House File 2782 - Reprinted HOUSE FILE 2782 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO HSB 777) (As Amended and Passed by the House May 1, 2026 ) 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; transfers, 8 cash flow, and nonreversions; report on nonreversion 9 of moneys; more options for maternal support program; 10 reimbursement rates review; mental diseases exclusion 11 waiver; full-time equivalent dashboard; comprehensive 12 family support program; federal community mental health 13 services block grant; behavioral health expenditure report; 14 opioid settlement fund; emergency rules; graduate medical 15 education; and special population nursing facilities; and 16 including effective date and retroactive applicability 17 provisions. 18 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 19 HF 2782 (2) 91 ak/ko/md

H.F. 2782 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, and for not more than the following full-time 11 equivalent positions: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 14 2. IOWA VETERANS HOME 15 For salaries, support, maintenance, and miscellaneous 16 purposes: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736 18 a. The Iowa veterans home billings involving the department 19 of health and human services shall be submitted to the 20 department on at least a monthly basis. 21 b. The Iowa veterans home expenditure report shall be 22 submitted monthly to the general assembly. 23 3. HOME OWNERSHIP ASSISTANCE PROGRAM 24 For transfer to the Iowa finance authority for the 25 continuation of the home ownership assistance program for 26 persons who are or were eligible members of the armed forces 27 of the United States or eligible service members pursuant to 28 section 16.54: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 30 DIVISION II 31 AGING AND DISABILITY SERVICES —— FY 2026-2027 32 Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 33 AND DISABILITY SERVICES. There is appropriated from the 34 general fund of the state to the department of health and human 35 -1- HF 2782 (2) 91 ak/ko/md 1/ 37

H.F. 2782 services for the fiscal year beginning July 1, 2026, and ending 1 June 30, 2027, the following amount, or so much thereof as is 2 necessary, to be used for the purposes designated: 3 For aging programs for the department of health and human 4 services and area agencies on aging to provide citizens of 5 Iowa who are 60 years of age and older with case management; 6 for Iowa’s aging and disabilities resource centers; for the 7 return to community program; for the purposes of chapter 231E; 8 to administer the prevention of elder abuse, neglect, and 9 exploitation program pursuant to section 231.56A, in accordance 10 with the requirements of the federal Older Americans Act of 11 1965, 42 U.S.C. §3001 et seq., as amended; for the operation 12 of the dependent adult abuse services program pursuant to 13 chapter 235B; for matching funding for programs to enable 14 persons with severe physical or mental disabilities to function 15 more independently; for costs associated with centers for 16 independent living; and for other services which may include 17 but are not limited to adult day care, respite care, chore, 18 information and assistance, and material aid; for information 19 and options counseling for persons with disabilities; and 20 for salaries, support, administration, maintenance, and 21 miscellaneous purposes, and for not more than the following 22 full-time equivalent positions: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,379,531 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 101.00 25 1. Moneys appropriated in this section may be used to 26 supplement federal moneys received under federal regulations. 27 To receive moneys appropriated in this section, a local area 28 agency on aging shall match the moneys with moneys from other 29 sources according to rules adopted by the department. Moneys 30 appropriated in this section may be used for services not 31 specifically enumerated in this section only if approved by the 32 department as part of an area agency on aging’s area plan. 33 2. Of the moneys appropriated in this section, $949,282 34 is allocated to be used for the comprehensive family support 35 -2- HF 2782 (2) 91 ak/ko/md 2/ 37

