Amendment vs bill Amendment H-1200 vs Enrolled

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STATE OF IOWA KIM REYNOLDS GOVERNOR Jne,025 TeHnoalealPte Sceayofaeofoa Saeaiol DsMins,oa5019 Darr.ertr, Ieebyasi:
Senate File 615 H-1200 Amend the amendment, H-1198, to Senate File 615, as passed by the Senate, as follows:
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I1 I i:' I GENF1ZAL A S S l i ' .
<<Sec.
M I 3 L Y 1p1p1 1.'afpl11 5:.:p3iilp§'' 6a{pI1 13G:I'aî1 I:Y'.1 31i1L:pli11 8pGISI Senate File 615 AN ACT RELATING TO WORK REQUIREMENTS FOR THE IOWA HEALTH AND WELLNESS PLAN, PUBLIC ASSISTANCE PROGRAMS, AN INFORMATION TECHNOLOGY FUND, THE PUBLIC ASSISTANCE MODERNIZATION FUND, AND THE MEDICAID FOR EMPLOYED PEOPLE WITH DISABILITIES PROGRAM, AND INCLUDING EFFECTIVE DATE PROVISIONS.
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
DIVISION I IOWA HEALTH AND WELLNESS PLAN — WORK REQUIREMENTS Section 1.
249NAA Work requirements.
249O.1 Definitions.
As used in this chapter, unless the context otherwise requires:
The department shall request any federal approval necessary to include work requirements as a condition of a Senate File 615, p .
“Countable income” means the income of an individual when the income is received and can be used to meet the individual’s needs for food, clothing, and shelter.
2 member maintaining eligibility for the Iowa health and wellness plan.
“Countable income” does not include the income of another member of the individual’s household, or certain receipts as described in 20 C.F.R.
§416.1103.
The goal of including work requirements is to reduce the dependence of low-income Iowans on public assistance programs through efforts that advance economic stability and mobility.
“Department” means the department of health and human services.
The department shall require as a condition of maintaining eligibility for the Iowa health and wellness plan that a member work at least eighty hours each month, as determined by the department.
“Disability” means a qualifying disability as determined by the federal social security administration, or the individual is determined by the department to have a physical or mental impairment, or combination of impairments, that have lasted or are expected to last for at least twelve months or result in death.
The department shall exempt an individual from the work requirements for the Iowa health and wellness plan if the individual meets any of the following criteria:
“Long-term services and supports” means the broad range of health, health-related, and personal care assistance services and supports, provided in home and community-based settings, necessary for persons with disabilities who experience limitations in their capacity for self-care due to a physical, cognitive, or mental disability or condition.
5.
“Program” means the work without worry program established in section 249O.3.
Sec.
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NEW SECTION.
249O.2 Program —— intent.
It is the intent of the general assembly to remove barriers to employment for individuals who, but for income and resources, meet the definition of disability, by providing H 1198.1280 (2) 91 -1- lh/ko 1/5 medical assistance to employed individuals with disabilities through a work without worry program in accordance with section 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act, and Medicaid eligibility, using less restrictive income and resource requirements through the application of section 1902(r)(2) of the federal Social Security Act, and cost-sharing requirements established by the department and approved by the centers for Medicare and Medicaid services of the United States department of health and human services.
Sec.
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NEW SECTION.
249O.3 Program —— established.
1.
The work without worry program is established under the medical assistance program and shall be administered by the department to provide employed individuals with disabilities access to health care coverage through the medical assistance program.
2.
Except as otherwise specified in this chapter, provisions applicable to the medical assistance program pursuant to chapter 249A shall be applicable to the program.
3.
In addition to the benefits received under the program, an individual shall have access to all traditional Medicaid services under the medical assistance program, as well as additional long-term services and supports and community-based services, including waiver services, for which the individual meets any applicable level of care requirements.
4.
The department shall make every effort to coordinate benefits with the health care coverage provided by an employer of an employed individual with a disability receiving benefits under this chapter.
Sec.
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NEW SECTION.
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249O.4 Program —— eligibility.
1.
Except as otherwise provided in this chapter, an individual may participate in the program if the individual meets all of the following criteria:
The individual is under nineteen years of age.
