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STATE OF IOWA
KIM REYNOLDS
GOVERNOR
June 2,2026 ,
The Honorable Paul Pate
Secretary of State of Iowa
State Capitol Building
LOCAL
Dear Mr. Secretary:
I hereby transmit House File 2782, an Act relating to and making appropriations to the department
of veterans affairs and the department of health and human services, including aging and disability
services, behavioral health, public health, and community access and eligibility^ the medical
assistance program, state supplementary assistance, hawld, and other health-related programs;
family well-being and protection; state-operated specialty care; administration and compliance;
transfers, cash flow, and nonreversions; report on nohreversion of moneys; more options for
maternal support program; reimbursement rates review; mental diseases exclusion waiver; full-
time equivalent dashboard; comprehensive family support program; federal community mental
health services block grant; behavioral health expenditure report; opioid settlement fund;
emergency rules; graduate medical education; and special population nursing facilities; and
including effective date and retroactive applicability provisions.
Houe File 2782 is approved this date with the following exceptions:
• Division XVm involves a federal community mental health services block grant. When I
signed behavioral health system redesign. House File 2673, into law in 2024,1 committed
to building a stronger, more coordinated behavioral health system. With bipartisan support,
we established a comprehensive ^proach to behavioral health prevention, early
intervention, treatment, recovery, and crisis services for all lowans.
Upon enactment, Iowa HHS engaged stakeholders statewide to bring the law's vision to
life. Feedback from providers, law enforcement, legislators, local leaders, individuals, and
families informed both the development of the plan and, on July 1, 2025, the
implementation of Iowa's first statewide behavioral health service system. We chartered a
clear path toward a north star vision: streamlined access, consistent care, stronger
coordination at every level, and reduced administrative burdens for our providers. Through
Behavioral Health District Advisory Councils, monthly virtual Town Hall meetings, and
roundtable conversations, ongoing stakeholder feedback now helps guide our assessment
of progress and outcomes and will inform our future plans.
STATE CAPITOL DES MOINES, IOWA 5.0319 515.281.5211 FAX. 515.725.3527 WWW.GOVERNOR.IOWA.GOV
In 2025, Senate File 626 modernized Iowa's use of federal Mental Health Block Grant
(MHBG) funds. For more than 20 years, 70 percent of MHBG funds were required to pass
directly to Community Mental Health Centers (CMHCs), despite CMHCs not offering, the
fiill range of services needed across the state and the allocation not being tied to need or
outcomes. Senate File 626 removed this passthrough beginning in FY27, allowing Iowa to
focus MHBG investments on areas of high need, expand training for all safety net
providers, and more strategically invest to improve outcomes statewide.
To support the FY27 transition, Iowa HHS adjusted the behavioral health safety net fee
schedule so CMHCs and Certified Community Behavioral Health Clinics (CCBHCs) now
receive 100 percent of Medicaid enhanced CMHC rates, effectively reimbursing at rates
that are 15 to 50 percent higher than other behavioral health providers. Additional funds to
sustain safety net access will continue to flow through the Behavioral Health
Administrative Service Organization (BHASO) contracts to ensure funding is aligned with
Iowa's statewide plan.
Iowa HHS has fully prepared for the changes directed in Senate File 626 and remains
committed to ensuring investments are aligned with local need, achieve the greatest impact,
and comply with federal requirements. Adhering to the framework built by House File
2673 and die intentional planning directed by Senate File 626 will continue to move our
state toward maximizing the impact of all available funding.
Division XX involves the opioid settlement fund. Since I signed House File 1038 following
the 2025 General Assembly, Iowa HHS has worked diligently to establish a competitive,
accessible and fair process for allocation of opioid settlement funds. The process empowers
providers and partners of all types and sizes to clearly and transparently apply for and
receive funding to address the impacts of the opioid crisis in Iowa - without having to hire
a lobbyist to secure an earmark.
After two years of discussion, House File 1038 directed that 75 percent of the state's
ongoiag share of opioid settlement ftinds be allocated to Iowa HHS. The legislation also
required the department to gather local feedback through the local Behavioral Health
District Advisory Councils regarding disbursement of funds, intended outcomes, and
recommendations for future investment and submit a report and recommendations annually
to the legislature. Iowa HHS submitted its first annual report and recommendations to the
legislature in November 2025; that report remains publicly available on the legislative
website.
Since enactment, Iowa HHS has worked proactively to allocate its share of funds swiftly
and directly to synergize effort in communities all across Iowa. Between the passage of the
bill and the end of FY25, the department invested $26M into initiatives identified in the
legislation. By the end of FY26, Iowa HHS anticipates an additional $20M, allocated
through three competitive procurements, will be invested to combat the opioid crisis m
Iowa. Iowa HHS' investments, thus far totaling $46M, have focused on a wide range of
projects including youth prevention, building and training specialized treatment and crisis
response teams, and expanding recovery housing.
The competitive process envisioned is now in place. As directed by the legislature in House
File 1038, work has been established with the direct input of Behavioral Health District
Advisory Councils. To ensure ongoing connection, Behavioral Health District Advisory
Council members assisted in application review for grant funding. This collaborative
approach ensures that the state's investments align with local need, target the most effective
opportunities, and remain fully compliant with the requirements of the opioid settlement
agreement and the process setup by HF1038. In this instance, this project was not awarded
a grant throu^ the competitive process. Iowa HHS will continue to utilize this process to
open additional funding opportunities, reflecting the ongoing and evolving work required
to address the impacts of &e opioid crisis on lowans.
For the above reasons, I disapprove those parts of House File 2782 as specified above, in
accordance with Article m. Section 16, of the Constitution of the State of Iowa. The remainder of
House File 2782 is approved as of this date.
Sincerely, ^ .
Kim Rasiaolds
Governor
cc: Secretary of the Senate
Clerk of the House
WILL MAINTAJ
GENKRAL ASSEMBl.Y
House File 2782
AN ACT
RELATING TO AND MAKING APPROPRIATIONS TO THE DEPARTMENT
OF VETERANS AFFAIRS AND THE DEPARTMENT OF HEALTH AND
HUMAN SERVICES, INCLUDING AGING AND DISABILITY SERVICES,
BEHAVIORAL HEALTH, PUBLIC HEALTH, AND COMMUNITY ACCESS
AND ELIGIBILITY; THE MEDICAL ASSISTANCE PROGRAM, STATE
SUPPLEMENTARY ASSISTANCE, HAWKI, AND OTHER HEALTH-RELATED
PROGRAMS; FAMILY WELL-BEING AND PROTECTION; STATE-OPERATED
SPECIALTY CARE; ADMINISTRATION AND COMPLIANCE; TRANSFERS,
CASH FLOW, AND NONREVERSIONS; REPORT ON NONREVERSION
OF MONEYS; MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM;
REIMBURSEMENT RATES REVIEW; MENTAL DISEASES EXCLUSION
WAIVER; FULL-TIME EQUIVALENT DASHBOARD; COMPREHENSIVE
FAMILY SUPPORT PROGRAM; FEDERAL COMMUNITY MENTAL HEALTH
SERVICES BLOCK GRANT; BEHAVIORAL HEALTH EXPENDITURE REPORT;
OPIOID SETTLEMENT FUND; EMERGENCY RULES; GRADUATE MEDICAL
EDUCATION; AND SPECIAL POPULATION NURSING FACILITIES; AND
INCLUDING EFFECTIVE DATE AND RETROACTIVE APPLICABILITY
PROVISIONS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA;
DIVISION I
DEPARTMENT OF VETERANS AFFAIRS FY 2026-2027
Section 1. DEPARTMENT OF VETERANS AFFAIRS. There is
appropriated from the general fund of the state to the
department of veterans affairs for the fiscal year beginning
July 1, 2026, and ending June 30, 2027, the following amounts.
