrary, for the fiscal year beginning July 1, 2026, and 29 ending June 30, 2027, the department of health and human 30 services shall base case-mix nursing facility rates on the 31 case-mix nursing facility rates annually in effect on June 30, 32 2026. 33 (2) The department of health and human services shall 34 calculate each nursing facility’s case-mix index for the period 35 -14- LSB 5013XG (19) 91 ak/ko 14/ 37

S.F. _____ H.F. _____ beginning July 1, 2025. 1 b. For the fiscal year beginning July 1, 2026, $1,167,867 2 shall be used to increase to the extent possible reimbursement 3 rates for ambulatory surgical centers compared to rates in 4 effect on June 30, 2026. 5 DIVISION VII 6 FAMILY WELL-BEING AND PROTECTION —— FY 2026-2027 7 Sec. 16. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— STATE 8 CHILD CARE ASSISTANCE. There is appropriated from the general 9 fund of the state to the department of health and human 10 services for the fiscal year beginning July 1, 2026, and ending 11 June 30, 2027, the following amount, or so much thereof as is 12 necessary, to be used for the purposes designated: 13 For state child care assistance in accordance with sections 14 237A.13 and 237A.14: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 31,983,000 16 1. If the appropriation made for purposes of the state child 17 care assistance program for the fiscal year is determined to 18 be insufficient, it is the intent of the general assembly to 19 appropriate sufficient moneys for the fiscal year to avoid 20 application of waiting list requirements. 21 2. A portion of the state match for the federal child care 22 and development block grant shall be provided as necessary to 23 meet federal matching moneys requirements through the state 24 general fund appropriation made for child development grants 25 and other programs for at-risk children in section 279.51. 26 Sec. 17. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— EARLY 27 INTERVENTION AND SUPPORTS. There is appropriated from the 28 general fund of the state to the department of health and human 29 services for the fiscal year beginning July 1, 2026, and ending 30 June 30, 2027, the following amount, or so much thereof as is 31 necessary, to be used for the purposes designated: 32 For promotion of optimum health status for children and 33 adolescents from birth through 21 years of age, and for 34 families: 35 -15- LSB 5013XG (19) 91 ak/ko 15/ 37

S.F. _____ H.F. _____ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 35,695,203 1 1. Of the moneys appropriated in this section, not more than 2 $734,000 is allocated for the healthy opportunities for parents 3 to experience success (HOPES) – healthy families Iowa (HFI) 4 program established pursuant to section 135.106. 5 2. Of the moneys appropriated in this section, $4,313,854 6 is allocated for the FaDSS grant program, and not more 7 than 5 percent of the allocated moneys shall be used for 8 administration of the grant program. 9 3. Of the moneys appropriated in this section, $29,256,799 10 shall be deposited in the early childhood Iowa fund created in 11 section 256I.11. 12 Sec. 18. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CHILD 13 PROTECTIVE SERVICES. There is appropriated from the general 14 fund of the state to the department of health and human 15 services for the fiscal year beginning July 1, 2026, and ending 16 June 30, 2027, the following amount, or so much thereof as is 17 necessary, to be used for the purposes designated: 18 For child, family, and adoption services, and for salaries, 19 support, maintenance, and miscellaneous purposes: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $164,052,467 21 1. Based on client need, a portion of the moneys 22 appropriated in this section may be used to provide other 23 resources required to support family preservation, emergency 24 client need, or family reunification efforts. 25 2. Of the moneys appropriated in this section, a sufficient 26 amount is allocated for foster family care, group foster care 27 maintenance and services, shelter care, child welfare emergency 28 services, qualified residential treatment programs, supervised 29 apartment living contracts, and for medical assistance program 30 reimbursement and associated costs. 31 3. Federal moneys received by the state during the fiscal 32 year beginning July 1, 2026, as the result of the expenditure 33 of state moneys appropriated during a previous state fiscal 34 year for a service or activity funded under this section, 35 -16- LSB 5013XG (19) 91 ak/ko 16/ 37

S.F. _____ H.F. _____ are appropriated to the department to be used as additional 1 moneys for services and purposes provided under this section. 2 Notwithstanding section 8.33, moneys appropriated under this 3 subsection that remain unencumbered or unobligated at the close 4 of the fiscal year shall not revert but shall remain available 5 for the purposes designated until the close of the succeeding 6 fiscal year. 7 4. a. Of the moneys appropriated in this section, $748,000 8 is allocated for the payment of the expenses of court-ordered 9 services provided to children who are under the supervision 10 of the department, which expenses are a charge upon the state 11 pursuant to section 232.141, subsection 4. 12 b. Notwithstanding chapter 232 or any other provision of 13 law to the contrary, a district or juvenile court shall not 14 order any service which is a charge upon the state pursuant to 15 section 232.141, subsection 4, if the moneys allocated under 16 paragraph “a” for court-ordered services are insufficient to 17 pay for the service. 18 5. Of the moneys appropriated in this section, $4,359,500 19 is allocated for the preparation for adult living program 20 established pursuant to section 234.46. 21 6. Of the moneys appropriated in this section, a portion may 22 be used for family-centered services for purposes of complying 23 with the federal Family First Prevention Services Act of 2018, 24 Pub. L. No. 115-123, and successor legislation. 25 7. a. Of the moneys appropriated in this section, 26 $39,823,955 is allocated for adoption subsidy payments and 27 related costs. 28 b. Any moneys remaining after the allocation under 29 paragraph “a” is designated and allocated as state savings 30 resulting from implementation of the federal Fostering 31 Connections to Success and Increasing Adoptions Act of 2008, 32 Pub. L. No. 110-351, and successor legislation, as determined 33 in accordance with 42 U.S.C. §673(a)(8), and shall be used for 34 post-adoption services and for other purposes allowed under 35 -17- LSB 5013XG (19) 91 ak/ko 17/ 37