SF 2422 — A bill for an act relating to public assistance programs under the purview of the department of health and human services, including the supplemental nutrition assistance program, Medicaid, and the Iowa health and wellness plan, and including effective date provisions.

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).

heThe patmntdepartment hllshall mpycomply ithwith dealfederal potigreporting rqureetsrequirements eatngrelating oto aoueolda mbrhousehold homember swho temiedis determined to ebe elgbleineligible oto rtciaeparticipate nin NAPSNAP rsatpursuant to 7F..7 C.F.R.

§7.4().§273.4(b).

Sc.Sec.

EW5. ETIN.

3912NEW SAPSECTION. rr ate — prtn.

Bgnnng239.12 ihSNAP heerror iclrate uater—— atreporting. trs n ctber 1, 2, ad vry ical ater erafe, wtin hrty cledr dys f anmisin f aa o he od nd trtin srvcesf he nted ats earmet f grcltre, e dpatmnt all bmt a prt o he neal sebly dtalig amet rrr ats socatd ith AP r he imeiaey reedng ical ate.

DVSINBeginning IIwith SPPEENALthe URIIONSSSTNCEfiscal OGAMquarter -that IVRSstarts Sc.on October 1, 2026, and every fiscal quarter thereafter, within thirty calendar days of transmission of data to the food and nutrition services of the United States department of agriculture, the department shall submit a report to the general assembly detailing payment error rates associated with SNAP for the immediately preceding fiscal quarter.

EDRALDIVISION PPEENALIII URIIONSUPPLEMENTAL SSTNCENUTRITION OGAMASSISTANCE —PROGRAM WIVR—— FWAIVERS XUNEMNTSec. LE.

The6. patmnt f alh nd uan evces all rqust aaver om he od d utiton evces f e Uitd ttes patmnt f giulure o ovde at, r prpss f tae dmnitrton f he ppemnal uriion Seate le 42, .

4FEDERAL asitaceSUPPLEMENTAL ogam,NUTRITION pugeentASSISTANCE fPROGRAM nfis—— nWAIVER aOF ushldsEXPUNGEMENT eecroicRULES. eeit cout ndr 7.FR.

24.()1. e prmttd fer hee oths r ntyone ys f ncivty, or f nfis eminn, on e lctonc enft ccun.

The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition Senate File 2422, p.

4 assistance program, expungement of benefits on a household’s electronic benefit account under 7 C.F.R.

§274.2(i) be permitted after three months or ninety-one days of inactivity, or of benefits remaining, on the electronic benefit account.

heThe patmntdepartment fof elhhealth ndand uanhuman eviesservices allshall iplmetimplement hethe ivrwaiver ponupon ceptreceipt fof prvalapproval fof ethe averwaiver fomfrom hethe iedUnited ttesStates patentdepartment fof riulue.agriculture.

Sc.Sec.

EDRAL7. PPEMNAL URIION SITNCE OGAM — WIVR F LGIILTY EIFCTIN ULS.

FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF ELIGIBILITY VERIFICATION RULES.

oNo aerlater hnthan anayJanuary ,1, 02,2027, hethe eatmntdepartment fof halhhealth ndand manhuman rvcesservices alshall rqestrequest aavra fomwaiver efrom fodthe ndfood titonand eviesnutrition fservices eof niedthe ttesUnited prtentStates department of riutueagriculture oto roideprovide a,that, orfor upoespurposes fof ttestate amiisrainadministration fof hethe uplmetlsupplemental utitonnutrition sisaceassistance poga,program, ifomtininformation romfrom ethe orcssources ndrunder ecionsection 96,239.6, ndand tethe olowngfollowing toatdautomated oucs,sources, hllshall ebe osierdconsidered eifedverified frfor uroespurposes fof 7.FR.7 C.F.R.

22.2c):§272.12(c):

Thea. ir-prty tmaed set eifcain erics cntaced y e eprtet r n quvaent ir-ary sst vriicton ltfr.

The toatdthird-party mpometautomated erfiatonasset evceverification nwnservices ascontracted eby okthe umerdepartment ror nan qialntequivalent hrdpatythird-party noeasset vriictonverification ltfr.platform.