House File 2782, p. 2
or so much thereof as is necessary, to be used for the purposes
designated:
1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
For salaries, support, maintenance, and miscellaneous
purposes, and for not more than the following full-time
equivalent positions:
$ 1,369,205
FTEs 15.00
2. IOWA VETERANS HOME
For salaries, support, maintenance, and miscellaneous
purposes:
$ 8,145,736
a. The Iowa veterans home billings involving the department
of health and human services shall be submitted to the
department on at least a monthly basis.
b. The Iowa veterans home expenditure report shall be
submitted monthly to the general assembly.
3. HOME OWNERSHIP ASSISTANCE PROGRAM
For transfer to the Iowa finance authority for the
continuation of the home ownership assistance program for
persons who are or were eligible members of the armed forces
of the United States or eligible service members pursuant to
section 16.54:
$ 2,200,000
DIVISION II
AGING AND DISABILITY SERVICES — FY 2026-2027
Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES — AGING
AND DISABILITY SERVICES. There is appropriated from the
general fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2026, and ending
June 30, 2027, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For aging programs for the department of health and human
services and area agencies on aging to provide citizens of
Iowa who are 60 years of age and older with case management;
for Iowa's aging and disabilities resource centers; for the
return to community program; for the purposes of chapter 231E;
to administer the prevention of elder abuse, neglect, and
exploitation program pursuant to section 231.56A, in accordance
House Pile 2782, p. 3
with the requirements of the federal Older Americans Act of
1965, 42 U.S.C. §3001 et seq., as amended; for the operation
of the dependent adult abuse services program pursuant to
chapter 235B; for matching funding for programs to enable
persons with severe physical or mental disabilities to function
more independently; for costs associated with centers for
independent living; and for other services which may include
but are not limited to adult day care, respite care, chore,
information and assistance, and material aid; for information
and options counseling for persons with disabilities; and
for salaries, support, administration, maintenance, and
miscellaneous purposes, and for not more than the following
full-time equivalent positions;
$ 19,379,531
PTEs 101,00
1. Moneys appropriated in this section may be used to
supplement federal moneys received under federal regulations.
To receive moneys appropriated in this section, a local area
agency on aging shall match the moneys with moneys from other
sources according to rules adopted by the department. Moneys
appropriated in this section may be used for services not
specifically enumerated in this section only if approved by the
department as part of an area agency on aging's area plan.
2. Of the moneys appropriated in this section, $949,282
is allocated to be used for the comprehensive family support
program created in section 231,80 as enacted under this Act,
3. Of the moneys appropriated in this section, $33,632
is allocated to be used to build community capacity through
the coordination and provision of training opportunities in
accordance with the consent decree of Conner v. Branstad, No.
4-86-CV-30871 (S.D. Iowa, July 15, 1994),
DIVISION III
BEHAVIORAL HEALTH — FY 2026-2027
Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —
BEHAVIORAL HEALTH, There is appropriated from the general fund
of the state to the department of health and human services for
the fiscal year beginning July 1, 2026, and ending June 30,
2027, the following amount, or so much thereof as is necessary,
to be used for the purposes designated:
House File 2782, p. 4
For behavioral health prevention, education, early
intervention, treatment, recovery support, and crisis
services in order to support statewide access to treatment for
behavioral health conditions; stabilization and mitigation of
behavioral health crises; and recovery for individuals and
families impacted by behavioral health conditions. Activities
shall align with accepted best practice guidance standards for
behavioral health including those published by the centers for
disease control and prevention of the United States department
of health and human services, and the substance abuse and
mental health services administration of the United States
department of health and human services, for health promotion;
universal, selective, and indicated prevention; treatment; and
recovery services and supports; and shall include a 24-hour
helpline, public information resources, professional training,
youth prevention, program evaluation, and efforts at the state
and local levels, and for not more than the following full-time
equivalent positions:
$ 23,127,121
FTEs 70.00
1. Of the moneys appropriated in this section, $300,000
is allocated to support the work of the children's behavioral
health system including evidence-based behavioral health
prevention, treatment, and recovery services and supports for
children and their families.
2. Of the moneys appropriated in this section, $950,000
is allocated for an integrated substance use disorder managed
care system. The department shall maintain the level of mental
health and substance use disorder treatment services provided
by the managed care contractors, and shall take the steps
necessary to continue the federal waivers as needed to maintain
the level of services.
Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES — SPORTS
WAGERING RECEIPTS FUND. There is appropriated from the
sports wagering receipts fund created in section 8.571, to the
department of health and human services for the fiscal year
beginning July 1, 2026, and ending June 30, 2027, the following
amount, or so much thereof as is necessary, to be used for
behavioral health prevention, education, early intervention.
House Pile 2782, p. 5
treatment, recovery support, and crisis services in order to
support statewide access to treatment for behavioral health
conditions; stabilization and mitigation of behavioral health
crises; and recovery for individuals and families impacted by
behavioral health conditions:
$ 1,750,000
DIVISION IV
PUBLIC HEALTH — FY 2026-2027
Sec. 5. DEPARTMENT OP HEALTH AND HUMAN SERVICES — PUBLIC
HEALTH. There is appropriated from the general fund of the
state to the department of health and human services for the
fiscal year beginning July 1, 2026, and ending June 30, 2027,
the following amount, or so much thereof as is necessary, to be
used for the purposes designated:
For programs that support health promotion, protect the
health and safety of the public, conduct disease surveillance
and investigation to reduce the incidence of morbidity and
mortality, serve individuals with chronic conditions including
but not limited to cancer, support the Iowa donor registry as
specified in section 142C.18, and strengthen the health care
delivery system and workforce to improve health outcomes for
all lowans, and for not more than the following full-time
equivalent positions:
$ 21,168,369
PTEs 348.60
1. Of the moneys appropriated in this section, $191,000
is allocated to the university of Iowa hospitals and clinics
to administer a child vision screening program through
continuation of an existing contract. The program shall submit
a report to the department regarding the use of funds allocated
under this subsection. The report shall include the objectives
and results for the program year including the target
population and how the funds allocated assisted the program in
meeting the objectives; the number, age, and location within
the state of individuals served; the type of services provided
to the individuals served; the distribution of moneys based on
the services provided; and the continuing needs of the program.
2. Of the moneys appropriated in this section, $144,000 is
allocated for the public purpose of allowing the department
House File 2782, p. 6
to continue an existing contract with an existing affiliated
organization to provide education, client-centered programs,
and client and family support, for people living with epilepsy
and their families. The moneys allocated in excess of $50,000
shall be matched dollar for dollar by the existing affiliated
organization. Moneys under this section shall be distributed
in their entirety on July 1, 2026, for the purpose specified.
3. Of the moneys appropriated in this section, the following
amounts are allocated to the department of health and human
services to be used as follows to support the goals of
increased access, health system integration, and engagement:
a. $600,000 for distribution to a nonprofit organization
that established the first statewide drug donation repository
for continuation of the pharmaceutical infrastructure for
safety net providers established as described in 2007 Iowa
Acts, chapter 218, section 108, and for the prescription drug
donation repository program established in chapter 135M.
Moneys under this paragraph shall be distributed in their
entirety on July 1, 2026, for the purpose specified.
b. $374,000 for distribution to free clinics, as defined in
section 135.24, and a nonprofit organization that facilitates
the initiation, operation, and collaboration of free clinics
for necessary infrastructure, statewide coordination, provider
recruitment, service delivery, and provision of assistance to
patients in securing a medical home inclusive of oral health
care. Of the moneys allocated, $40,000 shall be used to lower
fees associated with using an electronic prescribing system.
