Senate File 2422 - Reprinted SENATE FILE 2422 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO SSB 3140) (As Amended and Passed by the Senate February 25, 2026 ) 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 SF 2422 (4) 91 ak/ko/mb

S.F. 2422 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 but not limited to information 7 accessible through the systematic alien verification for 8 entitlements online service . 9 Sec. 2. Section 239.6, subsection 2, Code 2026, is amended 10 by adding the following new paragraph: 11 NEW PARAGRAPH . g. The systematic alien verification for 12 entitlements online service maintained by the United States 13 citizenship and immigration services of the United States 14 department of homeland security to verify immigration and 15 United States citizenship information. 16 DIVISION II 17 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 18 Sec. 3. Section 239.1, Code 2026, is amended by adding the 19 following new subsection: 20 NEW SUBSECTION . 01. “Alien” means any person not a citizen 21 or national of the United States. 22 Sec. 4. Section 239.2, Code 2026, is amended to read as 23 follows: 24 239.2 Supplemental nutrition assistance program —— income 25 eligibility. 26 1. a. The department shall establish the gross countable 27 monthly income threshold for the supplemental nutrition 28 assistance program at less than or equal to one hundred sixty 29 percent of the federal poverty level for the household size. 30 b. The department shall consider the income and 31 financial resources of all household members in determining 32 the eligibility and benefit allotment of the household, 33 including all household members determined to be ineligible 34 to participate in SNAP under this section or pursuant to 7 35 -1- SF 2422 (4) 91 ak/ko/mb 1/ 5

S.F. 2422 U.S.C. §2015(f). Notwithstanding 7 C.F.R. §273.11(c)(3), the 1 individual’s income, deductible expenses, and resources shall 2 be counted, and none shall be prorated. 3 c. Pursuant to 7 U.S.C. §2015(f), an individual shall be 4 ineligible to participate in SNAP unless the individual is a 5 resident of the United States and meets at least one of the 6 following criteria: 7 (1) The individual is a citizen or national of the United 8 States. 9 (2) The individual is an alien lawfully admitted for 10 permanent residence as an immigrant, as defined in 8 U.S.C. 11 §1101(a)(15) and 1101(a)(20), excluding alien visitors, 12 tourists, diplomats, students, or other individuals admitted 13 temporarily with no intention of abandoning their residence in 14 a foreign country. 15 (3) The individual is an alien who has been granted the 16 status of Cuban and Haitian entrant, as defined in section 17 501(e) of the federal Refugee Education Assistance Act of 1980, 18 Pub. L. No. 96-422. 19 (4) The individual lawfully resides in the United States in 20 accordance with a compact of free association referred to in 8 21 U.S.C. §1612(b)(2)(G). 22 2. The department shall comply with federal reporting 23 requirements relating to a household member who is determined 24 to be ineligible to participate in SNAP pursuant to 7 C.F.R. 25 §273.4(b). 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 deliver 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- SF 2422 (4) 91 ak/ko/mb 2/ 5

S.F. 2422 otherwise excluded from managed care program delivery pursuant 1 to a Medicaid state plan or waiver in effect on or before 2 January 1, 2027. 3 DIVISION IV 4 MEDICAID AND IOWA HEALTH AND WELLNESS PLAN —— RETROACTIVE 5 ELIGIBILITY AND REPORTING 6 Sec. 6. NEW SECTION . 249A.3B Medicaid —— retroactive 7 eligibility. 8 1. Notwithstanding any provision of state law to the 9 contrary, effective January 1, 2027, in compliance with 10 section 71112 of the One Big Beautiful Bill Act, Pub. L. No. 11 119-21, the department shall adopt rules to provide that the 12 eligibility of a individual who is a pregnant woman, a child, 13 or a resident of a nursing facility licensed under chapter 135C 14 shall be applied retroactively for no more than two months 15 prior to the month in which the individual submits a completed 16 medical assistance program application. 17 2. The department shall not adopt rules, or submit a 18 request for a waiver or state plan amendment to the centers for 19 Medicare and Medicaid services of the United States department 20 of health and human services, to permit the department to 21 provide medical assistance program eligibility retroactively to 22 any other adult individual except as provided in subsection 1. 23 Sec. 7. Section 249N.4, subsection 5, Code 2026, is amended 24 to read as follows: 25 5. A member is eligible for coverage effective the first day 26 of the month following the month of application for enrollment. 27 The department shall not adopt rules or submit a request for 28 a waiver or state plan amendment to the centers for Medicare 29 and Medicaid services of the United States department of health 30 and human services to permit the department to provide program 31 eligibility prior to the month in which the individual submits 32 a completed application for enrollment. 33 Sec. 8. 2017 Iowa Acts, chapter 174, section 12, subsection 34 15, paragraph a, subparagraph (7), as amended by 2018 Iowa 35 -3- SF 2422 (4) 91 ak/ko/mb 3/ 5