The individual is eligible for the medical assistance program under chapter 249A.
The individual is sixty-five years of age or older.
The individual is at least eighteen years of age.
c.
H 1198.1280 (2) 91 -2- lh/ko 2/5 c.
The individual is determined to be disabled by the United States social security administration.
The individual is less than sixty-five years of age.
The individual is identified as medically frail or medically exempt under the Medicaid program.
The individual has a disability.
The individual is a caretaker of a dependent child under six years of age.
The individual is employed, earns income from employment which may include self-employment, and works at least one hour per month.
f.
2.
The individual is pregnant and the pregnancy is high risk.
The department shall not adopt a rule for program eligibility based upon any of the following:
g.
a.
The individual is receiving unemployment compensation as determined by the department of workforce development.
An individual’s income or resources.
h.
b.
The individual is participating in substance use disorder treatment, not to exceed a consecutive six-month period.
A resource test or limit.
i.
c.
The individual is otherwise exempt for good cause as determined by the director.
An individual’s receipt of federal disability benefits.
5.
3.
To maximize fiscal stability and administrative efficiency, any exemption applied under the Iowa health and wellness plan shall be substantially similar to the exemptions applied under other public assistance programs.
An individual who receives supplemental security income shall be automatically eligible for the program and may participate in the program.
6.
4.
Upon the department's receipt of federal approval, and the department's operationalizing of a real-time system to facilitate recipient reporting and department evaluation efforts, the department shall implement work requirements as a condition of maintaining eligibility for the Iowa health and wellness plan.
An individual may be eligible for or receive other health care coverage including through an employer, through Medicare, or through the medically needy program, the qualified Medicare beneficiary program, or the specified low-income Medicare beneficiary program.
The department shall adopt rules pursuant to Senate File 615, p.
If the individual has such other coverage and is subject to payment of copayments or premiums for that coverage, notwithstanding the premium requirements under the program to the contrary, the individual shall not be subject to payment of premiums otherwise applicable under the program.
3 chapter 17A as necessary to administer the work requirements for the Iowa health and wellness plan.
7.
The department may resubmit a request for federal approval submitted under subsection 1 if the initial request is denied or withdrawn for any reason.
8.
If the department receives federal approval to include work requirements as a condition of a member maintaining eligibility for the Iowa health and wellness plan, and if federal law or regulations affecting work requirements for the Iowa health and wellness plan are modified to exclude work requirements as a condition of a member maintaining eligibility as provided in this section, the department shall discontinue the Iowa health and wellness plan, subject to federal approval.
If, under federal law, the department is not allowed to discontinue the Iowa health and wellness plan, the department may implement an alternative plan as specified in the medical assistance state plan or waiver for coverage of the affected population, subject to prior statutory approval of implementation of the alternative plan.
EFFECTIVE DATE.
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This division of this Act, being deemed of immediate importance, takes effect upon enactment.
DIVISION II WORK RULES AND REQUIREMENTS FOR PUBLIC ASSISTANCE PROGRAMS Sec.
PUBLIC ASSISTANCE PROGRAMS — WORK RULES AND REQUIREMENTS ALIGNMENT.
The department of health and human services shall work with the United State department of health and human services and the United States department of agriculture to align the requirements and rules for participants of public assistance programs related to working, including but not limited to rules and requirements related to employment and training for the supplemental nutrition assistance program.
DIVISION III INFORMATION TECHNOLOGY Sec.
217.25 Information technology fund.
249O.5 Program —— premiums.
An information technology fund is created in the state treasury under the control of the department of health and human services.
An individual’s monthly program premium amount shall equal, rounded down to the nearest whole dollar, any of the following:
The fund shall consist of moneys appropriated or transferred to, or deposited in, the fund as provided Senate File 615, p.
a.
4 by law.
If the individual’s verified countable income is less than one hundred fifty percent of the federal poverty level applicable to the individual’s household’s size, zero percent of the individual’s verified countable income.
All moneys deposited or paid into the fund are appropriated to the department of health and human services to be used for information technology systems and related modernization initiatives.
b.
