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Senate
File
2422
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Senate
File
2422
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.
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
DIVISION
I
PUBLIC
ASSISTANCE
PROGRAMS
——
VERIFICATION
Senate
File
2422,
p.
2
Section
1.
Section
239.6,
subsection
1,
paragraph
a,
subparagraph
(4),
Code
2026,
is
amended
to
read
as
follows:
(4)
Information
maintained
by
the
United
States
citizenship
and
immigration
services
of
the
United
States
department
of
homeland
security
,
including
but
not
limited
to
information
accessible
through
the
systematic
alien
verification
for
entitlements
online
service,
or
successor
federal
verification
system
.
Sec.
2.
Section
239.6,
subsection
2,
Code
2026,
is
amended
by
adding
the
following
new
paragraph:
NEW
PARAGRAPH
.
g.
The
systematic
alien
verification
for
entitlements
online
service
maintained
by
the
United
States
citizenship
and
immigration
services
of
the
United
States
department
of
homeland
security
to
verify
immigration
and
United
States
citizenship
information,
or
successor
federal
verification
system.
DIVISION
II
SUPPLEMENTAL
NUTRITION
ASSISTANCE
PROGRAM
AND
MEDICAID
——
ELIGIBILITY
AND
ERROR
RATE
REPORTING
Sec.
3.
Section
239.1,
Code
2026,
is
amended
by
adding
the
following
new
subsection:
NEW
SUBSECTION
.
01.
“Alien”
means
any
person
not
a
citizen
or
national
of
the
United
States.
Sec.
4.
Section
239.2,
Code
2026,
is
amended
to
read
as
follows:
239.2
Supplemental
nutrition
assistance
program
——
income
eligibility.
1.
a.
The
department
shall
establish
the
gross
countable
monthly
income
threshold
for
the
supplemental
nutrition
assistance
program
at
less
than
or
equal
to
one
hundred
sixty
percent
of
the
federal
poverty
level
for
the
household
size.
b.
The
department
shall
consider
the
income
and
financial
resources
of
all
household
members
in
determining
the
eligibility
and
benefit
allotment
of
the
household,
including
all
household
members
determined
to
be
ineligible
to
participate
in
SNAP
under
this
section
or
pursuant
to
7
U.S.C.
§2015(f).
Notwithstanding
7
C.F.R.
§273.11(c)(3),
the
individual’s
income,
deductible
expenses,
and
resources
shall
be
counted,
and
none
shall
be
prorated.
Senate
File
2422,
p.
3
c.
Pursuant
to
7
U.S.C.
§2015(f),
an
individual
shall
be
ineligible
to
participate
in
SNAP
unless
the
individual
is
a
resident
of
the
United
States
and
meets
at
least
one
of
the
following
criteria:
(1)
The
individual
is
a
citizen
or
national
of
the
United
States.
(2)
The
individual
is
an
alien
lawfully
admitted
for
permanent
residence
as
an
immigrant,
as
defined
in
8
U.S.C.
§1101(a)(15)
and
1101(a)(20),
excluding
alien
visitors,
tourists,
diplomats,
students,
or
other
individuals
admitted
temporarily
with
no
intention
of
abandoning
their
residence
in
a
foreign
country.
(3)
The
individual
is
an
alien
who
has
been
granted
the
status
of
Cuban
and
Haitian
entrant,
as
defined
in
section
501(e)
of
the
federal
Refugee
Education
Assistance
Act
of
1980,
Pub.
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).
2.
The
department
shall
comply
with
federal
reporting
requirements
relating
to
a
household
member
who
is
determined
to
be
ineligible
to
participate
in
SNAP
pursuant
to
7
C.F.R.
§273.4(b).
Sec.
5.
NEW
SECTION
.
239.12
SNAP
error
rate
——
reporting.
Beginning
with
the
fiscal
quarter
that
starts
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.
DIVISION
III
SUPPLEMENTAL
NUTRITION
ASSISTANCE
PROGRAM
——
WAIVERS
Sec.
6.
FEDERAL
SUPPLEMENTAL
NUTRITION
ASSISTANCE
PROGRAM
——
WAIVER
OF
EXPUNGEMENT
RULES.
1.
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.
2.
The
department
of
health
and
human
services
shall
implement
the
waiver
upon
receipt
of
approval
of
the
waiver
from
the
United
States
department
of
agriculture.
Sec.
7.
FEDERAL
SUPPLEMENTAL
NUTRITION
ASSISTANCE
PROGRAM
——
WAIVER
OF
ELIGIBILITY
VERIFICATION
RULES.
1.
No
later
than
January
1,
2027,
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
assistance
program,
information
from
the
sources
under
section
239.6,
and
the
following
automated
sources,
shall
be
considered
verified
for
purposes
of
7
C.F.R.
§272.12(c):
a.
The
third-party
automated
asset
verification
services
contracted
by
the
department
or
an
equivalent
third-party
asset
verification
platform.
b.
The
automated
employment
verification
service
known
as
the
work
number
or
an
equivalent
third-party
income
verification
platform.
2.
The
department
of
health
and
human
services
shall
implement
the
waiver
upon
receipt
of
approval
of
the
waiver
from
the
United
States
department
of
agriculture.
DIVISION
IV
MEDICAID
AND
IOWA
HEALTH
AND
WELLNESS
PLAN
——
RETROACTIVE
ELIGIBILITY
Sec.
8.
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:
5.
A
member
is
eligible
for
coverage
effective
the
first
day
of
the
month
following
the
month
of
application
for
enrollment.
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
program
eligibility
prior
to
the
month
in
which
the
individual
submits
a
completed
application
for
enrollment.
Sec.
10.