Theb. patmnt f alh nd uan evces all iplmet he ivr pon cipt f prval f e aver fom henied ttes patent f riulue.

DIIIONThe Vautomated MEICIDemployment Dverification OWAservice ALHknown NDas LLESSthe ANwork -number TRACIVEor ELGBIITYan Sc.equivalent third-party income verification platform.

EW ETIN.

49.3B eicid — tracie eiibliy.

Nowihsaning y rviion f ate w o he cntay, fecive nury , 27, n mpiace th etin fub.

192, cmony efrrd o s he e Bg eatful ll c, he patmnt hll dpt les o povde at he igbiiy f n ndviul wo s arenat wmn, ahid, r aesdnt f auring ciiy icnsd udr cater 5C hll e pled eroctvey or o re tan woonhs ror o e onh n hih he diidal Seate le 42, .

5 sbmts aoplted dial sitace rgrm ppiaton.

heThe patmntdepartment hllof thealth dotand uls,human rservices bmtshall aimplement rqustthe rwaiver awivrupon rreceipt taeof lnapproval medmntof othe ewaiver enersfrom rthe MdiareUnited dStates eiciddepartment evies f e nied tts eprtent of alhagriculture. nd man rvcs, o emit e eprmet o povde dial sisane rorm liibliy etoatvey o ay ter dlt nivdul xept s ovded n becion .

Sc.DIVISION IV MEDICAID AND IOWA HEALTH AND WELLNESS PLAN —— RETROACTIVE ELIGIBILITY Sec.

ecion8. 9.4, bscton , oe 06, s mndd to ad s llw:

NEW SECTION.

249A.3B Medicaid —— retroactive eligibility.

1.

Notwithstanding any provision of state law to the contrary, effective January 1, 2027, in compliance with section 71112 of Pub.

L.

No.

119-21, commonly referred to as the One Big Beautiful Bill Act, the department shall adopt rules to provide that the eligibility of an individual who is a pregnant woman, a child, or a resident of a nursing facility licensed under chapter 135C shall be applied retroactively for no more than two months prior to the month in which the individual Senate File 2422, p.

5 submits a completed medical assistance program application.

2.

The department shall not adopt rules, or submit a request for a waiver or state plan amendment to the centers for Medicare and Medicaid services of the United States department of health and human services, to permit the department to provide medical assistance program eligibility retroactively to any other adult individual except as provided in subsection 1.

Sec.

9.

Section 249N.4, subsection 5, Code 2026, is amended to read as follows:

AemerA smember lgbleis religible ovraefor ffcivecoverage eeffective irtthe ayfirst day of ethe othmonth olwig-tefollowing oththe fmonth pliatonof rapplication nrllet.for enrollment.

TeThe eprmetdepartment halshall otnot dptadopt lesrules ror bmtsubmit a qestrequest rfor a avrwaiver ror taestate lanplan edmntamendment oto hethe ntrscenters rfor edcaeMedicare adand edcidMedicaid eviesservices fof heniedthe ttesUnited patentStates fdepartment alhof adhealth umnand evieshuman oservices emtto tepermit earmetthe odepartment rvieto roramprovide eigbiiyprogram rireligibility oprior heto nththe nmonth ichin ewhich ndvdulthe ubitsindividual submits a opltdcompleted ppictinapplication orfor nolmnt.enrollment.

Sc.Sec.

20710. owact, hater 4, eton 2, bscton 1, argaph , bprarph 7, s meded y 18 wa At, cater 65, cton 7, s mndd y tikng he sbprgrph.

Sc.2017 Iowa Acts, chapter 174, section 12, subsection 15, paragraph a, subparagraph (7), as amended by 2018 Iowa Acts, chapter 1165, section 107, is amended by striking the subparagraph.

MEICIDSec. ERACIVE IGBIIY - AIE.

he11. dpatent f alh nd uan rvces all bit a rqust r a cton 15 eontrtin aier o e eners fr eicre nd diaid rics f he ntd Saes dpatent f alh nd uan rvces r proal o alw, or rpses f ae dmnitrtin f eicid, r iplmettin y he eatmnt f o erocive igbiity fr ny ult diidal o s ot arennt oan, ahl, or aeient f ausig ailty iened der aper 15, uon e ubisionf a mpetd edcid pliato, istad f ree nts s euied ner 2 F..

