Bills › 91st General Assembly

SF 2422Signed by Governor · June 2, 2026

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

Sponsored by the Senate Health and Human Services Committee

Topics:Health care Families & human services Immigration Medicaid

Same legislation: SSB 3140

Write your legislators about itWhat changed before it passed

Official bill page Lobbyist declarations One-pager to print

Where it is now

Done: IntroducedFebruary 10, 2026
Done: SubcommitteeFebruary 10, 2026
Done: Senate committeeFebruary 19, 2026
Done: Passes the SenateFebruary 25, 202630–17
Done: House committeeMarch 19, 2026
Done: Passes the HouseApril 21, 202665–28
Done: To the GovernorMay 11, 2026
Done: Signed into lawJune 2, 2026

Signed into law What’s a funnel?

What’s in it

AI summary The Department of Health and Human Services must check the citizenship and immigration status of people applying for programs like SNAP and Medicaid. For SNAP, the state will look at the income of everyone in a household, even if they are not eligible for benefits. Starting in 2027, certain groups like pregnant women and children can receive up to two months of Medicaid benefits for medical care they received before they applied. Additionally, the state must ensure that new plans to expand Medicaid coverage do not cost more than they save.¹

Read the official explanation

This bill relates to the supplemental nutrition assistance program (SNAP), the medical assistance program (Medicaid), the Iowa health and wellness plan (IHAWP), and other programs under the purview of the department of health and human services (HHS). DIVISION I —— PUBLIC ASSISTANCE PROGRAMS —— ELIGIBILITY AND REPORTING. 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 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.

Changed since by amendments S-5206, H-8384, S-5033; see Amendments.

Full bill text · What changed before it passed²

House subcommittee

Named March 4, 2026. On March 10, 2026 it recommended passage.

Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part

25 written public comments to its subcommittee: March 10, 2026 (24), February 17, 2026 (1) · on the Legislature’s site

Fiscal note

AI summary This bill modifies several public assistance programs managed by the Department of Health and Human Services. It is estimated to cost the state $2.0 million in fiscal year 2027 and $1.3 million in fiscal year 2028 for new staff and technology to verify citizenship, while also costing approximately $615,000 in fiscal year 2027 and $608,000 in fiscal year 2028 for new staff to oversee Medicaid waiver changes. However, the bill may reduce state costs by $265,000 in fiscal year 2027 and $672,000 in fiscal year 2028 due to changes in how Medicaid coverage is applied retroactively.³

Read the fiscal note

Description

Senate File 2422 modifies various public assistance programs under the Department of Health and Human Services (HHS).

The Bill is comprised of eight divisions, four of which have a fiscal impact and four of which do not.

The following divisions of the Bill have no fiscal impact:

Division II — Supplemental Nutrition Assistance Program and Medicaid — Eligibility and

Error Rate Reporting

Division III — Supplemental Nutrition Assistance Program — Waivers
Division VI — Medicaid — Hospital Directed Payment Program
Division VIII — Effective Date

The following divisions of the Bill have a fiscal impact and are described in further detail below:

Division I — Public Assistance Programs — Verification
Division IV — Medicaid and Iowa Health and Wellness Plan — Retroactive Eligibility
Division V — Medicaid — Medicaid Managed Care Organization Health Care Tax Fund; Expenditure Neutrality; and Exceptions to Policy
Division VII — Program Administration — Electronic Benefits Funds Payment The Bill takes effect upon enactment.

Division I — Public Assistance Programs — Verification

Description

Division I of the Bill requires the HHS to use the Systematic Alien Verification for Entitlements (SAVE) online service maintained by the U.S. Department of Homeland Security (DHS) to verify immigration and citizenship information when determining eligibility for public assistance programs.

Background

The HHS is currently required to access information maintained by the U.S. Citizenship and Immigration Services (USCIS) of the DHS when determining eligibility for public assistance programs.

The SAVE system is an online service for registered federal, State, territorial, tribal, and local government agencies to verify the immigration and citizenship status of applicants seeking benefits or licenses and is administered by the USCIS of the DHS. A user agency is charged a monthly service charge of $25 for each month in which the user agency submits at least one SAVE case. As of April 1, 2025, nonfederal user agencies are not charged a fee for each case run through SAVE.

Assumptions

Verifying the citizenship status of public assistance program applicants using the SAVE system will require approximately 44,000 hours of additional work annually.
The HHS may require up to 34.0 full-time equivalent (FTE) positions to verify the citizenship status of public assistance program applicants through the SAVE system, which will cost the following annual amounts for salary and benefits:
28.0 Income Maintenance Worker 2 FTE positions at $84,000 each.
2.0 Income Maintenance Supervisor FTE positions at $109,000 each.
4.0 Administrative Support Assistance 1 FTE positions at $58,000 each.
Each FTE position will require support costs of $4,000 in the first year of employment and $2,000 for subsequent years.
The State will pay 43.18% of costs for each FTE position, while the federal government will pay 56.82%.
The HHS may require one-time information technology (IT) costs of $3.0 million for the HHS’s eligibility system to verify citizenship through the SAVE system.
The State will pay 25.34% of IT costs, while the federal government will pay 74.66%.