H.F. 2782 program created in section 231.80 as enacted under this Act. 1 3. Of the moneys appropriated in this section, $33,632 2 is allocated to be used to build community capacity through 3 the coordination and provision of training opportunities in 4 accordance with the consent decree of Conner v. Branstad, No. 5 4-86-CV-30871 (S.D. Iowa, July 15, 1994). 6 DIVISION III 7 BEHAVIORAL HEALTH —— FY 2026-2027 8 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 9 BEHAVIORAL HEALTH. There is appropriated from the general fund 10 of the state to the department of health and human services for 11 the fiscal year beginning July 1, 2026, and ending June 30, 12 2027, the following amount, or so much thereof as is necessary, 13 to be used for the purposes designated: 14 For behavioral health prevention, education, early 15 intervention, treatment, recovery support, and crisis 16 services in order to support statewide access to treatment for 17 behavioral health conditions; stabilization and mitigation of 18 behavioral health crises; and recovery for individuals and 19 families impacted by behavioral health conditions. Activities 20 shall align with accepted best practice guidance standards for 21 behavioral health including those published by the centers for 22 disease control and prevention of the United States department 23 of health and human services, and the substance abuse and 24 mental health services administration of the United States 25 department of health and human services, for health promotion; 26 universal, selective, and indicated prevention; treatment; and 27 recovery services and supports; and shall include a 24-hour 28 helpline, public information resources, professional training, 29 youth prevention, program evaluation, and efforts at the state 30 and local levels, and for not more than the following full-time 31 equivalent positions: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 23,127,121 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 70.00 34 1. Of the moneys appropriated in this section, $300,000 35 -3- HF 2782 (2) 91 ak/ko/md 3/ 37

H.F. 2782 is allocated to support the work of the children’s behavioral 1 health system including evidence-based behavioral health 2 prevention, treatment, and recovery services and supports for 3 children and their families. 4 2. Of the moneys appropriated in this section, $950,000 5 is allocated for an integrated substance use disorder managed 6 care system. The department shall maintain the level of mental 7 health and substance use disorder treatment services provided 8 by the managed care contractors, and shall take the steps 9 necessary to continue the federal waivers as needed to maintain 10 the level of services. 11 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 12 WAGERING RECEIPTS FUND. There is appropriated from the 13 sports wagering receipts fund created in section 8.57I, to the 14 department of health and human services for the fiscal year 15 beginning July 1, 2026, and ending June 30, 2027, the following 16 amount, or so much thereof as is necessary, to be used for 17 behavioral health prevention, education, early intervention, 18 treatment, recovery support, and crisis services in order to 19 support statewide access to treatment for behavioral health 20 conditions; stabilization and mitigation of behavioral health 21 crises; and recovery for individuals and families impacted by 22 behavioral health conditions: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 24 DIVISION IV 25 PUBLIC HEALTH —— FY 2026-2027 26 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 27 HEALTH. There is appropriated from the general fund of the 28 state to the department of health and human services for the 29 fiscal year beginning July 1, 2026, and ending June 30, 2027, 30 the following amount, or so much thereof as is necessary, to be 31 used for the purposes designated: 32 For programs that support health promotion, protect the 33 health and safety of the public, conduct disease surveillance 34 and investigation to reduce the incidence of morbidity and 35 -4- HF 2782 (2) 91 ak/ko/md 4/ 37

H.F. 2782 mortality, serve individuals with chronic conditions including 1 but not limited to cancer, support the Iowa donor registry as 2 specified in section 142C.18, and strengthen the health care 3 delivery system and workforce to improve health outcomes for 4 all Iowans, and for not more than the following full-time 5 equivalent positions: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 21,168,369 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 348.60 8 1. Of the moneys appropriated in this section, $191,000 9 is allocated to the university of Iowa hospitals and clinics 10 to administer a child vision screening program through 11 continuation of an existing contract. The program shall submit 12 a report to the department regarding the use of funds allocated 13 under this subsection. The report shall include the objectives 14 and results for the program year including the target 15 population and how the funds allocated assisted the program in 16 meeting the objectives; the number, age, and location within 17 the state of individuals served; the type of services provided 18 to the individuals served; the distribution of moneys based on 19 the services provided; and the continuing needs of the program. 20 2. Of the moneys appropriated in this section, $144,000 is 21 allocated for the public purpose of allowing the department 22 to continue an existing contract with an existing affiliated 23 organization to provide education, client-centered programs, 24 and client and family support, for people living with epilepsy 25 and their families. The moneys allocated in excess of $50,000 26 shall be matched dollar for dollar by the existing affiliated 27 organization. Moneys under this section shall be distributed 28 in their entirety on July 1, 2026, for the purpose specified. 29 3. Of the moneys appropriated in this section, the following 30 amounts are allocated to the department of health and human 31 services to be used as follows to support the goals of 32 increased access, health system integration, and engagement: 33 a. $600,000 for distribution to a nonprofit organization 34 that established the first statewide drug donation repository 35 -5- HF 2782 (2) 91 ak/ko/md 5/ 37