S.F. 2422 Acts, chapter 1165, section 107, is amended by striking the 1 subparagraph. 2 Sec. 9. MEDICAID RETROACTIVE ELIGIBILITY —— WAIVER. The 3 department of health and human services shall submit a 4 request for a section 1115 demonstration waiver to the centers 5 for Medicare and Medicaid services of the United States 6 department of health and human services for approval to 7 allow, for purposes of state administration of Medicaid, for 8 implementation by the department of no retroactive eligibility 9 for any adult individual who is not a pregnant woman, a child, 10 or a resident of a nursing facility licensed under chapter 11 135C, upon the submission of a completed Medicaid application, 12 instead of three months as required under 42 C.F.R. §435.915. 13 The department shall implement the waiver upon receipt of 14 approval of the waiver by the centers for Medicare and Medicaid 15 services of the United States department of health and human 16 services. 17 DIVISION V 18 MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— COST NEUTRALITY 19 Sec. 10. NEW SECTION . 249A.32C Medicaid waivers and state 20 plan amendments —— cost neutrality. 21 1. As used in this section, “cost neutral” means federal 22 approval of a waiver submitted by the department to the federal 23 government will not result in a net increase in spending for 24 the administration of the Medicaid program by the state. 25 2. Prior to submitting a request to the centers for Medicare 26 and Medicaid services of the United States department of health 27 and human services for a section 1115 demonstration waiver, 28 a section 1915 home and community-based services waiver, or 29 a state plan amendment to expand coverage under the medical 30 assistance program to additional individuals or a class of 31 individuals, the department shall conduct an analysis to 32 determine if the waiver is cost neutral. For any waiver that 33 is determined to be not cost neutral, the department shall not 34 submit the request for a waiver unless the waiver has been 35 -4- SF 2422 (4) 91 ak/ko/mb 4/ 5

S.F. 2422 presented to the general assembly and approved by a majority 1 vote of both houses of the general assembly. This subsection 2 shall apply to a section 1115 demonstration waiver, a section 3 1915 home and community-based services waiver, and a state 4 plan amendment to expand coverage under the medical assistance 5 program to additional individuals or classes of individuals 6 submitted to, or approved by, the centers for Medicare and 7 Medicaid services of the United States department of health and 8 human services prior to the effective date of this division of 9 this Act. 10 3. The department shall annually conduct an analysis to 11 determine the cost neutrality of all approved or implemented 12 cost waivers, and on or before October 1, submit a report to 13 the general assembly detailing the department’s cost neutrality 14 analysis and the department’s compliance with section 7118 of 15 the federal One Big Beautiful Bill Act, Pub. L. No. 119-21, 16 that requires cost neutrality for all Medicaid section 1115 17 demonstration waivers. 18 4. This section does not apply to a modification of a 19 state plan amendment that is required due to federal law or 20 regulation. 21 DIVISION VI 22 EFFECTIVE DATE 23 Sec. 11. EFFECTIVE DATE. This Act, being deemed of 24 immediate importance, takes effect upon enactment. 25 -5- SF 2422 (4) 91 ak/ko/mb 5/ 5