43.95.MEDICAID RETROACTIVE ELIGIBILITY —— WAIVER.

TeThe eprmetdepartment halof mpeenthealth eand aierhuman pnservices eeitshall fsubmit aprvla frequest hefor avra 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 ethe etesdepartment of no retroactive eligibility for any adult individual who is not a pregnant woman, a child, or eiarea dresident edcadof srvcsa fnursing hefacility ntedlicensed aesunder earmetchapter f135C, elthupon dthe umnsubmission srvcs.of a completed Medicaid application, instead of three months as required under 42 C.F.R.

IISON§435.915. V EDCID - EICID AAED AE RGNIATON ALH ARE X FND;

PEDIUREThe URAIT;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.

NDDIVISION XEPINSV OMEDICAID OICY—— SeateMEDICAID leMANAGED 42,CARE .ORGANIZATION HEALTH CARE TAX FUND;

6EXPENDITURE Sc.NEUTRALITY;

SetinAND 49.3,EXCEPTIONS usetinTO ,POLICY oeSenate 02,File s2422, aenedp. o ad s olws:

6 Sec.

12.

Section 249A.13, subsection 2, Code 2026, is amended to read as follows:

oeysMoneys nin ethe udfund reare proritdappropriated toheto earmetthe department of alhhealth ndand manhuman rvcsservices frfor hethe rpsspurposes of ethe eiclmedical asitaceassistance ogam.program.

nlssUnless xrssyexpressly ppovdapproved yby hethe nealgeneral aseblyassembly rughthrough gilain,legislation, ror sas euiedrequired yby eealfederal awlaw or guaios,regulations, hethe patentdepartment allshall tnot aketake yany cionaction atthat rduesreduces nesmoneys epsieddeposited nin ethe undfund omfrom aeatha inenncehealth ogaiztonmaintenance otrctngorganization ihcontracting hewith patmntthe odepartment diiserto headminister mdialthe sitacemedical rgrmassistance nerprogram hsunder hatr.this chapter.

SchSuch oeysmoneys sallshall tnot ebe iere,diverted, rdce,reduced, ror sedused yby ethe earmetdepartment orfor ayany throther upoespurposes hnthan hoethose emitedpermitted yby isthis bscto.subsection.

Sc.Sec.

NEW13. CTON.

4A.9NEW MdiaidaiersSECTION. d tte pan enmets — pedtue etrliy.

249A.59 Medicaid waivers and state plan amendments —— expenditure neutrality.

orFor rpsespurposes fof isthis cto,section, ulesunless hethe ntxtcontext ohewieotherwise euies,requires, xpnitre“expenditure utal"masneutral” tatmeans ethat ostthe fcost of a eerlyfederally ppovdapproved hagechange oto nan isig,existing, ror ewnew qustrequest orfor a, diadMedicaid aierwaiver ror ttestate anplan mndentamendment llwill tnot esltresult nin a ntnet nceseincrease nin xenitrsexpenditures fomfrom ethe ppopitinappropriation natedenacted rfor tethe isalfiscal aryear hethe anechange ror ewnew qustrequest sis de,made, sas rtfidcertified by nan taryactuary tanedretained yby ethe earmet.department.

Tea. eprmet hal ot mlmet a ane o a Mdiaid ier r atae ln medmnt proed y e cntrs r edcae nd eiaid rvces f e nted Sats eprmet f eath d umn eries, r bmt a nw eqet, f he ane r ew qust s t xpndtue nuta, ulss xresly prvd y he eeal semly trogh eilaion ior o plmnttin f he ane r sbmsson f e ew eust.

The patmntdepartment allshall tnot mpemntimplement ahngea ochange aeiaidto wivra rMedicaid ataewaiver lanor enmnta proedstate yplan eamendment enersapproved rby Mdiaethe adcenters eicidfor eviesMedicare fand eMedicaid niedservices tts eprtent of alhthe ndUnited manStates rvcs,department rof umithealth aewand qes,human fservices, heor canesubmit ra ewnew qustrequest, xadsif oergethe nerchange eor edcadnew pogamrequest ois niidalsnot rexpenditure asesneutral, funless diiuas,expressly nessapproved eprssyby proedthe ygeneral heassembly nralthrough seblylegislation roghprior gilaionto piorimplementation oof plmnttinthe fchange heor anesubmission rof ubisinthe fnew herequest. ew rqust.

b.