Fiscal Impact

Division I of the Bill is estimated to require 34.0 additional FTE positions and cost approximately $5.9 million in FY 2027 and $2.9 million in FY 2028. The State cost is estimated to be $2.0 million in FY 2027 and $1.3 million in FY 2028.

Division IV — Medicaid and Iowa Health and Wellness Plan — Retroactive

Eligibility

Description

Division IV of the Bill relates to Medicaid retroactive eligibility and does the following:

Requires the HHS to adopt administrative rules and submit a Medicaid waiver to the Centers for Medicare and Medicaid Services (CMS) to allow for two months of retroactive eligibility for pregnant women, children, and residents of certain nursing facilities who apply for Medicaid.
Prohibits the HHS from adopting administrative rules or submitting a request for a waiver or State plan amendment to the CMS to provide retroactive eligibility to any other adult applying for Medicaid or the Iowa Health and Wellness Plan (IHAWP).

Background

Federal law currently allows states to provide up to three months of retroactive eligibility for Medicaid. The One Big Beautiful Bill Act (OBBBA) reduces the retroactive eligibility period from three months to two months for traditional Medicaid and from three months to one month for Medicaid expansion, which, in Iowa, is IHAWP. The OBBBA changes are scheduled to take effect January 1, 2027.

Retroactive eligibility in Iowa is currently available to pregnant women, infants, and residents of certain nursing facilities. Traditional Medicaid members may receive up to three months of retroactive eligibility. Iowa does not provide retroactive eligibility to IHAWP members.

Assumptions

The State will receive federal approval for the retroactive coverage changes.
The retroactive coverage changes will become effective January 1, 2027, and will apply to half of FY 2027 and all of FY 2028 and FY 2029.
Approximately 3,100 individuals may lose one month of retroactive coverage annually.
The average annual cost per member for retroactive coverage is approximately $596.
The reduced costs will be applied 36.67% to State costs and 63.33% to federal costs.
The HHS will require one-time information technology (IT) costs of $225,000 for the HHS’s eligibility system to implement the retroactive coverage changes.
The Department of Management Division of IT (DOM DoIT) will require one-time IT costs of $63,000.
The State will pay 25.34% of IT costs, while the federal government will pay 74.66%.

Fiscal Impact

Division IV of the Bill may reduce net costs by $628,000 in FY 2027, of which $265,000 is for State costs and $364,000 is for federal costs. The total estimated reduction for FY 2028 is $1.8 million, of which $672,000 is for State costs and $1.2 million is for federal costs. Division V — Medicaid — Medicaid Managed Care Organization Health Care Tax Fund; Expenditure Neutrality; and Exceptions to Policy

Description

Division V of the Bill relates to Medicaid waivers, state plan amendments (SPAs) and exceptions to policy and does the following:

Prohibits the HHS from implementing a change to a Medicaid waiver or SPA approved by the CMS, or submitting a new request, if the change or new request is not expenditure-neutral or if the change or new request expands coverage under Medicaid unless expressly approved by the General Assembly through legislation prior to the implementation of the change or submission of the new request.
Provides that the cost neutrality requirements do not apply when the HHS implements a federally approved change to, or submits a new request for, a Medicaid waiver or SPA that meets any of the following requirements:
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 HHS by January 1, 2026.
The change or new request is required by federal law or regulation or is necessary to comply with federal law or regulation.
The change or new request is necessary to comply with a settlement agreement, consent decree, or other resolution of a State violation of Medicaid. A change or new request initiated in this manner is required to be reported to the General Assembly, with an estimate of the fiscal impact, within 30 days of the date of the settlement agreement, consent decree, or other resolution of a State violation of Medicaid.
The change or new request involves the development or implementation of actuarially sound capitation rates consistent with 42 C.F.R. §438.4.
Allows the HHS to adopt administrative rules to administer expenditure neutrality provisions in Division V.
Requires the HHS to make information on exceptions to policy publicly available.

Background

Section 1115 waivers allow states to temporarily modify their Medicaid programs and evaluate specific policy approaches.

State plan amendments are the process in which states can make permanent changes to their Medicaid programs.