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.
Sec.
11.
MEDICAID
RETROACTIVE
ELIGIBILITY
——
WAIVER.
The
department
of
health
and
human
services
shall
submit
a
request
for
a
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
the
department
of
no
retroactive
eligibility
for
any
adult
individual
who
is
not
a
pregnant
woman,
a
child,
or
a
resident
of
a
nursing
facility
licensed
under
chapter
135C,
upon
the
submission
of
a
completed
Medicaid
application,
instead
of
three
months
as
required
under
42
C.F.R.
§435.915.
The
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.
DIVISION
V
MEDICAID
——
MEDICAID
MANAGED
CARE
ORGANIZATION
HEALTH
CARE
TAX
FUND;
EXPENDITURE
NEUTRALITY;
AND
EXCEPTIONS
TO
POLICY
Senate
File
2422,
p.
6
Sec.
12.
Section
249A.13,
subsection
2,
Code
2026,
is
amended
to
read
as
follows:
2.
Moneys
in
the
fund
are
appropriated
to
the
department
of
health
and
human
services
for
the
purposes
of
the
medical
assistance
program.
Unless
expressly
approved
by
the
general
assembly
through
legislation,
or
as
required
by
federal
law
or
regulations,
the
department
shall
not
take
any
action
that
reduces
moneys
deposited
in
the
fund
from
a
health
maintenance
organization
contracting
with
the
department
to
administer
the
medical
assistance
program
under
this
chapter.
Such
moneys
shall
not
be
diverted,
reduced,
or
used
by
the
department
for
any
other
purposes
than
those
permitted
by
this
subsection.
Sec.
13.
NEW
SECTION
.
249A.59
Medicaid
waivers
and
state
plan
amendments
——
expenditure
neutrality.
1.
For
purposes
of
this
section,
unless
the
context
otherwise
requires,
“expenditure
neutral”
means
that
the
cost
of
a
federally
approved
change
to
an
existing,
or
new
request
for
a,
Medicaid
waiver
or
state
plan
amendment
will
not
result
in
a
net
increase
in
expenditures
from
the
appropriation
enacted
for
the
fiscal
year
the
change
or
new
request
is
made,
as
certified
by
an
actuary
retained
by
the
department.
2.
a.
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
is
not
expenditure
neutral,
unless
expressly
approved
by
the
general
assembly
through
legislation
prior
to
implementation
of
the
change
or
submission
of
the
new
request.
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.
3.
This
section
shall
not
apply
when
the
department
Senate
File
2422,
p.
7
implements
a
federally
approved
change
to,
or
submits
a
new
request
to
the
federal
government
for,
a
Medicaid
waiver
or
state
plan
amendment
that
meets
any
of
the
following
requirements:
a.
The
change
or
new
request
was
submitted
for
federal
approval
prior
to
January
1,
2026,
regardless
of
whether
federal
approval
has
been
received
by
the
department
by
January
1,
2026.
b.
The
change
or
new
request
is
required
by
federal
law
or
regulation,
or
is
necessary
to
comply
with
federal
law
or
regulations.
c.
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.
4.
The
department
may
adopt
rules
pursuant
to
chapter
17A
to
administer
this
section.
Sec.
14.
NEW
SECTION
.
249A.60
Medicaid
——
exceptions
to
policy.
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:
1.
The
total
number
of
exceptions
to
policy
granted.
2.
The
cumulative
cost
of
the
exceptions
to
policy
that
were
granted.
3.
The
types
of
exceptions
to
policy
that
were
granted.
4.
Identifiable
trends
noted
by
the
department
including
any
of
the
following:
a.
The
number
of
exceptions
to
policy
granted
in
a
Senate
File
2422,
p.
8
particular
geographic
location.
b.
The
types
of
Medicaid
services
that
were
the
basis
for
exceptions
to
policy.
c.
The
Medicaid
program
classification
of
individuals
granted
exceptions
to
policy.
Sec.
15.
EFFECTIVE
DATE.
The
following
takes
effect
on
January
1,
2027:
The
section
of
this
division
of
this
Act
amending
section
249A.13,
subsection
2.
DIVISION
VI
MEDICAID
——
HOSPITAL
DIRECTED
PAYMENT
PROGRAM
Sec.
16.
Section
249O.2,
Code
2026,
is
amended
by
adding
the
following
new
subsection:
NEW
SUBSECTION
.
01.
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.
1.
The
department
shall
continue
expanding
the
practice
of
making
payments
to
program
participants
and
vendors
by
means
of
electronic
funds
transfer.
The
department
shall
seek
the
capacity
for
making
payment
by
such
means
for
all
programs
administered
by
the
department.
2.
The
department,
in
coordination
with
the
department
of
management’s
division
of
information
technology,
shall
seek
the
capacity
to
allow
premium
payments
by
program
participants
to
be
made
by
electronic
benefits
transfer
for
all
programs
administered
by
the
department
that
require
premium
payments.
By
January
1,
2028,
the
department
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.
DIVISION
VIII
EFFECTIVE
DATE
Senate
File
2422,
p.
9
Sec.
18.
EFFECTIVE
DATE.
This
Act,
being
deemed
of
immediate
importance,
takes
effect
upon
enactment.
______________________________
AMY
SINCLAIR
President
of
the
Senate
______________________________
PAT
GRASSLEY
Speaker
of
the
House
I
hereby
certify
that
this
bill
originated
in
the
Senate
and
is
known
as
Senate
File
2422,
Ninety-first
General
Assembly.
______________________________
W.
CHARLES
SMITHSON
Secretary
of
the
Senate
Approved
_______________,
2026
______________________________
KIM
REYNOLDS
Governor