Moneys under this paragraph shall be distributed in their
entirety on July 1, 2026, for the purpose specified.
c. $25,000 for distribution to an organization that raises
awareness about issues related to rural health clinics for
necessary infrastructure and service delivery transformation.
Moneys under this paragraph shall be distributed in their
entirety on July 1, 2026, for the purpose specified.
4. Of the moneys appropriated in this section, $400,000
is allocated for rural psychiatric residencies for residents
selected on or before June 30, 2026.
5. Of the moneys appropriated in this section, $20,000 is
allocated to make radon test kits available, free of charge.
House File 2782, p. 7
to homeowners and renters in the state. The department shall
provide a link on the department's internet site for homeowners
and renters in the state to order radon test kits.
6. Of the moneys appropriated in this section, $1,500,000 is
allocated for awarding grants for medical residency programs in
the state that meet the following criteria:
a. The medical residency program is not related to the
practice of family medicine.
b. The medical residency program is not located in a county
that has a population of one hundred fifty thousand or more
based on the most recent federal decennial census, and in which
the main campus of an institution of higher learning governed
by the state board of regents is located.
7. The university of Iowa hospitals and clinics under
the control of the state board of regents shall not receive
indirect costs from the moneys appropriated in this section.
The university of Iowa hospitals and clinics billings to the
department shall be, at a minimum, on a quarterly basis.
DIVISION V
COMMUNITY ACCESS AND ELIGIBILITY — CHILD SUPPORT SERVICES —
TANF — FY 2026-2027
Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES — COMMUNITY
ACCESS AND ELIGIBILITY. There is appropriated from the
general fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2026, and ending
June 30, 2027, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
To be used for salaries, support, maintenance, and
miscellaneous purposes and for family investment program (FIP)
assistance in accordance with chapter 239B, and for other costs
associated with providing needs-based benefits or assistance
including but not limited to maternal and child health, oral
health, obesity prevention, the promoting independence and
self-sufficiency through employment, job opportunities and the
basic skills (PROMISE JOBS) program, supplemental nutrition
assistance program (SNAP) employment and training, the FIP
diversion program, family planning, rent reimbursement,
and eligibility determinations for medical assistance, food
assistance, and the children's health insurance program, and
House File 2782, p. 8
for not more than the following full-time equivalent positions:
$ 76,371,516
PTEs 883.90
1. Of the child support collections assigned under PIP,
the federal share of the child support collections shall be
credited to the child support services appropriation made in
this division of this Act. Of the remainder of the child
support collections assigned under PIP, a portion shall be
credited to community access and eligibility, and the remaining
moneys may be used to increase recoveries, to sustain cash flow
in the collection services center refund account as provided in
section 252B.13A, or for technology needs. If child support
collections assigned under PIP are greater than estimated or
are otherwise determined not to be required for maintenance of
efforts, the state share of either amount is appropriated to
the department for child support services as described in this
division of this Act, or may be transferred to or retained in
the collection services center refund account.
2. Of the moneys appropriated in this section, $3,075,000 is
allocated for continuation of the department's initiative to
provide for adequate developmental surveillance and screening
during a child's first five years. The moneys shall first be
used to fully fund the current participating counties to ensure
that those counties are fully operational, with the remaining
moneys to be used for expanding participation to additional
counties. Pull implementation and expansion shall include
enhancing the scope of the initiative through collaboration
with child health specialty clinics to promote the use of
developmental surveillance and screening to support healthy
child development through early identification and response to
biomedical and social determinants of healthy development by
providing practitioner consultation and continuous improvement
through training and education, particularly for children
with behavioral conditions and needs. The department shall
also collaborate with the Medicaid program and child health
specialty clinics to assist in coordinating the activities
of the first five initiative into the establishment of
patient-centered medical homes developed to improve health
quality and population health while reducing health care costs.
House File 2782, p. 9
To the maximum extent possible, moneys allocated in this
subsection shall be utilized as matching moneys for Medicaid
program reimbursement.
3. Of the moneys appropriated in this section, $1,145,102 is
allocated to the Iowa commission on volunteer service created
in section 15H.2 for programs and grants.
4. The university of Iowa hospitals and clinics under
the control of the state board of regents shall not receive
indirect costs from the moneys appropriated in this section.
The university of Iowa hospitals and clinics billings to the
department shall be, at a minimum, on a quarterly basis.
Sec. 7. DEPARTMENT OF HEALTH AND HUMAN SERVICES — CHILD
SUPPORT SERVICES. There is appropriated from the general fund
of the state to the department of health and human services for
the fiscal year beginning July 1, 2026, and ending June 30,
2027, the following amount, or so much thereof as is necessary,
to be used for the purposes designated:
For child support services, including salaries, support,
maintenance, and miscellaneous purposes, and for not more than
the following full-time equivalent positions:
$ 15,644,114
FTEs 464.00
1. Federal access and visitation grant moneys shall be used
for services designed to increase compliance with the child
access provisions of court orders, including but not limited to
neutral visitation sites and mediation services.
2. Moneys appropriated in this section may be used
throughout the fiscal year in the manner necessary for
cash flow management. For cash flow management under this
subsection, the department may temporarily draw more than the
amount appropriated provided the amount appropriated is not
exceeded at the close of the fiscal year.
Sec. 8. DEPARTMENT OF HEALTH AND HUMAN SERVICES —
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT. There is
appropriated from the special fund created in section 8.41 to
the department of health and human services for the fiscal year
beginning July 1, 2026, and ending June 30, 2027, from moneys
received under the federal temporary assistance for needy
families (TANF) block grant pursuant to the federal Personal
House File 2782, p. 10
Responsibility and Work Opportunity Reconciliation Act of 1996,
Pub. L. No. 104-193, and successor legislation, including TANF
block grant moneys received in any prior fiscal year that
were deposited in the special fund and remain unencumbered
or unobligated on June 30, 2026, the following amounts, or
so much thereof as is necessary, to be used for the purposes
designated:
1. For community access and eligibility:
$ 12,566,312
2. For community access and eligibility to provide
pregnancy prevention grants on the condition that family
planning services are funded:
$ 1,913,203
Pregnancy prevention grants shall be awarded to programs
in existence on or before July 1, 2026, if the programs have
demonstrated positive outcomes. Grants shall be awarded
to pregnancy prevention programs developed after July 1,
2026, if the programs are based on existing models that have
demonstrated positive outcomes. Grants must comply with the
requirements provided in 1997 Iowa Acts, chapter 208, section
14, subsections 1 and 2, including the requirement that a
program awarded a grant must emphasize sexual abstinence.
Priority in awarding grants shall be given to programs
that serve areas of the state which demonstrate the highest
percentage of unplanned pregnancies of females of childbearing
age within the geographic area to be served by the grant.
3. To meet one of the four purposes of TANF as specified
in 45 C.F.R. §260.20, including by modernizing the program
to promote economic mobility and self-sufficiency, ensuring
that families are able to overcome benefit cliffs, encouraging
healthy families, and streamlining service delivery to reduce
duplication:
$ 25,000,000
4. For early intervention and supports for child abuse
prevention and the family development and self-sufficiency
(FaDSS) grant program in accordance with section 216A.107:
$ 3,013,980
5. For accountability, compliance, program integrity,
technology needs, and other resources necessary to meet
House File 2782, p. 11
federal and state reporting, tracking, and case management
requirements, and other departmental needs:
$ 3,533,647
6. For state child care assistance:
$ 42,281,826
7. For child protective services:
$ 65,364,100
DIVISION VI
MEDICAL ASSISTANCE PROGRAM — STATE SUPPLEMENTARY ASSISTANCE —
HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED
PROGRAMS — FY 2026-2027
Sec. 9. DEPARTMENT OF HEALTH AND HUMAN SERVICES — MEDICAL
ASSISTANCE PROGRAM, STATE SUPPLEMENTARY ASSISTANCE, AND HEALTHY
AND WELL KIDS IN IOWA PROGRAM. There is appropriated from the
general fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2026, and ending
June 30, 2027, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For medical assistance program reimbursement and associated
costs as specifically provided in the reimbursement
methodologies in effect on June 30, 2026, except as otherwise
expressly authorized by law, consistent with options under
federal law and regulations, and contingent upon receipt of
approval from the office of the governor of reimbursement for
each abortion performed under the medical assistance program;
for the state supplementary assistance program; for the health
insurance premium payment program; and for maintenance of
the healthy and well kids in Iowa (Hawki) program pursuant
to chapter 5141, including supplemental dental services,
for receipt of federal financial participation under Tit.