If the individual’s verified countable income is between one hundred fifty percent and two hundred fifty percent of the federal poverty level applicable to the individual’s household’s size, three percent of the individual’s verified countable income.
H 1198.1280 (2) 91 -3- lh/ko 3/5 c.
If the individual’s verified countable income is more than two hundred fifty percent of the federal poverty level applicable to the individual’s household’s size, six percent of the individual’s verified countable income.
Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.
a.
Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys in the fund shall be credited to the fund.
An individual shall report any change in the individual’s countable income to the department.
b.
The department shall utilize the individual’s verified countable income until the individual reports a change in countable income and the change is processed by the department, unless there is good cause for the department’s delay in verifying the change in the individual’s countable income.
c.
A change in an individual’s program premium amount shall be effective the month after the change in the individual’s countable income is reported to and verified by the department.
3.
An individual shall be covered under the program for six consecutive months beginning the first day of the month in which the department approves the individual’s application for the program.
4.
The department shall create a six-month grace period that provides continuous program coverage to an individual following the individual’s temporary loss of employment, or a health crisis that temporarily prevents the individual from continuing employment.
The individual shall be required to continue to pay the program premium based on the individual’s verified countable income during the six-month grace period.
5.
The department may terminate an individual’s program coverage if the individual fails to pay four consecutive months of program premiums.
6.
An individual must pay a program premium in full for any month that program coverage is provided, including a month when a redetermination of coverage is made, a month when continued coverage is requested, and during the period of an eligibility determination appeal.
TRANSFER OF MONEYS.
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Any unobligated or unencumbered moneys remaining in the public assistance modernization fund created in section 239.11, on June 30, 2025, shall be transferred to the information technology fund created in section 217.25, as enacted in this division of this Act.
NEW SECTION.
249O.6 Rules.
The department shall adopt rules pursuant to chapter 17A to H 1198.1280 (2) 91 -4- lh/ko 4/5 administer this chapter.
REPEAL.
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Section 239.11, Code 2025, is repealed.
WORK WITHOUT WORRY PROGRAM —— DEPARTMENT OF HEALTH AND HUMAN SERVICES.
DIVISION IV MEDICAID FOR EMPLOYED PEOPLE WITH DISABILITIES PROGRAM Sec.
1.
7.
The department of health and human services shall submit any waiver request or state plan amendment, or combination thereof, to the centers for Medicare and Medicaid services of the United States department of health and human services as necessary to create a work without worry program in accordance with this Act.
Section 249A.3, subsection 2, paragraph a, subparagraph ( 1), subparagraph division ( a), Code 2025, is amended to read as follows:
2.
(a) As allowed under 42 U.S.C.
Any individual participating in the Medicaid for employed persons with disabilities program when the work without worry program is implemented shall be transferred to and enrolled in the work without worry program.>> 3.
§1396a(a)(10)(A)(ii)(XIII), individuals with disabilities, who are less than sixty-five years of age, who are members of families whose income is less than two hundred fifty percent of the most recently revised official poverty guidelines published by the United States department of health and human services for the family, who have earned income and who are eligible for mandatory medical assistance or optional medical assistance under this section if earnings are disregarded.
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As allowed by 42 U.S.C.
<<Sec.
§1396a(r)(2), unearned income shall also be disregarded in determining whether an individual is eligible for assistance under this subparagraph.
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For the purposes of determining the amount of an individual's resources under this subparagraph and as allowed by 42 U.S.C.
EFFECTIVE DATE.
§1396a(r)(2), a maximum of ten thousand dollars of available resources for an individual and twenty-one thousand dollars of available resources for a couple shall be disregarded, and any additional resources held in a retirement Senate File 615, p.
This division of this Act, being deemed of immediate importance, takes effect upon enactment.>> 4.
5 account, in a medical savings account, or in any other account approved under rules adopted by the department shall also be disrear .
By renumbering as necessary.
2tGCC•« l AMY SINCL"R PAT GRASSLEY President of the Senate Speaker of the House I hereby certify that this bill originated in the Senate and is known as Senate File 615, Ninety-first General Assembly.
______________________________ TUREK of Pottawattamie H 1198.1280 (2) 91 -5- lh/ko 5/5
W.
CHARLES SMITHSON • Approved 2025