H.F. 2782 for continuation of the pharmaceutical infrastructure for 1 safety net providers established as described in 2007 Iowa 2 Acts, chapter 218, section 108, and for the prescription drug 3 donation repository program established in chapter 135M. 4 Moneys under this paragraph shall be distributed in their 5 entirety on July 1, 2026, for the purpose specified. 6 b. $374,000 for distribution to free clinics, as defined in 7 section 135.24, and a nonprofit organization that facilitates 8 the initiation, operation, and collaboration of free clinics 9 for necessary infrastructure, statewide coordination, provider 10 recruitment, service delivery, and provision of assistance to 11 patients in securing a medical home inclusive of oral health 12 care. Of the moneys allocated, $40,000 shall be used to lower 13 fees associated with using an electronic prescribing system. 14 Moneys under this paragraph shall be distributed in their 15 entirety on July 1, 2026, for the purpose specified. 16 c. $25,000 for distribution to an organization that raises 17 awareness about issues related to rural health clinics for 18 necessary infrastructure and service delivery transformation. 19 Moneys under this paragraph shall be distributed in their 20 entirety on July 1, 2026, for the purpose specified. 21 4. Of the moneys appropriated in this section, $400,000 22 is allocated for rural psychiatric residencies for residents 23 selected on or before June 30, 2026. 24 5. Of the moneys appropriated in this section, $20,000 is 25 allocated to make radon test kits available, free of charge, 26 to homeowners and renters in the state. The department shall 27 provide a link on the department’s internet site for homeowners 28 and renters in the state to order radon test kits. 29 6. Of the moneys appropriated in this section, $1,500,000 is 30 allocated for awarding grants for medical residency programs in 31 the state that meet the following criteria: 32 a. The medical residency program is not related to the 33 practice of family medicine. 34 b. The medical residency program is not located in a county 35 -6- HF 2782 (2) 91 ak/ko/md 6/ 37

H.F. 2782 that has a population of one hundred fifty thousand or more 1 based on the most recent federal decennial census, and in which 2 the main campus of an institution of higher learning governed 3 by the state board of regents is located. 4 7. The university of Iowa hospitals and clinics under 5 the control of the state board of regents shall not receive 6 indirect costs from the moneys appropriated in this section. 7 The university of Iowa hospitals and clinics billings to the 8 department shall be, at a minimum, on a quarterly basis. 9 DIVISION V 10 COMMUNITY ACCESS AND ELIGIBILITY —— CHILD SUPPORT SERVICES —— 11 TANF —— FY 2026-2027 12 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 13 ACCESS AND ELIGIBILITY. There is appropriated from the 14 general 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 To be used for salaries, support, maintenance, and 19 miscellaneous purposes and for family investment program (FIP) 20 assistance in accordance with chapter 239B, and for other costs 21 associated with providing needs-based benefits or assistance 22 including but not limited to maternal and child health, oral 23 health, obesity prevention, the promoting independence and 24 self-sufficiency through employment, job opportunities and the 25 basic skills (PROMISE JOBS) program, supplemental nutrition 26 assistance program (SNAP) employment and training, the FIP 27 diversion program, family planning, rent reimbursement, 28 and eligibility determinations for medical assistance, food 29 assistance, and the children’s health insurance program, and 30 for not more than the following full-time equivalent positions: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 76,371,516 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 883.90 33 1. Of the child support collections assigned under FIP, 34 the federal share of the child support collections shall be 35 -7- HF 2782 (2) 91 ak/ko/md 7/ 37