XXI of the federal Social Security Act, which creates the
children's health insurance program; and for other specified
health-related programs:
$ 1,992,550,706
1. Of the moneys appropriated in this section,
$1,919,596,113 is allocated for medical assistance program
reimbursement and associated costs. Of the moneys allocated
in this subsection, $3,383,880 shall be used for program
administration, outreach, and enrollment activities of the
House File 2782, p. 12
state family planning services program pursuant to section
217.41B, and of this amount, the department may use $200,000
for administrative expenses.
2. lowans support reducing the number of abortions
performed in our state. Moneys appropriated under this section
shall not be used for abortions, unless otherwise authorized
under this section.
3. The provisions of this section relating to abortions
shall also apply to the Iowa health and wellness plan created
pursuant to chapter 249N.
4. Of the moneys appropriated in this section, $4,479,762 is
allocated for the state supplementary assistance program.
5. Of the moneys appropriated in this section, $68,474,831
is allocated for maintenance of the Hawki program pursuant
to chapter 5141, including supplemental dental services, for
receipt of federal financial participation under Tit. XXI of
the federal Social Security Act, which creates the children's
health insurance program.
Sec. 10. DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH
PROGRAM OPERATIONS. There is appropriated from the general
fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2026, and ending
June 30, 2027, the following amount, or so much thereof as is
necessary, to be used for the purposes designated;
For health program operations and the autism support program
under section 225D.2, and for not more than the following
full-time equivalent positions;
$ 40,342,766
FTEs 97.00
1. The department of inspections, appeals, and licensing
shall provide all state matching moneys for survey and
certification activities performed by the department of
inspections, appeals, and licensing. The department of health
and human services shall be solely responsible for distributing
the federal matching moneys for such activities.
2. Of the moneys appropriated in this section, a sufficient
amount is allocated for the administration of the health
insurance premium payment program, including salaries, support,
maintenance, and miscellaneous purposes.
House Pile 2782, p. 13
3. Of the moneys appropriated in this section, $750,000 is
allocated for a nonprofit organization that provides access
to emergency poison information and treatment. Pursuant to
the directive under 2014 Iowa Acts, chapter 1140, section
102, the federal matching moneys available to the nonprofit
organization from the department under the federal Children's
Health Insurance Program Reauthorization Act of 2009 shall be
subject to the federal administrative cap rule of 10 percent
applicable to moneys provided under Tit. XXI of the federal
Social Security Act, and shall be included in the department's
calculations of the cap.
4. Unless otherwise provided by law, if a contract for
services provided under this section initially entered into
during the fiscal year beginning July 1, 2026, and ending
June 30, 2027, provides for an annual increase of the cost of
services provided under the contract, the annual increase shall
not exceed the amount by which the consumer price index for
all urban consumers increased during the immediately preceding
calendar year. This subsection does not affect a contract
entered into on or before June 30, 2026, that is for a term of
more than one year.
Sec. 11, DEPARTMENT OF HEALTH AND HUMAN SERVICES
PHARMACEUTICAL SETTLEMENT ACCOUNT, There is appropriated
from the pharmaceutical settlement account created in section
249A,33 to the department of health and human services for the
fiscal year beginning July 1, 2026, and ending June 30, 2027,
the following amount, or so much thereof as is necessary, to be
used for the purposes designated:
Notwithstanding any provision of law to the contrary, to
supplement the appropriation made in this Act from the general
fund of the state for health program operations under the
medical assistance program for the same fiscal year:
$ 234,193
Sec, 12. DEPARTMENT OF HEALTH AND HUMAN SERVICES QUALITY
ASSURANCE TRUST FUND,
1. Notwithstanding any provision of law to the contrary, and
subject to the availability of moneys, there is appropriated
from the quality assurance trust fund created in section 249L,4
to the department of health and human services for the fiscal
House File 2782, p. 14
year beginning July 1, 2026, and ending June 30, 2027, the
following amount, or so much thereof as is necessary, for the
purposes designated:
To supplement the appropriation made in this Act from the
general fund of the state to the department of health and human
services for medical assistance for the same fiscal year:
$111,216,205
2. Notwithstanding section 249L.4, subsection 2, after the
appropriation in subsection 1, any moneys remaining in the
quality assurance trust fund for the fiscal year beginning
July 1, 2026, and ending June 30, 2027, are appropriated to
the department of health and human services to supplement the
appropriation made in this Act from the general fund of the
state for the medical assistance program for the same fiscal
year.
Sec. 13. DEPARTMENT OF HEALTH AND HUMAN SERVICES — HOSPITAL
HEALTH CARE ACCESS TRUST FUND.
1. Notwithstanding any provision of law to the contrary, and
subject to the availability of moneys, there is appropriated
from the hospital health care access trust fund created in
section 249M.4, to the department of health and human services
for the fiscal year beginning July 1, 2026, and ending June 30,
2027, the following amount, or so much thereof as is necessary,
for the purposes designated:
To supplement the appropriation made in this Act from the
general fund of the state to the department of health and human
services for medical assistance for the same fiscal year:
$ 33,920,554
2. Notwithstanding section 249M.4, subsection 2, after
the appropriation in subsection 1, any moneys remaining in
the hospital health care access trust fund for the fiscal
year beginning July 1, 2026, and ending June 30, 2027, are
appropriated to the department of health and human services to
supplement the appropriation made in this Act from the general
fund of the state for the medical assistance program for the
same fiscal year.
Sec. 14. DEPARTMENT OF HEALTH AND HUMAN SERVICES —
BEHAVIORAL HEALTH FUND. Notwithstanding section 225A.7,
subsection 2, and subject to the availability of moneys, there
House File 2782, p. 15
is appropriated from the behavioral health fund established in
section 225A.7, to the department of health and human services
for the fiscal year beginning July 1, 2026, and ending June 30,
2027, the following amount, or so much thereof as is necessary,
for the purposes designated:
To supplement the appropriation made in this Act from the
general fund of the state to the department of health and human
services for medical assistance for the fiscal year beginning
July 1, 2026, and ending June 30, 2027:
$ 5,580,938
Sec. 15. REIMBURSEMENT RATES.
1. Reimbursement for medical assistance, state
supplementary assistance, and social service providers and
services reimbursed under the purview of the department of
health and human services shall remain at the reimbursement
rate in effect on June 30, 2026, or shall be determined
pursuant to the reimbursement methodology in effect on June 30,
2026, with the exception of the following:
a. If reimbursement is otherwise negotiated by contract or
pursuant to an updated fee schedule.
b. As otherwise provided in this section.
2. a. (1) Notwithstanding any provision of law to the
contrary, for the fiscal year beginning July 1, 2026, and
ending June 30, 2027, the department of health and human
services shall reimburse case-mix nursing facility rates based
on the methodology in effect on June 30, 2026.