The department shall not implement a change to a Medicaid waiver or a state plan amendment approved by the centers for Medicare and Medicaid services of the United States department of health and human services, or submit a new request, if the change or new request expands coverage under the Medicaid program to individuals or classes of individuals, unless expressly approved by the general assembly through legislation prior to implementation of the change or submission of the new request.

hsThis ecionsection alshall otnot plyapply hnwhen hethe patmntdepartment SeateSenate leFile 42,2422, .p.

7 iplmetsimplements aeerllya prvdfederally cageapproved o,change rto, bitsor aewsubmits rqusta onew erequest edralto venentthe r,federal aedcidgovernment averfor, a Medicaid waiver or atelanstate enmetplan htamendment eesthat nymeets fany heof lowngthe rqurmets:following requirements:

Thea. ane r ew qust as bited or deal aprvl pir o anary, 02, egrdes f heher fdeal prval s een cevd y he eatmnt y auay 1, 2.

The anechange ror ewnew qustrequest swas euredsubmitted yfor dealfederal awapproval orprior guaio,to rJanuary s1, ecssry2026, oregardless mpyof ithwhether dralfederal wapproval rhas rguatos.been received by the department by January 1, 2026.

Theb. ane r ew qust s eesay o omly th a sttemnt remet, oset ere, r thr esltin f a sate oaton f he deal diaid ora.

AThe hagechange ror nwnew eqetrequest iiiaed ner is aagaphrequired alby efederal eprtdlaw toor eregulation, eerlor ssmby,is ihnecessary nto simtecomply fwith efederal isallaw mactor ofregulations. e hnge r w eqet o he xent ts non, ihin tiry as f he ae f he ttemnt gemet, oset dcre, r her souton f atte ilain f he eerl Mdiaid ora.

Thec. ane r ew qust noles e evlomet r iplmettin f ctaraly ond aittin aes ositet wth 2 F..

43..The change or new request is necessary to comply with a settlement agreement, consent decree, or other resolution of a state violation of the federal Medicaid program.

A change or new request initiated under this paragraph shall be reported to the general assembly, with an estimate of the fiscal impact of the change or new request to the extent it is known, within thirty days of the date of the settlement agreement, consent decree, or other resolution of a state violation of the federal Medicaid program.

d.

The change or new request involves the development or implementation of actuarially sound capitation rates consistent with 42 C.F.R.

§438.4.

heThe patmntdepartment ymay dotadopt ulsrules uruntpursuant oto hptrchapter 7A17A oto amiiteradminister isthis etin.section.

Sc.Sec.

NEW14. CTON.

4A.0NEW MdiaidSECTION. —xcpios o plcy.

Te249A.60 earmetMedicaid hal—— aeexceptions ubicyto valbl,policy. uruat o scton 1.2, noraton n tiios or aave, lso rfered oy he earmnt s xepios o oic, f he rles vrnng he les feprten, ncudng t ot lmied o e olown:

The department shall make publicly available, pursuant to section 217.22, information on petitions for a waiver, also referred to by the department as exceptions to policy, of the rules governing the rules of department, including but not limited to the following:

heThe taltotal mbrnumber fof xepiosexceptions oto oicypolicy ane.granted.

heThe muatvecumulative otcost fof hethe cetinsexceptions oto liypolicy hatthat rewere gane.granted.

heThe pestypes fof cetonsexceptions oto liypolicy htthat erewere ane.granted.

dntfibleIdentifiable enstrends oednoted yby hethe patentdepartment cldigincluding ayany fof hethe llwig:following:

Thea. mbr f xcpios o olcy aned n a Seate le 42, .

8The prtcuarnumber egapicof oato.exceptions to policy granted in a Senate File 2422, p.

The8 pesparticular fgeographic dcadlocation. erics hat re e ass or ecetins o liy.