H.F. 2782 credited to the child support services appropriation made in 1 this division of this Act. Of the remainder of the child 2 support collections assigned under FIP, a portion shall be 3 credited to community access and eligibility, and the remaining 4 moneys may be used to increase recoveries, to sustain cash flow 5 in the collection services center refund account as provided in 6 section 252B.13A, or for technology needs. If child support 7 collections assigned under FIP are greater than estimated or 8 are otherwise determined not to be required for maintenance of 9 efforts, the state share of either amount is appropriated to 10 the department for child support services as described in this 11 division of this Act, or may be transferred to or retained in 12 the collection services center refund account. 13 2. Of the moneys appropriated in this section, $3,075,000 is 14 allocated for continuation of the department’s initiative to 15 provide for adequate developmental surveillance and screening 16 during a child’s first five years. The moneys shall first be 17 used to fully fund the current participating counties to ensure 18 that those counties are fully operational, with the remaining 19 moneys to be used for expanding participation to additional 20 counties. Full implementation and expansion shall include 21 enhancing the scope of the initiative through collaboration 22 with child health specialty clinics to promote the use of 23 developmental surveillance and screening to support healthy 24 child development through early identification and response to 25 biomedical and social determinants of healthy development by 26 providing practitioner consultation and continuous improvement 27 through training and education, particularly for children 28 with behavioral conditions and needs. The department shall 29 also collaborate with the Medicaid program and child health 30 specialty clinics to assist in coordinating the activities 31 of the first five initiative into the establishment of 32 patient-centered medical homes developed to improve health 33 quality and population health while reducing health care costs. 34 To the maximum extent possible, moneys allocated in this 35 -8- HF 2782 (2) 91 ak/ko/md 8/ 37

H.F. 2782 subsection shall be utilized as matching moneys for Medicaid 1 program reimbursement. 2 3. Of the moneys appropriated in this section, $1,145,102 is 3 allocated to the Iowa commission on volunteer service created 4 in section 15H.2 for programs and grants. 5 4. The university of Iowa hospitals and clinics under 6 the control of the state board of regents shall not receive 7 indirect costs from the moneys appropriated in this section. 8 The university of Iowa hospitals and clinics billings to the 9 department shall be, at a minimum, on a quarterly basis. 10 Sec. 7. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CHILD 11 SUPPORT SERVICES. There is appropriated from the general fund 12 of the state to the department of health and human services for 13 the fiscal year beginning July 1, 2026, and ending June 30, 14 2027, the following amount, or so much thereof as is necessary, 15 to be used for the purposes designated: 16 For child support services, including salaries, support, 17 maintenance, and miscellaneous purposes, and for not more than 18 the following full-time equivalent positions: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,644,114 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 464.00 21 1. Federal access and visitation grant moneys shall be used 22 for services designed to increase compliance with the child 23 access provisions of court orders, including but not limited to 24 neutral visitation sites and mediation services. 25 2. Moneys appropriated in this section may be used 26 throughout the fiscal year in the manner necessary for 27 cash flow management. For cash flow management under this 28 subsection, the department may temporarily draw more than the 29 amount appropriated provided the amount appropriated is not 30 exceeded at the close of the fiscal year. 31 Sec. 8. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 32 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT. There is 33 appropriated from the special fund created in section 8.41 to 34 the department of health and human services for the fiscal year 35 -9- HF 2782 (2) 91 ak/ko/md 9/ 37