(2) July 1, 2025, through December 31, 2025, the department
of health and human services shall calculate each nursing
facility's case-mix index for rates effective July 1, 2026.
(3) January 1, 2026, through June 30, 2026, the department
of health and human services shall calculate each nursing
facility's case-mix index for rates effective January 1, 2027.
(4) All nursing facility rate adjustments under this
paragraph shall be budget neutral.
b. For the fiscal year beginning July 1, 2026, $1,167,867
shall be used to increase to the extent possible reimbursement
rates for ambulatory surgical centers compared to rates in
effect on June 30, 2026.
c. For the fiscal year beginning July 1, 2026, $3,000,000
House File 2782, p. 16
shall be used to increase to the extent possible, compared
with rates in effect on June 30, 2026, reimbursement rates for
providers of Hedicaid home and community-based services waiver
services used most frequently by elderly waiver recipients
including attendant care, homemaker, and assisted living
services.
d. (1) Adjustments to Medicaid reimbursement rates
developed using cost reports shall be applied starting on the
effective date specified in the applicable rate letter issued
to a provider.
(2) Minimum Medicaid reimbursement rates for all provider
and service types shall be no lower than the reimbursement
rates established in the department's minimum fee schedule.
(3) Any increase in a Medicaid reimbursement rate specified
under this section shall be effective October 1, 2026.
DIVISION VII
FAMILY WELL-BEING AND PROTECTION — FY 2026-2027
Sec. 16. DEPARTMENT OF HEALTH AND HUMAN SERVICES — STATE
CHILD CARE ASSISTANCE. There is appropriated from the general
fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2026, and ending
June 30, 2027, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For state child care assistance in accordance with sections
237A.13 and 237A.14, and for not more than the following
full-time equivalent positions:
$ 32,723,000
FTEs 53.00
1. If the appropriation made for purposes of the state child
care assistance program for the fiscal year is determined to
be insufficient, it is the intent of the general assembly to
appropriate sufficient moneys for the fiscal year to avoid
application of waiting list requirements.
2. A portion of the state match for the federal child care
and development block grant shall be provided as necessary to
meet federal matching moneys requirements through the state
general fund appropriation made for child development grants
and other programs for at-risk children in section 279.51.
Sec. 17. DEPARTMENT OF HEALTH AND HUMAN SERVICES — EARLY
House File 2782, p. 17
INTERVENTION AND SUPPORTS. There is appropriated from the
general fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2026, and ending
June 30, 2027, the following amount, or so much thereof as is
necessary, to be used for the purposes designated;
For promotion of optimum health status for children and
adolescents from birth through 21 years of age, and for
families, and for not more than the following full-time
equivalent positions:
$ 36,495,203
FTEs 28.00
1. Of the moneys appropriated in this section, not more than
$734,000 is allocated for the healthy opportunities for parents
to experience success (HOPES) — healthy families Iowa (HFI)
program established pursuant to section 135.106.
2. Of the moneys appropriated in this section, $4,313,854
is allocated for the FaDSS grant program, and not more
than 5 percent of the allocated moneys shall be used for
administration of the grant program.
3. Of the moneys appropriated in this section, $29,256,799
shall be deposited in the early childhood Iowa fund created in
section 2561.11.
4. Of the moneys appropriated in this section, $1,493,299 is
allocated for program administration and provision of pregnancy
support services through the more options for maternal support
program pursuant to section 217.41C.
Sec. 18, DEPARTMENT OF HEALTH AND HUMAN SERVICES — CHILD
PROTECTIVE SERVICES. There is appropriated from the general
fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2026, and ending
June 30, 2027, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For child, family, and adoption services, and for salaries,
support, maintenance, and miscellaneous purposes, and for not
more than the following full-time equivalent positions:
$164,527,690
FTEs 977.00
1. Based on client need, a portion of the moneys
appropriated in this section may be used to provide other
House File 2782, p. 18
resources required to support family preservation, emergency
client need, or family reunification efforts.
2. Of the moneys appropriated in this section, a sufficient
amount is allocated for foster family care, group foster care
maintenance and services, shelter care, child welfare emergency
services, qualified residential treatment programs, supervised
apartment living contracts, and for medical assistance program
reimbursement and associated costs.
3. Federal moneys received by the state during the fiscal
year beginning July 1, 2026, as the result of the expenditure
of state moneys appropriated during a previous state fiscal
year for a service or activity funded under this section,
are appropriated to the department to be used as additional
moneys for services and purposes provided under this section.
Notwithstanding section 8.33, moneys appropriated under this
subsection that remain unencumbered or unobligated at the close
of the fiscal year shall not revert but shall remain available
for the purposes designated until the close of the succeeding
fiscal year.
4. a. Of the moneys appropriated in this section, $748,000
is allocated for the payment of the expenses of court-ordered
services provided to children who are under the supervision
of the department, which expenses are a charge upon the state
pursuant to section 232.141, subsection 4.
b. Notwithstanding chapter 232 or any other provision of
law to the contrary, a district or juvenile court shall not
order any service which is a charge upon the state pursuant to
section 232.141, subsection 4, if the moneys allocated under
paragraph ^^a" for court-ordered services are insufficient to
pay for the service.
5. Of the moneys appropriated in this section, $4,359,500
is allocated for the preparation for adult living program
established pursuant to section 234.46.
6. Of the moneys appropriated in this section, a portion may
be used for family-centered services for purposes of complying
with the federal Family First Prevention Services Act of 2018,
Pub. L. No. 115-123, and successor legislation.
7. a. Of the moneys appropriated in this section,
$38,414,178 is allocated for adoption subsidy payments and
House File 2782, p. 19
related costs.
b. Any moneys remaining after the allocation under
paragraph ^^a" is designated and allocated as state savings
resulting from implementation of the federal Fostering
Connections to Success and Increasing Adoptions Act of 2008,
Pub. L. No. 110-351, and successor legislation, as determined
in accordance with 42 U.S.C. S673(a)(8), and shall be used for
post-adoption services and for other purposes allowed under
those federal Acts and regulations, and Tit. IV-B or Tit. IV-E
of the federal Social Security Act.
8. Of the moneys appropriated in this section, a sufficient
amount is allocated to support training needs for child welfare
providers and to address disproportionality within the child
welfare system.
9. Of the moneys appropriated in this subsection,
$1,658,000 shall be allocated for child protection centers
located in Iowa pursuant to the child protection center grant
program under section 135.118. The grant amounts under the
program shall be equalized so that each center receives a
uniform base amount of $245,000, and the remaining moneys
are awarded through a funding formula based upon the volume
of children served by a center. To increase access to child
protection center services for children in rural areas, the
funding formula for awarding the remaining moneys shall provide
for awarding an enhanced amount to eligible grantees to develop
and maintain satellite centers in underserved regions of the
state.
10. Of the moneys appropriated in this subsection, up to
$227,000 shall be used for the public purpose of continuing a
grant to a nonprofit human services organization that provides
services to individuals and families in multiple locations in
southwest Iowa and Nebraska, for support of a project providing
immediate, sensitive support and forensic interviews, medical
exams, needs assessments, and referrals for victims of child
abuse and their nonoffending family members.
11. If a separate funding source is available that reduces
the need for state moneys within an allocation under this
section, the allocated state moneys may be redistributed to
other allocations under this section for the same fiscal year.
House File 2782, p. 20
DIVISION VIII
STATE-OPERATED SPECIALTY CARE — FY 2026-2027
Sec. 19. DEPARTMENT OF HEALTH AND HUMAN SERVICES —
STATE-OPERATED SPECIALTY CARE. There is appropriated from the
general fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2026, and ending
June 30, 2027, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For salaries, support, maintenance, and miscellaneous
purposes at institutions under the jurisdiction of the
department of health and human services, and for not more than
the following full-time equivalent positions:
$100,225,768
FTEs 1,304.45
1. The department shall utilize the moneys appropriated in
this section as necessary to maximize bed capacity and to most
effectively meet the needs of the individuals served.
