Relating to the supplemental nutrition assistance program, the medical assistance program, and other public assistance programs under the purview of the department of health and human services

The bill requires that HHS request an appropriate waiver of specific federal SNAP regulations regarding earned income, independent verification of eligibility, expungement of benefits from certain electronic benefit accounts, calculations by HHS of the program payment error rate, and required program application information. HHS shall implement any requested waiver upon receipt of approval of the waiver by the federal government. DIVISION II —— MEDICAL ASSISTANCE PROGRAM. §1396a. The bill amends current eligibility provisions requiring the department to cap premiums for individuals whose income falls below 250 percent of the federal poverty level (FPL), and that any acceptance by the department of the payment of a premium does not automatically confer initial or continuing MEPD eligibility on an individual.3 also requires HHS to not consider certain assets when determining asset eligibility under MEPD. The bill requires that HHS extend MEPD eligibility to those 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 provides that HHS must allow for the electronic payment of MEPD premiums through a page maintained on the department’s internet site. _____ Beginning October 1, 2026, the bill requires the director of HHS to submit a report every fiscal quarter to the general assembly detailing payment error rates associated with the medical assistance program for the preceding fiscal quarter. 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 petitions for a waiver, which the department refers to as exceptions to policy, to rules governing the Medicaid program granted by HHS during the immediately preceding fiscal year. Under current law, the reimbursement rate set by HHS for providers under the home and community-based waivers does not cover the provider’s travel time 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. The bill requires HHS to conduct an analysis to determine if a waiver related to the medical assistance program is cost neutral prior to submission of a request for the waiver to the United States department of health and human services. Prior to submitting a waiver request related to the medical assistance program that is not 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 the federal government will not result in a net increase in spending on the administration of the program by the state. HHS is required to conduct a review of petitions for a waiver, also referred to by the department as exceptions to policy, of rules governing the Medicaid program 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 as detailed in the bill. DIVISION III —— ELIGIBILITY FOR CERTAIN PROGRAMS. _____ of determining eligibility for assistance from certain public assistance programs under the purview of HHS, to require proof of months of continuous residency through documentation that attests to employment within the state and other reasons for being in the state, as well as the length of residency of the applicant. HHS may not require proof of residency for people who are receiving social security benefits. “Public assistance program” is defined as 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 of the United States department of homeland security. DIVISION IV —— MISCELLANEOUS PUBLIC ASSISTANCE PROGRAM PROVISIONS. Section 742 of the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 neither prohibits a state from providing nor requires a state to provide food assistance to a person who is not a citizen or qualified alien under certain programs, including the special supplemental nutrition program for women, infants, and children (WIC). The bill provides that HHS shall restrict participation in WIC to citizens and qualified aliens pursuant to federal law. Under current law, a provider under the Iowa health and wellness plan (IHAWP) cannot charge a member a nonattendance fee. Under the bill, a provider can charge a member a nonattendance fee. HHS has established monthly member contributions and copayment amounts for IHAWP members by rule. _____ a $5 nonattendance fee and all IHAWP members must pay an $8 copayment for each nonemergency use of a hospital emergency department. Under current law, IHAWP members with household incomes above percent and not in excess of 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 when receiving diagnostic dental procedures, and a $1 copay when buying a prescription drug when an equivalent generic drug is available. The bill defines “diagnostic dental procedure”. Current Code chapter 239 sets forth specific requirements for specifically defined public assistance programs under the purview of HHS. Under current law, HHS set a goal of fully implementing 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 pursuant to Code chapter 239 by January 1, 2027. _____ the program without first paying any outstanding monthly contributions, if the member has not been terminated from the program previously for nonpayment of monthly contributions; if the IHAWP member has previously been terminated from the program for nonpayment of monthly contributions, the member shall be subject to payment of any outstanding monthly contributions prior to reenrollment in the program. Currently, HHS has established by rule certain reimbursement rate limits for special population nursing facilities enrolled in the Medicare program on or after June 1, 1993. The bill requires HHS to apply these same reimbursement rate limits to special population nursing facilities enrolled in the federal Medicare program on or after July 1, 2023. DIVISION V —— PUBLIC ASSISTANCE FRAUD —— REPORT. The bill requires the department of inspections, appeals, and licensing to submit a report on or before October 1, 2026, to the general assembly concerning the department’s activities relative to fraud in public assistance programs for the immediately preceding fiscal year. The report shall include but is not limited to a summary of the number of cases investigated, case outcomes, overpayment dollars identified, amount of cost avoidance, and actual dollars recovered. DIVISION VI —— HIGH-ACUITY WORK GROUP —— REPORT. Under the bill, HHS is required to convene a work group to identify barriers to the ability of high-acuity Medicaid recipients and members of Iowa health and wellness kids in Iowa (Hawki) to remain in the least restrictive environment possible, and develop a proposal for a tiered reimbursement methodology to provide high-acuity home health services tailored to meet the allowable medical and nonmedical support needs of such individuals. _____ organizations deemed appropriate by HHS. The work group shall submit a report to the general assembly on or before December 1, 2026, that outlines barriers identified by the work group to high-acuity pediatric members remaining in the least restrictive environment possible, and provides the estimated fiscal impact of the work group’s proposed tiered reimbursement methodology on affected providers and health care facilities. HHS shall provide administrative support to the work group.