H.F. 2782 beginning July 1, 2026, and ending June 30, 2027, from moneys 1 received under the federal temporary assistance for needy 2 families (TANF) block grant pursuant to the federal Personal 3 Responsibility and Work Opportunity Reconciliation Act of 1996, 4 Pub. L. No. 104-193, and successor legislation, including TANF 5 block grant moneys received in any prior fiscal year that 6 were deposited in the special fund and remain unencumbered 7 or unobligated on June 30, 2026, the following amounts, or 8 so much thereof as is necessary, to be used for the purposes 9 designated: 10 1. For community access and eligibility: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,566,312 12 2. For community access and eligibility to provide 13 pregnancy prevention grants on the condition that family 14 planning services are funded: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 16 Pregnancy prevention grants shall be awarded to programs 17 in existence on or before July 1, 2026, if the programs have 18 demonstrated positive outcomes. Grants shall be awarded 19 to pregnancy prevention programs developed after July 1, 20 2026, if the programs are based on existing models that have 21 demonstrated positive outcomes. Grants must comply with the 22 requirements provided in 1997 Iowa Acts, chapter 208, section 23 14, subsections 1 and 2, including the requirement that a 24 program awarded a grant must emphasize sexual abstinence. 25 Priority in awarding grants shall be given to programs 26 that serve areas of the state which demonstrate the highest 27 percentage of unplanned pregnancies of females of childbearing 28 age within the geographic area to be served by the grant. 29 3. To meet one of the four purposes of TANF as specified 30 in 45 C.F.R. §260.20, including by modernizing the program 31 to promote economic mobility and self-sufficiency, ensuring 32 that families are able to overcome benefit cliffs, encouraging 33 healthy families, and streamlining service delivery to reduce 34 duplication: 35 -10- HF 2782 (2) 91 ak/ko/md 10/ 37

H.F. 2782 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000,000 1 4. For early intervention and supports for child abuse 2 prevention and the family development and self-sufficiency 3 (FaDSS) grant program in accordance with section 216A.107: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,013,980 5 5. For accountability, compliance, program integrity, 6 technology needs, and other resources necessary to meet 7 federal and state reporting, tracking, and case management 8 requirements, and other departmental needs: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 10 6. For state child care assistance: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 42,281,826 12 7. For child protective services: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 65,364,100 14 DIVISION VI 15 MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— 16 HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 17 PROGRAMS —— FY 2026-2027 18 Sec. 9. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— MEDICAL 19 ASSISTANCE PROGRAM, STATE SUPPLEMENTARY ASSISTANCE, AND HEALTHY 20 AND WELL KIDS IN IOWA PROGRAM. There is appropriated from the 21 general fund of the state to the department of health and human 22 services for the fiscal year beginning July 1, 2026, and ending 23 June 30, 2027, the following amount, or so much thereof as is 24 necessary, to be used for the purposes designated: 25 For medical assistance program reimbursement and associated 26 costs as specifically provided in the reimbursement 27 methodologies in effect on June 30, 2026, except as otherwise 28 expressly authorized by law, consistent with options under 29 federal law and regulations, and contingent upon receipt of 30 approval from the office of the governor of reimbursement for 31 each abortion performed under the medical assistance program; 32 for the state supplementary assistance program; for the health 33 insurance premium payment program; and for maintenance of 34 the healthy and well kids in Iowa (Hawki) program pursuant 35 -11- HF 2782 (2) 91 ak/ko/md 11/ 37

H.F. 2782 to chapter 514I, including supplemental dental services, 1 for receipt of federal financial participation under Tit. 2 XXI of the federal Social Security Act, which creates the 3 children’s health insurance program; and for other specified 4 health-related programs: 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,992,550,706 6 1. Of the moneys appropriated in this section, 7 $1,919,596,113 is allocated for medical assistance program 8 reimbursement and associated costs. Of the moneys allocated 9 in this subsection, $3,383,880 shall be used for program 10 administration, outreach, and enrollment activities of the 11 state family planning services program pursuant to section 12 217.41B , and of this amount, the department may use $200,000 13 for administrative expenses. 14 2. Iowans support reducing the number of abortions 15 performed in our state. Moneys appropriated under this section 16 shall not be used for abortions, unless otherwise authorized 17 under this section. 18 3. The provisions of this section relating to abortions 19 shall also apply to the Iowa health and wellness plan created 20 pursuant to chapter 249N . 21 4. Of the moneys appropriated in this section, $4,479,762 is 22 allocated for the state supplementary assistance program. 23 5. Of the moneys appropriated in this section, $68,474,831 24 is allocated for maintenance of the Hawki program pursuant 25 to chapter 514I , including supplemental dental services, for 26 receipt of federal financial participation under Tit. XXI of 27 the federal Social Security Act, which creates the children’s 28 health insurance program. 29 Sec. 10. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HEALTH 30 PROGRAM OPERATIONS. There is appropriated from the general 31 fund of the state to the department of health and human 32 services for the fiscal year beginning July 1, 2026, and ending 33 June 30, 2027, the following amount, or so much thereof as is 34 necessary, to be used for the purposes designated: 35 -12- HF 2782 (2) 91 ak/ko/md 12/ 37