2. Of the moneys appropriated in this section, the following
amounts are allocated to each institution as follows:
a. For the state mental health institute at Cherokee:
$ 19,878,962
b. For the state mental health institute at Independence:
$ 23,760,205
c. For the civil commitment unit for sexual offenders at
Cherokee:
$ 23,272,111
d. For the state resource center at Woodward:
$ 12,567,092
e. For the state training school at Eldora:
$ 19,805,171
f. For outstanding obligations related to workers'
compensation, the sick leave insurance program, unemployment,
and other costs related to the closure of the state resource
center at Glenwood:
$ 942,227
DIVISION IX
ADMINISTRATION AND COMPLIANCE — FY 2026-2027
Sec. 20. DEPARTMENT OF HEALTH AND HUMAN SERVICES —
ACCOUNTABILITY, COMPLIANCE, AND PROGRAM INTEGRITY. There
House File 2782, p. 21
is appropriated from the general fund of the state to the
department of health and human services for the fiscal year
beginning July 1, 2026, and ending June 30, 2027, the following
amount, or so much thereof as is necessary, to be used for the
purposes designated:
For accountability, compliance, and program integrity,
including salaries, support, maintenance, and miscellaneous
purposes, and for not more than the following full-time
equivalent positions:
$ 23,152,404
FTEs 382.00
1. Of the moneys appropriated in this section, $2,602,312
is allocated for foster care review and the court appointed
special advocate program, including for salaries, support,
maintenance, and miscellaneous purposes.
2. Of the moneys appropriated in this section, $1,148,959
is allocated for the office of long-term care ombudsman
for salaries, support, administration, maintenance, and
miscellaneous purposes.
DIVISION X
TRANSFERS, CASH FLOW, AND NONREVERSIONS — FY 2026-2027
Sec. 21. DEPARTMENT OF HEALTH AND HUMAN SERVICES —
TRANSFERS AND CASH FLOW.
1. Notwithstanding any provision of law to the contrary,
the department of health and human services may transfer moneys
appropriated in this Act to support continuing alignment
efforts, to maximize federal support in accordance with the
department's federal costs allocation plan, and to secure
resources necessary to implement and administer the services
for which moneys are appropriated. The department shall report
any transfers made pursuant to this subsection to the general
assembly. On or before December 1, 2026, the department shall
report to the chairpersons of the health and human services
appropriations subcommittee the allocations and full-time
equivalent positions for each division of the department for
the fiscal year beginning July 1, 2027.
2. If, due to ongoing cost management efforts,
appropriations under this Act for the Medicaid program
exceed the associated costs for the Medicaid program for the
House File 2782, p. 22
fiscal year, the department may transfer any savings to the
appropriations made in this Act for health program operations,
or for accountability, compliance, and program integrity,
to defray the costs associated with ongoing cost management
efforts.
3. Notwithstanding any provision of law to the contrary,
the department may transfer moneys appropriated under this Act
for child protective services to pay the nonfederal share costs
of services reimbursed under the medical assistance program,
state child care assistance program, or family investment
program which are provided to children who would otherwise
receive services paid by the appropriation for child protective
services.
4. The department may transfer moneys from the temporary
assistance for needy families block grant to the federal social
services block grant appropriation, and to the child care and
development block grant appropriation, in accordance with
federal law.
5. To the extent the department determines that moneys
appropriated under this Act, or allocated for a specific
purpose under this Act, will remain unencumbered or unobligated
at the close of the fiscal year, such unencumbered or
unobligated moneys may be used in the same fiscal year for any
other purpose for which the appropriated moneys may be used, or
for any other allocation within the same appropriation.
Sec. 22. DEPARTMENT OF HEALTH AND HUMAN SERVICES —
NONREVERSIONS.
1. Notwithstanding section 8.33, moneys appropriated under
this Act from the general fund of the state and the temporary
assistance for needy families block grant to the department of
health and human services for the fiscal year beginning July
1, 2026, and ending June 30, 2027, for the purposes of the
FaDSS grant program, 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.
2. Notwithstanding section 8.33, of the moneys appropriated
under this Act from the general fund of the state, the quality
assurance trust fund, and the hospital health care access trust
House File 2782, p. 23
fund to the department of health and human services for the
fiscal year beginning July 1, 2026, and ending June 30, 2027,
for the purposes of the medical assistance program, the amount
in excess of actual expenditures for the medical assistance
program that remains unencumbered or unobligated at the close
of the fiscal year shall not revert but shall remain available
for expenditure for the medical assistance program until the
close of the succeeding fiscal year.
3. Notwithstanding section 8.33, and notwithstanding the
nonreversion amount limitation specified for state resource
centers in section 222.92, subsection 4, moneys appropriated
under this Act from the general fund of the state to the
department of health and human services for the fiscal year
beginning July 1, 2025, and ending June 30, 2027, for the
purposes of state-operated specialty care, 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 for subsequent fiscal years.
4. Notwithstanding section 8.33, moneys appropriated in
this Act from the general fund of the state to the department
of health and human services for the fiscal year beginning July
1, 2026, and ending June 30, 2027, for the Iowa commission
on volunteer service for programs and grants, 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 for subsequent fiscal years.
5. Notwithstanding section 8.33, moneys appropriated under
this Act from the general fund of the state to the department
of health and human services for the fiscal year beginning
July 1, 2026, and ending June 30, 2027, and allocated for
rural psychiatric residencies, 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.
6. Notwithstanding section 8.33, moneys appropriated under
this Act from the general fund of the state to the department
of health and human services for the fiscal year beginning July
1, 2026, and ending June 30, 2027, and allocated for adoption
subsidy payments and related costs, or for post-adoption
House File 2782, p. 24
services and allowable related purposes, that remain
unencumbered or unobligated at the close of the fiscal year
shall not revert but shall remain available for expenditure for
adoption reinvestment obligations.
7. Notwithstanding section 8.33, moneys appropriated under
this Act from the general fund of the state to the department
of health and human services for the fiscal year beginning July
1, 2026, and ending June 30, 2027, and allocated for child
protective services, 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.
DIVISION XI
REPORT ON NONREVERSION OF MONEYS
Sec. 23. DEPARTMENT OF HEALTH AND HUMAN SERVICES — REPORT
ON NONREVERSION OF MONEYS. The department of health and
human services shall report the expenditure of any moneys for
which nonreversion authorization was provided for the fiscal
year beginning July 1, 2026, and ending June 30, 2027, to the
general assembly on a quarterly basis beginning October 1,
2027.
DIVISION XII
EMERGENCY RULES
Sec. 24. DEPARTMENT OF HEALTH AND HUMAN SERVICES —
EMERGENCY RULES.
1. If necessary to comply with federal requirements,
including time frames, the department of health and human
services shall adopt administrative rules under section 17A.4,
subsection 3, and section 17A.5, subsection 2, paragraph ^''b",
to implement the applicable provisions of this Act. The rules
shall be effective immediately upon filing unless a later date
is specified in the rules. Any rules adopted in accordance
with this section shall also be published as a notice of
intended action as provided in section 17A.4.
