Relating to the supplemental nutrition assistance program, the medical assistance program, the Iowa health and wellness plan, and other programs under the purview of the department of health and human services and including effective date provisions

DIVISION II —— SUPPLEMENTAL NUTRITION PROGRAM. The bill provides for additional requirements when HHS is determining the initial eligibility of a household for SNAP within the state. 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 an eligible immigration or United States citizenship status as detailed in the bill. HHS is required to notify the United States department of agriculture 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. _____ 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 HHS shall request a section 1115 demonstration waiver from the centers for Medicare and Medicaid services of the United States department of health and human services (CMS) to provide for two months of retroactive eligibility under Medicaid as described in the bill. Contingent upon the approval such waiver by CMS, HHS shall provide for a retroactive eligibility period of no more than two months upon request by a Medicaid-eligible applicant. HHS shall only provide retroactive eligibility if it determines that the person was eligible during the period of retroactive eligibility. HHS shall adopt rules as necessary pursuant to Code chapter 17A to implement and enforce retroactive eligibility. HHS may establish procedures, in compliance with federal requirements relating to notice and due process, to notify affected individuals and providers about retroactive Medicaid eligibility. The bill provides that HHS shall submit a request for a state plan amendment from CMS to provide for one month of retroactive eligibility under IHAWP as detailed in the bill. Contingent upon the approval of such state plan amendment by CMS, HHS shall provide for a retroactive eligibility period of no more than one month upon request by eligible IHAWP applicants. HHS shall only provide retroactive eligibility if it determines that the applicants were eligible during the period of retroactive eligibility. HHS shall adopt rules as necessary pursuant to Code chapter 17A to implement and enforce retroactive eligibility. _____ retroactive IHAWP eligibility. On or before January 15, HHS shall submit annually a report to the general assembly detailing specific data and the costs to the state related to retroactive eligibility under both Medicaid and IHAWP. HHS shall make the report available on HHS’s internet site. DIVISION V —— MEDICAID WAIVERS AND STATE PLAN AMENDMENTS —— COST NEUTRALITY. The bill requires HHS to conduct an analysis, prior to a request for a waiver or state plan amendment being submitted to CMS to expand coverage under the medical assistance program to additional individuals or classes of individuals, to determine if the waiver or state plan amendment is cost neutral. For any such waiver or state plan amendment that is determined to not be cost neutral, HHS shall not submit the request for a waiver to CMS unless the waiver 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. HHS shall conduct an 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.