Relating to the supplemental nutrition assistance program; the medical assistance program; the special supplemental nutrition program for women, infants, and children; and other public assistance programs under the purview of the department of health and human services

The bill requires HHS to request waivers of specific federal SNAP regulations regarding earned income, independent verification of eligibility, expungement of benefits from certain electronic benefit accounts, and determining the state’s SNAP payment error rate. HHS shall implement any requested waiver upon receipt of approval of the waiver by the federal government. DIVISION II —— MEDICAL ASSISTANCE PROGRAM. Under current law, for an individual to be eligible for the Medicaid for employed persons with disabilities (MEPD) program, their household income must be below 250 percent of the federal poverty level (FPL), and the individual must also meet the maximum amount of resources allowed under federal law, with certain resources being disregarded by HHS in determining an individual’s MEPD program eligibility. Individuals in the MEPD program pay a set premium every month to HHS on a sliding scale based on household income. A premium payment accepted directly or indirectly through an automated case management system by HHS does not automatically make an individual eligible for MEPD. The bill requires HHS to extend MEPD eligibility to individuals with household incomes up to 300 percent of the FPL. Moneys in a pension fund are not to be considered by HHS for purposes of determining asset eligibility under MEPD. The bill strikes the maximum MEPD premium payable by individuals whose income exceeds 150 percent of the FPL, and the policy that an individual’s MEPD premium payment being accepted directly or indirectly through an automated case management system by HHS does not make the individual automatically eligible for MEPD. The bill provides that HHS must allow for the electronic payment of MEPD premiums through a page maintained on the department’s internet site. The bill requires the director of HHS to submit a report to the general assembly within thirty days of the release of the official Medicaid payment error rate by the federal centers for Medicare and Medicaid services (CMS), detailing the official Medicaid payment error rate and a summary of the payment error data as submitted to CMS by HHS. The bill also requires the director of HHS to submit an annual report to the general assembly on or before October 1, 2026, with specific information as detailed in the bill related to certain petitions for a waiver to rules adopted by HHS (exceptions to policy) to administer Medicaid during the immediately preceding fiscal year. Under current law, the reimbursement rate set by HHS for providers under home and community-based service waiver programs does not cover the provider’s travel and other expenses associated with providing care to a resident in a rural area of the state. The bill requires HHS to cover such costs for those providers. Prior to submission of a request by HHS for certain Medicaid waivers, the bill requires HHS to conduct a cost-neutrality analysis. If the waiver is determined by HHS to not be cost neutral, HHS must seek the approval of the general assembly by majority vote of both houses of the general assembly. “Cost neutral” is defined to mean that approval of a waiver by CMS will not result in a net increase in spending on the administration of Medicaid by the state. HHS is required to conduct a review of exceptions to policy granted by the department between January 1, 2020, and January 1, 2026. On or before December 15, 2026, the department shall submit a report to the general assembly with specific information about these exceptions as detailed in the bill. The bill provides that the provisions of the bill related to MEPD take effect contingent upon receipt of federal approval. DIVISION III —— ELIGIBILITY FOR CERTAIN PROGRAMS. Unless prohibited by federal law, the bill permits HHS, for purposes of determining eligibility for assistance for certain public assistance programs, to require proof of months of continuous residency through documentation as detailed in the bill. HHS may not require proof of residency for people who are receiving social security benefits. “Public assistance program” is defined as the state child care assistance program, the family investment program, medical assistance program, supplemental nutrition assistance program, and the special nutrition assistance program for women, infants, and children. The bill requires HHS, prior to determining the initial eligibility of an applicant for, or the ongoing eligibility of a recipient of, public assistance benefits to verify immigration and United States citizenship information of the applicant or recipient through the systematic alien verification for entitlements online service maintained by the United States citizenship and immigration services, or other accessible source. DIVISION IV —— MISCELLANEOUS PUBLIC ASSISTANCE PROGRAMS. The bill provides that HHS shall restrict participation in WIC to citizens and qualified aliens pursuant to section 742 of the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Under current law, a provider under the Iowa health and wellness plan (IHAWP) cannot charge a member a fee for missing an appointment with the provider. Under the bill, IHAWP providers may charge a member up to a $5 fee for missing an appointment. Under current law, members whose household income is at or above percent of the FPL must pay a monthly contribution. The bill changes the requirement to 100 percent of the FPL. Under the bill, all IHAWP members must pay an $8 copayment for nonemergency use of a hospital emergency department. Monthly contributions and copayment amounts are established by HHS by rule. Under current law, IHAWP members with household incomes between percent and 100 percent of the FPL who fail to complete the required preventative services and wellness services annually are required to pay a monthly contribution of $5, while those members with household incomes in excess of 100 percent of the FPL that fail to complete the required preventative services and wellness services annually are required to pay a monthly contribution of $10. The bill instead requires any member that fails to complete the required preventative services and wellness services annually to pay a monthly fee of $5 during the subsequent membership year. The bill requires an IHAWP member whose household income is at or above 100 percent of the FPL to pay a $5 copay for diagnostic dental procedures, and a $1 copay for a prescription drug when an equivalent generic drug is available. The bill defines “diagnostic dental procedure”. Under current law, HHS was to have fully implemented the requirements for public assistance programs pursuant to Code chapter 239 by July 1, 2025. Under the bill, the department must fully implement the requirements by January 1, 2027. The bill requires HHS to seek approval of an amendment to the section 1115 demonstration waiver for the Iowa health and wellness plan from CMS to provide that an IHAWP member whose eligibility for the program is terminated due to nonpayment of monthly contributions owed as a result of the member’s failure to complete