H.F. 2782 For health program operations and the autism support program 1 under section 225D.2, and for not more than the following 2 full-time equivalent positions: 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 40,342,766 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 97.00 5 1. The department of inspections, appeals, and licensing 6 shall provide all state matching moneys for survey and 7 certification activities performed by the department of 8 inspections, appeals, and licensing. The department of health 9 and human services shall be solely responsible for distributing 10 the federal matching moneys for such activities. 11 2. Of the moneys appropriated in this section, a sufficient 12 amount is allocated for the administration of the health 13 insurance premium payment program, including salaries, support, 14 maintenance, and miscellaneous purposes. 15 3. Of the moneys appropriated in this section, $750,000 is 16 allocated for a nonprofit organization that provides access 17 to emergency poison information and treatment. Pursuant to 18 the directive under 2014 Iowa Acts, chapter 1140, section 19 102, the federal matching moneys available to the nonprofit 20 organization from the department under the federal Children’s 21 Health Insurance Program Reauthorization Act of 2009 shall be 22 subject to the federal administrative cap rule of 10 percent 23 applicable to moneys provided under Tit. XXI of the federal 24 Social Security Act, and shall be included in the department’s 25 calculations of the cap. 26 4. Unless otherwise provided by law, if a contract for 27 services provided under this section initially entered into 28 during the fiscal year beginning July 1, 2026, and ending 29 June 30, 2027, provides for an annual increase of the cost of 30 services provided under the contract, the annual increase shall 31 not exceed the amount by which the consumer price index for 32 all urban consumers increased during the immediately preceding 33 calendar year. This subsection does not affect a contract 34 entered into on or before June 30, 2026, that is for a term of 35 -13- HF 2782 (2) 91 ak/ko/md 13/ 37

H.F. 2782 more than one year. 1 Sec. 11. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 2 PHARMACEUTICAL SETTLEMENT ACCOUNT. There is appropriated 3 from the pharmaceutical settlement account created in section 4 249A.33 to the department of health and human services for the 5 fiscal year beginning July 1, 2026, and ending June 30, 2027, 6 the following amount, or so much thereof as is necessary, to be 7 used for the purposes designated: 8 Notwithstanding any provision of law to the contrary, to 9 supplement the appropriation made in this Act from the general 10 fund of the state for health program operations under the 11 medical assistance program for the same fiscal year: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 13 Sec. 12. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— QUALITY 14 ASSURANCE TRUST FUND. 15 1. Notwithstanding any provision of law to the contrary, and 16 subject to the availability of moneys, there is appropriated 17 from the quality assurance trust fund created in section 249L.4 18 to the department of health and human services for the fiscal 19 year beginning July 1, 2026, and ending June 30, 2027, the 20 following amount, or so much thereof as is necessary, for the 21 purposes designated: 22 To supplement the appropriation made in this Act from the 23 general fund of the state to the department of health and human 24 services for medical assistance for the same fiscal year: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 26 2. Notwithstanding section 249L.4, subsection 2, after the 27 appropriation in subsection 1, any moneys remaining in the 28 quality assurance trust fund for the fiscal year beginning 29 July 1, 2026, and ending June 30, 2027, are appropriated to 30 the department of health and human services to supplement the 31 appropriation made in this Act from the general fund of the 32 state for the medical assistance program for the same fiscal 33 year. 34 Sec. 13. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HOSPITAL 35 -14- HF 2782 (2) 91 ak/ko/md 14/ 37