Theb. diaid ogam asifcaion f dviuas ganed xetins o oiy.

Sc.The types of Medicaid services that were the basis for exceptions to policy.

EFECIVEc. T.

The llwigMedicaid aesprogram fectclassification nof Jnuryindividuals ,granted 27:exceptions to policy.

TeSec. etin f his vsin f his t mndng etin 29A1, sbscion .

DIIION15. I MDIAID - SPTL DRCTD AYENT ORAM Sc.

SetinEFFECTIVE 49.,DATE. ode 2, is eded y dig he fllwig ew bscto:

NWThe UBETIN.following takes effect on January 1, 2027:

0.The section of this division of this Act amending section 249A.13, subsection 2.

UlesDIVISION thrwseVI uhriedMEDICAID y—— heHOSPITAL gnealDIRECTED seblyPAYMENT roghPROGRAM eilaio,Sec. he earmnt hll cntnue o pemnt aosial ieced amet rgrm uder is aper tliig rts p o he aium munt s prmttd ner 2 ...

§3.6.16.

DVSINSection II249O.2, RORAMDMNITRTINCode -2026, LCTONCis ENFISamended UDSby AMETadding Sc.the following new subsection:

SetinNEW 172,SUBSECTION ode. 2, is eded o ad s fllws:

Pyent01. y etrnic ns raser.

Unless otherwise authorized by the general assembly through legislation, the department shall continue to implement a hospital directed payment program under this chapter utilizing rates up to the maximum amount as permitted under 42 C.F.R.

§438.6.

DIVISION VII PROGRAM ADMINISTRATION —— ELECTRONIC BENEFITS FUNDS PAYMENT Sec.

17.

Section 217.24, Code 2026, is amended to read as follows:

217.24 Payment by electronic funds transfer.

heThe patmntdepartment hllshall ntnuecontinue padngexpanding hethe acicepractice fof mkigmaking ametspayments oto rgrmprogram atiipntsparticipants dand enosvendors yby easmeans of ecrnicelectronic ndsfunds anfr.transfer.

TeThe eprtetdepartment salshall eekseek ethe cpaitycapacity rfor aingmaking ymntpayment yby chsuch ensmeans rfor llall rgrmsprograms amiiseedadministered yby hethe paten.department.

,2. The paten, in odiaton ih he patmnt f mnaemn's iison f noraion choog, sal eek te apcty o low rmim amets y rgrm atiipnts to e de y ecroic eeits anfer r ll ogams amiiseed y he patent at euie reim ayens.

ByThe nurydepartment, ,in 28,coordination ewith eprmetthe haldepartment llwof rmimmanagement’s ayensdivision mdeof yinformation rtcianstechnology, uruntshall oseek etinthe 49.,capacity sbecionto 2,allow rarphpremium a,payments ubargaphby ),program oparticipants eto debe ymade lctoncby bneiselectronic tasfr.benefits transfer for all programs administered by the department that require premium payments.

IISONBy IIJanuary EFETIE1, ATE2028, Seatethe iedepartment 222,shall .allow premium payments made by participants pursuant to section 249A.3, subsection 2, paragraph “a”, subparagraph (1), to be made by electronic benefits transfer.

9DIVISION Sc.VIII EFFECTIVE DATE Senate File 2422, p.

8.9 Sec.

EFECTVE18. AE.

ThsEFFECTIVE At,DATE. eig demd of imedate morane, tkes fect pn natmet.

AYThis SNCAIRAct, PATbeing ASLE.deemed of immediate importance, takes effect upon enactment.

Pesient______________________________ f______________________________ heAMY eateSINCLAIR SpakrPAT GRASSLEY President of hethe useSenate Speaker of the House I erbyhereby erifycertify htthat tisthis ilbill oigiatdoriginated in ethe SnaeSenate adand is nwnknown sas enteSenate ileFile 42,2422, intyfirtNinety-first GnealGeneral ssmby.Assembly.

______________________________ W.

HALESCHARLES MTHONSMITHSON SecretlySecretary oof eSentethe AproeSenate 026Approved KIMRENODS_______________, Goeror2026 ______________________________ KIM REYNOLDS Governor