Assumptions

The Medicaid waiver cost neutrality analysis will require 6.0 new FTE positions, which will cost the following annual amounts for salary and benefits:
1.0 Compliance Officer 2 FTE position at $125,000.
2.0 Management Analyst 3 FTE positions at $114,000 each.
2.0 Budget Analyst 3 FTE positions at $114,000 each.
1.0 Budget Analyst 4 FTE position at $125,000.
Each FTE position will require support costs of $4,000 in the first year of employment and $2,000 for subsequent years.
The State and the federal government will each pay 50.0% of costs for the cost neutrality FTE positions.
The HHS will require increased annual actuarial services for the Medicaid waiver cost neutrality analysis.
The State and the federal government will each pay 50.0% of costs for actuarial services.

Fiscal Impact

Division V of the Bill is estimated to require 6.0 additional FTE positions and cost approximately $1.2 million in FY 2027 and FY 2028. The State cost is estimated to be approximately $615,000 in FY 2027 and $608,000 in FY 2028.

Division VII — Program Administration — Electronic Benefits Funds Payment

Description

Division VII requires the HHS, in coordination with the DOM DoIT, to seek the capacity to allow premium payments by program participants to be made by electronic benefits transfer for all programs administered by the HHS that require premium payments. Requires the HHS to allow premium payments made by participants of the Medicaid for Employed People with Disabilities (MEPD) program to be made by electronic benefits transfer.

Background

The MEPD program is a Medicaid coverage group that allows persons with disabilities to work and continue to have access to medical assistance. Currently, to be eligible for MEPD, members must earn a net family income of less than 250.0% of the federal poverty level (FPL). Members must also have resources of less than $12,000 for an individual and $24,000 for a married couple, with resources held in a retirement account, a medical savings account, or an assistive technology account being disregarded. Enrollees must pay a monthly premium for coverage if their income is above 150.0% of the FPL. The monthly premium amount for an enrollee at 250.0% of the FPL is $113. Medicare premiums and prescription services are also covered by MEPD.

Assumptions

The online premium payment system will require implementation costs.
The State and the federal government will each pay 50.0% of costs for the online premium payment system.
The DOM DoIT will require one-time IT costs.
The State will pay 25.0% of the DOM DoIT IT costs, while the federal government will pay 75.0%.

Fiscal Impact

Division VII of the Bill is estimated to cost $466,000 in FY 2027, of which $231,000 is for State costs and $364,000 is for federal costs. The total estimated reduction for FY 2028 is $20,000, of which $10,000 is for State costs and $10,000 is for federal costs.

Fiscal Impact Summary

In addition to the costs specified for each division of the Bill, there are estimated costs associated with multiple divisions of the Bill in FY 2027, including the following:

Waiver technical assistance costs.
Additional IT costs.
Implementation costs for the eligibility system.

The total anticipated costs for SF 2422 in FY 2027 are estimated to be $9.3 million and 40.0 FTE positions, of which the State cost is $3.2 million and the federal cost is $6.1 million. For FY 2028, costs are estimated to be $2.3 million and 40.0 FTE positions, of which the State cost is $1.2 million and the federal cost is $1.0 million. Figure 1 shows the breakout of costs in FY 2027. Figure 2 shows the breakout of costs in FY 2028. The figures include cost reductions from retroactive eligibility changes and MEPD premiums collected, offsetting costs. Figure 1 — Senate File 2422 Estimated Costs for FY 2027

Division Category State Federal Total

I SAVE FTE Positions $ 1,209,000 $ 1,591,000 $ 2,801,000 I FTE Position Support Costs 59,000 78,000 137,000 I Eligibility System 760,000 2,240,000 3,000,000 IV Retroactive Coverage Changes -338,000 -579,000 -916,000 IV Eligibility System 57,000 168,000 225,000 IV DOM DoIT IT 16,000 47,000 63,000 V Cost Neutrality FTE Positions 353,000 353,000 705,000 V FTE Position Support Costs 12,000 12,000 24,000 V Cost Neutrality Actuarial Services 250,000 250,000 500,000 VII Premium Payment System 229,000 229,000 457,000 VII DOM DoIT IT 2,000 6,000 8,000 Full Bill Waiver Tech. Assistance 50,000 50,000 100,000 Full Bill IT Costs 239,000 781,000 1,020,000 Full Bill Eligibility System 304,000 896,000 1,200,000 Total $ 3,202,000 $ 6,121,000 $ 9,324,000 Totals may not sum due to rounding.

Figure 2 — Senate File 2422 Estimated Costs for FY 2028

Division Category State Federal Total

I SAVE FTE Positions $ 1,209,000 $ 1,591,000 $ 2,801,000 I FTE Position Support Costs 26,000 35,000 61,000 IV Retroactive Coverage Changes -672,000 -1,161,000 -1,833,000 V Cost Neutrality FTE Positions 353,000 353,000 705,000 V FTE Position Support Costs 5,000 5,000 11,000 V Cost Neutrality Actuarial Services 250,000 250,000 500,000 VII Premium Payment System 10,000 10,000 20,000 Total $ 1,181,000 $ 1,083,000 $ 2,265,000 Totals may not sum due to rounding.