H.F. 2782 HEALTH CARE ACCESS TRUST FUND. 1 1. Notwithstanding any provision of law to the contrary, and 2 subject to the availability of moneys, there is appropriated 3 from the hospital health care access trust fund created in 4 section 249M.4, to the department of health and human services 5 for the fiscal year beginning July 1, 2026, and ending June 30, 6 2027, the following amount, or so much thereof as is necessary, 7 for the purposes designated: 8 To supplement the appropriation made in this Act from the 9 general fund of the state to the department of health and human 10 services for medical assistance for the same fiscal year: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 12 2. Notwithstanding section 249M.4, subsection 2, after 13 the appropriation in subsection 1, any moneys remaining in 14 the hospital health care access trust fund for the fiscal 15 year beginning July 1, 2026, and ending June 30, 2027, are 16 appropriated to the department of health and human services to 17 supplement the appropriation made in this Act from the general 18 fund of the state for the medical assistance program for the 19 same fiscal year. 20 Sec. 14. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 21 BEHAVIORAL HEALTH FUND. Notwithstanding section 225A.7, 22 subsection 2, and subject to the availability of moneys, there 23 is appropriated from the behavioral health fund established in 24 section 225A.7, to the department of health and human services 25 for the fiscal year beginning July 1, 2026, and ending June 30, 26 2027, the following amount, or so much thereof as is necessary, 27 for the purposes designated: 28 To supplement the appropriation made in this Act from the 29 general fund of the state to the department of health and human 30 services for medical assistance for the fiscal year beginning 31 July 1, 2026, and ending June 30, 2027: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,580,938 33 Sec. 15. REIMBURSEMENT RATES. 34 1. Reimbursement for medical assistance, state 35 -15- HF 2782 (2) 91 ak/ko/md 15/ 37

H.F. 2782 supplementary assistance, and social service providers and 1 services reimbursed under the purview of the department of 2 health and human services shall remain at the reimbursement 3 rate in effect on June 30, 2026, or shall be determined 4 pursuant to the reimbursement methodology in effect on June 30, 5 2026, with the exception of the following: 6 a. If reimbursement is otherwise negotiated by contract or 7 pursuant to an updated fee schedule. 8 b. As otherwise provided in this section. 9 2. a. (1) Notwithstanding any provision of law to the 10 contrary, for the fiscal year beginning July 1, 2026, and 11 ending June 30, 2027, the department of health and human 12 services shall reimburse case-mix nursing facility rates based 13 on the methodology in effect on June 30, 2026. 14 (2) July 1, 2025, through December 31, 2025, the department 15 of health and human services shall calculate each nursing 16 facility’s case-mix index for rates effective July 1, 2026. 17 (3) January 1, 2026, through June 30, 2026, the department 18 of health and human services shall calculate each nursing 19 facility’s case-mix index for rates effective January 1, 2027. 20 (4) All nursing facility rate adjustments under this 21 paragraph shall be budget neutral. 22 b. For the fiscal year beginning July 1, 2026, $1,167,867 23 shall be used to increase to the extent possible reimbursement 24 rates for ambulatory surgical centers compared to rates in 25 effect on June 30, 2026. 26 c. For the fiscal year beginning July 1, 2026, $3,000,000 27 shall be used to increase to the extent possible, compared 28 with rates in effect on June 30, 2026, reimbursement rates for 29 providers of Medicaid home and community-based services waiver 30 services used most frequently by elderly waiver recipients 31 including attendant care, homemaker, and assisted living 32 services. 33 d. (1) Adjustments to Medicaid reimbursement rates 34 developed using cost reports shall be applied starting on the 35 -16- HF 2782 (2) 91 ak/ko/md 16/ 37