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. Contingent effective date, effective 06/02/2026, 01/01/2027

DIVISION II —— SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM. The bill provides that HHS shall consider the income and financial resources of all household members in determining the eligibility and benefit allotment of the household, including household members determined to be ineligible for benefits. An individual shall be ineligible to participate in SNAP unless they have eligible immigration or United States citizenship status as detailed in the bill. HHS is required to notify the United States citizenship and immigration services if HHS is unable to verify the immigration or United States citizenship status of any household member listed on a SNAP application. DIVISION III —— MEDICAID —— MANAGED CARE. The bill provides that HHS shall deliver all Medicaid benefits utilizing a managed care program as defined in the bill, except for Medicaid benefits provided on a fee-for-service basis or otherwise excluded from managed care program delivery pursuant to a Medicaid state plan or waiver in effect on or before July 1, 2026. DIVISION IV —— MEDICAID AND IOWA HEALTH AND WELLNESS PLAN —— RETROACTIVE ELIGIBILITY AND REPORTING. The bill provides that beginning on January 1, 2027, notwithstanding any provision of state law to the contrary and in compliance with federal law, HHS shall adopt rules to provide for two months of retroactive benefit eligibility for pregnant women, children, and residents of certain nursing facilities who apply for Medicaid. HHS shall not adopt rules or submit a request for a waiver or state plan amendment to CMS for retroactive benefit eligibility for any other adult applying for Medicaid or any individual applying to enroll in IHAWP. The bill strikes a provision related to a prior directive by the general assembly to the department to request a waiver to limit retroactive benefit eligibility. The bill directs HHS to submit a waiver to CMS to allow HHS to deviate from federal law, which provides for three months of retroactive eligibility, and provide for no retroactive eligibility to adults who are not pregnant women, children, or residents of certain nursing facilities. HHS shall implement the waiver upon receipt of approval of the waiver by CMS. DIVISION V —— MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— COST NEUTRALITY. The bill requires HHS to conduct an analysis to determine if a waiver or state plan amendment is cost neutral prior to submitting a request for a waiver or state plan amendment to CMS to expand coverage under the medical assistance program to additional individuals or classes of individuals. For any waiver or state plan amendment that is determined not to be cost neutral, HHS shall not submit the request to CMS unless the request has been presented to the general assembly and approved by a majority vote of both houses of the general assembly. HHS is not required to seek legislative approval for waivers or state plan amendments already submitted to, or approved by, CMS prior to the effective date of the bill. HHS shall conduct an annual analysis to determine if all approved or implemented Medicaid section 1115 demonstration waivers are cost neutral. On or before October 1, HHS shall submit a report to the general assembly detailing medical assistance program compliance with the federal One Big Beautiful Bill Act, which requires all Medicaid section 1115 demonstration waivers to be cost neutral. The report shall include HHS’s cost neutrality analysis for all demonstration waivers implemented or approved by Medicaid. The bill defines “cost neutral”. DIVISION VI —— EFFECTIVE DATE. The bill takes effect upon enactment.