2. If the department of health and human services adopts
emergency rules in accordance with this section, or as
otherwise directed or authorized by state law, and the rules
will result in an increase in expenditures beyond the amount
anticipated in the budget for the fiscal year, or if the
House File 2782, p. 25
expenditures were not addressed in the budget for the fiscal
year, the department shall notify the general assembly and the
department of management concerning the rules and the increase
in expenditures. The notification shall be provided at least
thirty calendar days prior to the date notice of the rules
is submitted to the administrative rules coordinator and the
administrative code editor,
DIVISION XIII
MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM APPROPRIATION
NONREVERSION
Sec. 25. 2025 Iowa Acts, chapter 169, section 27, is amended
by adding the following new subsection:
NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
appropriated from the general fund of the state to the
department of health and human services for the fiscal year
beginning July 1, 2025, and ending June 30, 2026, for the more
options for maternal support program created in section 217.41C
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.
Sec. 26, EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
Sec. 27. RETROACTIVE APPLICABILITY. This division of this
Act applies retroactively to July 1, 2025.
DIVISION XIV
REIMBURSEMENT RATES — REVIEW
Sec. 28. Section 235.2, Code 2026, is amended by adding the
following new subsection:
NEW SUBSECTION. 9. Upon implementation by the department
of a uniform cost report for shelter care and qualified
residential treatment providers, biennially conduct a review of
shelter care and qualified residential treatment provider costs
compared to current shelter care and qualified residential
treatment provider rates. On or before October 1 of the
calendar year immediately succeeding the calendar year in
which the review is conducted, the department shall submit a
report to the governor and the general assembly detailing the
results of the department's review and recommendations for rate
House File 2782, p. 26
adjustments.
Sec. 29. Section 249A.4, Code 2026, is amended by adding the
following new subsection:
NEW SUBSECTION. 15. a. Conduct an annual review of
provider reimbursement rates for medical and health services
provided under this chapter that are reimbursed by a statewide
fee schedule and that are not periodically updated or rebased
pursuant to federal or state law or rule. The department shall
compare each provider reimbursement rate in the following
manner:
(1) For all medical and health services other than dental
services, to reimbursement rates under the federal Medicare
program.
(2) For dental services, to reimbursement rates for
Medicaid programs in states contiguous to Iowa.
b. On or before January 15 of each calendar year, the
department shall submit to the general assembly a report
summarizing the department's review under paragraph
DIVISION XV
MENTAL DISEASES EXCLUSION WAIVER
Sec. 30. DEPARTMENT OF HEALTH AND HUMAN SERVICES — MEDICAL
DISEASES EXCLUSION WAIVER. No later than July 1, 2027, the
department of health and human services shall apply to the
centers for Medicare and Medicaid services of the United
States department of health and human services for a waiver of
Medicaid's institution for mental diseases exclusion.
DIVISION XVI
DEPARTMENT OF HEALTH AND HUMAN SERVICES FULL-TIME EQUIVALENT
DASHBOARD
Sec. 31. DEPARTMENT OF HEALTH AND HUMAN SERVICES
FULL-TIME EQUIVALENT DASHBOARD. Pursuant to section 217.22,
the department of health and human services shall make publicly
available information on full-time equivalent positions as
described in section 8.36A, that details all of the following:
1. The number of full-time equivalent positions authorized
by the general assembly for the department, categorized by the
department division or appropriation.
2. The number of filled full-time, part-time, or temporary
positions by department division or appropriation.
House Pile 2782, p. 27
3. The percentage of moneys from each federal, state,
or other funding source for each department division and
department appropriation.
DIVISION XVII
COMPREHENSIVE FAMILY SUPPORT PROGRAM
Sec. 32. NEW SECTION. 231,80 Comprehensive family support
program.
1. For the purposes of this section, unless the context
otherwise requires;
a, ^Comprehensive family support" means services and
supports that assist families caring for an individual with
a disability who is a member of the family, including but
not limited to programs, services, parent-to-parent support,
assistive devices, and various adaptations that allow an
individual with a disability to participate more fully in
family and community life.
b, (1) "^Family" means a group of interdependent persons
living in the same household. A family consists of an
individual with a disability and any of the following:
(a) The individual's parent.
(b) The individual's sibling.
(c) The individual's grandparent, aunt, or uncle.
(d) The individual's legal custodian.
(e) A person providing short-term foster care to the
individual with a disability subject to a case permanency plan
that provides for reunification between the individual and the
individual's parent.
(2) '^Family" does not include a person who is employed
to provide services to an individual with a disability in an
out-of-home setting, including but not limited to a hospital,
nursing facility, personal care home, board and care home,
group foster care home, or other institutional setting.
c, ^Individual with a disability" means an individual who is
less than twenty-two years of age and meets the definition of
developmental disability in 42 U.S.C. S15002.
d, '^Services and support" means assistance intended
to enable an individual with a disability to control
the individual's environment, to remain living with the
individual's family, to function more independently, and
House File 2782, p. 28
to increase the integration of the individual into the
individual's community including but not limited to funding
for purchase of equipment, respite care, supplies, assistive
technology, and payment of other costs attributable to
the individual's disability which are identified by the
individual's family.
2. A comprehensive family support program is created under
the purview of the department to provide a statewide system of
services and support to eligible families. The program shall
be implemented in a manner that enables a family member of an
individual with a disability to identify the needed services
and support.
3. Eligibility for the program is limited to families who
meet all of the following criteria:
a. The family resides in the state of Iowa.
b. The family intends for the family member who is an
individual with a disability to remain living in the family's
home.
c. The family's taxable income is less than sixty thousand
dollars for the most recently completed tax year.
4. A family may apply to the department or to a family
support center for assistance under the comprehensive family
support program. The department or family support center shall
determine eligibility for the comprehensive family support
program in accordance with subsection 3.
5. The department shall adopt rules pursuant to chapter
17A to implement the comprehensive family support program.
The comprehensive family support program must do all of the
following:
a. To the extent possible, incorporate in the application
process the eligibility determination processes that the
department uses for other disability services programs.
b. Ensure the ability of families to maintain control of
decisions which affect an individual with a disability who is a
member of a family.
c. Utilize existing local agencies to provide facilities and
a single entry point for program applicants.
d. Ensure services and support are provided in a timely
manner and emergency access to needed services and support is
House Pile 2782, p. 29
provided.
e. Ensure technical assistance is provided to providers and
users of services and support.
f. Utilize state, regional, and local media to publicize the
program,
g. Incorporate a process to appeal the department's or
family support center's denial of services and support to a
family under the program, including reasonable efforts by the
department to utilize telecommunications in the appeal process.
h. Identify the services and support, and service provider
components, included in the program.
i. Upon request by a family member, provide a family with
assistance in locating a service provider.
j. Make payment for services and support directly to
families by voucher or other appropriate means,
k. Utilize a voucher system for payment for the family
support center component of the program under subsection 7.
6. Services and support provided under the comprehensive
family support program shall not be used to supplant other
services and support available to a family of an individual
with a disability but shall be used to meet family needs that
will not be met without the program.
7. The comprehensive family support program shall include a
family support center component. Under the component, a family
member of an individual with a disability shall be assisted
by a family support center in identifying the services and
support to be provided to the family under the family support
subsidy program or the comprehensive family support program.
The identification of services and support must be based upon
the specific needs of the individual with a disability and
the individual's family which are not met by other service
programs available to the individual with a disability and the
individual's family.
8. The comprehensive family support program shall be funded
by appropriations made by the general assembly for purposes of
the program. Notwithstanding section 8.33, moneys appropriated
for the comprehensive family support program under this section
that remain unobligated or unexpended at the close of each
fiscal year shall not revert but shall remain available for
House File 2782, p. 30
expenditure for the purposes designated until the close of the
immediately succeeding fiscal year.
Sec. 33. CODE EDITOR DIRECTIVE. The Code editor is directed
to designate section 231.80, as enacted in this division
of this Act, as subchapter VIII of chapter 231 entitled
^Comprehensive Family Support Program".
Sec. 34. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
Sec. 35. RETROACTIVE APPLICABILITY. This division of this
Act applies retroactively to July 1, 2025.
DIVIfllOM XVIII
nfr Ifw rnrn Inim nrli) rhnpli I ll'i". Ill I ii iii T. iiili iii iii
paragraph d, ib imandad to road oiij folluwA.
d. fpdpnl fineal year beginning Octeobog ili|i"iaQ2G^
Qftd ewding Dopbombor JQi aOfl6| moBGya Qllooabod
tso providers under paragraph ^^o"i 70 pci'eenL af Lhe BieuGye
»llooatod oaoh fodosgl fiatml bliall Be JimilbuLud by
a hr>h-aii.i /->yaT Viaalt-Vi a i i n 4-t-a 4T.i.TTe> o e. .• r. j a T^ j ^ /sr.
bhe department q£ hoalth and human oorviooo to the etate^e
4-»/q miaT^4->.^ V>i^.a14-K
fahr. ^r. j ^ ^
that rf?irfnnrft Tt.^r.^yo
diotributod und<iMr..-tpfaii.Qr
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^a.tal iiljgHoooir 'Or -p^gov-i-d-^n^—&er-v->aQO bo ohAJidgion
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thT frd^rn"* inhntan^r nhnnr
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-Iv^
House File 2782, p. 31
DIVISION XIX
DEPARTMENT OF HEALTH AND HUMAN SERVICES BEHAVIORAL HEALTH
EXPENDITURE REPORT
Sec. 37- NEW SECTION, 225A.10 Behavioral health services
expenditure report.
No later than December 15 of each year, the department shall
submit to the general assembly a summary of the department's
expenditures for behavioral health services for adults and
children for the immediately preceding fiscal year, including a
summary of which appropriations or funding sources were used to
fund the expenditures.
OPIOID DBTrPLEilENiT FUNDEi¥ aoac aoa7
Sooi 30 ■ OnOID SErpilLEMENT'-PUND
HUHiUI? ounvious,
1 Thnrn if Rppropr.i atied from
fljTiaatad in eeofciaa laiBl to bhiO—dQipaiBi'timQint^MOifi—hioalfah^indHpmmon
\ — i r-ii"*-- 1, T'Tf. nnti nniiing^
f/-si 1 wg atn/^nn4-^ rNr- o mno^ ,f]ioror>f ic ao
no 0 PC B^a g y, 1 - ■£ o r tha-^itW^pao o.b^ oo A g nQii>odf;
^ 11 111111111 11 I OOP I OOP
Af, ^-hn mnnnyo ippr f^pr i a <-oH. _H_hQ y <-Tn^Ti4- hoa-T-fc-h - a
^ gVial^l
A .fcr.o^±ino.nt-—pr_^f^r_aTn_i-ha1- a
rwiinibi|i riitih nh 1 m n <- nnn VinnHjc^La— Li^anearl 4-K-:^4-
rn]->r<ran/p9 fSQr<^f>r treatment ff nppnr^ rT>Tnpr-f>.hft.nR-ijnp
^ ^ rQg jdOHtlinHJ—■tr.paitim'=^" i
Tnnr^i n->f inn~arri rl-o/q t-roa4-mafs^
n llnnnTrn HJ-gJaii-r-cfaH nnHar
thffi ■r,pi7,i,niiifinifB.ii nii irnmpi i anPBwJoy.fr.J^ l-ihp>MriiPanT-r.Qm^^<-^-q,f„f]l"
f\mnn hmr'y i^n-o.am^n -a-n/i— R T,
pi ant nhial
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llih i ijL¥iUi
House File 2782, p. 32
p4 ^n4-^ fP f j hrnfflilitih iiiifl huiTian
-JtL- DIVISION XXI
GRADUATE MEDICAL EDUCATION
Sec. 39. 2025 Iowa Acts, chapter 120, section 19, is amended
to read as follows:
SEC. 19. TRANSFER OF MONEYS. Notwithstanding section
8.33 or any other provision to the contrary, any unobligated
or unencumbered moneys in any of the following accounts or
funds or constituting any specified appropriation, shall not
revert but are appropriated to the department of health and
human services to fund ModicQid graduate medical education
efforts award grants to start medical residency programs in
the state that are not related to the practice of family
medicine, are not located in a county which has a population
of one hundred fifty thousand or more based on the most recent
federal decennial census, and in which the main campus of an
institution of higher learning governed by the state board of
regents is located.
1. The health care workforce shortage fund created in
section 135.175, subsection 1, paragraph ^^b". Code 2025.
2. The medical residency training account created in
section 135.175, subsection 5, paragraph ^^a", Code 2025, except
$298,000 of such moneys is appropriated to the department of
health and human services for the purposes of implementing the
waiver of Medicaid^s institution for mental diseases exclusion
the department must apply for under this 2026 Iowa Act.
3. The nurse residency state matching grants program
account created in section 135.175, subsection 5, paragraph
"b". Code 2025.
4. The health care workforce shortage national initiatives
account created in section 135.175, subsection 5, paragraph
"c". Code 2025.
5. The family medicine obstetrics fellowship program fund
created in section 135.193, Code 2025.
6. Moneys appropriated to the department of health and human
services for rural psychiatric residencies to fund psychiatric
residents to provide mental health services in underserved
areas of the state as described in the following:
Iowa ActSr chapter 1131, section 3, subsection 4,
j", as amended by 2024 Iowa Acts, chapter 1157,
Iowa Acts, chapter 182, section 3, subsection 4,
3 .
Iowa Acts, chapter 85, section 3, subsection 4,
j", as amended by 2020 Iowa Acts, chapter 1121,
House File 2782, p. 33
a. 2024 Iowa Acts, chapter 1157, section 5, subsection 3,
and 2024 Iowa Acts, chapter 1157, section 22, subsection 5.
b. 2023 Iowa Acts, chapter 112, section 5, subsection 4,
paragraph '"j", as amended by 2024 Iowa Acts, chapter 1157,
section 29.
c. 2022
paragraph
section 23.
d. 2021
paragraph
e. 2019
paragraph
section 19.
DIVISION XXII
MEDICAID REIMBURSEMENT RATE — SPECIAL POPULATION NURSING
FACILITIES
Sec. 40. Section 249A.2, Code 2026, is amended by adding the
following new subsection:
NEW SUBSECTION. 15. '^''Special population nursing facility''
refers to a nursing facility that serves one of the following
populations and has been designated as a special population
nursing facility by the department:
a. One hundred percent of the residents served are aged
thirty and under and require a skilled level of care.
b. Seventy percent of the residents served require a skilled
level of care for neurological disorders.
c. One hundred percent of the residents require care from a
facility licensed by the department of inspections, appeals,
and licensing as an intermediate care facility for persons with
mental illness.
d. One hundred percent of the residents require care from a
facility licensed by the department of inspections, appeals,
and licensing as an intermediate care facility for persons with
medical complexity.
Sec. 41. NEW SECTION. 249A.38C Medicaid reimbursement rate
— special population nursing facilities.
The provider reimbursement rate for each special population
nursing facility must be the special population nursing
facility's average allowable per diem costs as adjusted in
House File 2782, p. 34
compliance with applicable federal laws and regulations,
including the upper payment limits specified in 42 C.F.R.
§447.272(b). If a special population nursing facility subject
to this section increases the special population nursing
facility's number of beds or expands to provide additional
services on or after July 1, 2026, the reimbursement rate in
this section shall apply to such additional beds or services.
PAT grassle:
speaker or the House
AMY SINQJilAiR
President of the Senate
I hereby certify that this bill originated in the House and
is known as House File 2782, Ninety-first General Assembly.
Approved , 2026^
RESRAli NELSON
fief Clerk of the House
KIS RSYNOLD
Governor