Bills Associated with Iowa Psychological Association

Realigns the health and human services system by designating 'health and human services districts' (HHS districts) for the statewide delivery of programs and services, replacing previous behavioral health districts. It updates terminology and structure throughout the code, consolidates planning and service areas for aging and disability services to match HHS district boundaries, and creates a new volunteerism subunit within HHS to support and coordinate volunteer activities and the Iowa commission on volunteer service. Other changes include clarifying advisory council composition and duties, and formalizing processes for designation, review, and modification of districts.

Key Points & Impacts:

• Replaces 'behavioral health districts' with 'health and human services districts' (HHS districts) for program delivery; initial HHS districts mirror existing behavioral health districts.

• Adds and updates definitions throughout the code, including creation of 'behavioral health district advisory councils' and 'behavioral health service system district plans'.

• Removes language that allowed judicial review of district boundary modifications by HHS; such decisions are now not subject to judicial review.

• Aligns planning and service areas for aging and disability services to exactly match new HHS district boundaries, contingent on federal approval.

• Revises the structure and duties of advisory councils for behavioral health districts, specifying membership requirements and functions.

• Creates a subunit for volunteerism within HHS to manage volunteer programs and provide support to the Iowa commission on volunteer service, including appointment of an executive director and staff.

• Clarifies that registered volunteers are considered state employees for liability purposes, with exceptions for volunteer guardians/conservators.

• Authorizes the commission on volunteer service to delegate non-policymaking administrative duties to the new subunit for volunteerism.

Signed by Governor April 30, 2026. Provisions related to behavioral health districts takes effect April 30, 2026. Other provisions take effect July 1, 2026.

The legislation enacts wide-ranging reforms across healthcare, education, and nutrition. Notable changes include mandatory nutrition/metabolic health continuing education for physicians, required nutrition coursework for all medical school graduates, new restrictions on food dyes and additives in school meals, over-the-counter access to ivermectin, digital device time limits in elementary schools, and Iowa's adoption of the Psychology Interjurisdictional Compact.

Key Points & Impacts

• Requires at least 1 hour of continuing education on nutrition and metabolic health every 4 years for physicians as a license renewal condition.

• Mandates at least 40 hours of nutrition and metabolic health coursework for graduation from Iowa medical schools, effective July 1, 2028.

• Establishes strict prohibitions on specific food dyes and additives (e.g., Blue 1/2, Green 3, Potassium bromate, Propylparaben, Red 40, Yellow 5/6) in school meals and sales during the school day, applying to public, charter, innovation zone, and nonpublic schools receiving state funds (beginning July 1, 2027).

• Directs HHS to apply for a waiver to apply the same food restrictions to the 'summer electronic benefits transfer for children program' (summer EBT).

• Expands permissible epinephrine delivery systems (including nasal sprays, not just auto-injectors) in schools and public facilities, updating liability protections and staff training requirements accordingly.

• Allows pharmacists to distribute ivermectin as an over-the-counter medicine for human use without a prescription, and protects them from professional discipline or legal penalties for such distribution.

• Limits digital instruction to 60 minutes per day for K-5 students (with exceptions), requires technology use policies in elementary schools, and establishes a working group to study technology's cognitive impact on grades 6-12.

• Reintroduces the Presidential Fitness Test in schools, requires K-4 students to have at least 40 minutes of physical activity each day and 5th graders have at least 30 minutes per day.

• Adopts the Psychology Interjurisdictional Compact, enabling licensed psychologists to provide telepsychology and temporary in-person services across state lines under uniform rules and mutual recognition.

Signed by Governor May 20, 2026. Takes effect July 1, 2026; applicable July 1, 2027.

Revises the process and authority regarding parental consent for the voluntary admission and treatment of minors in mental health and substance use disorder. Eliminates the requirement that juvenile court approval is needed when a minor objects to admission for mental health or substance use treatment, granting parents or guardians the power to authorize such services over a minor's objection. It also provides that any limitations on these parental rights will be subject to strict judicial scrutiny. The bill also clarifies that healthcare professionals or facilities are not required to provide treatment if it is deemed inappropriate or the criteria for admission are not met. Effective 7/1/2026.

Key Points & Impacts

• Removes the requirement that juvenile court approval is necessary for voluntary admission of a minor to a hospital for mental health treatment when the minor objects.

• Grants parents or guardians the explicit right to consent to and authorize various mental health and substance use disorder services for their minor child, even if the child objects.

• Clarifies that such parental or guardian consent and authorization supersedes the minor child's objections.

• Establishes that any restriction of these parental rights is subject to strict scrutiny, raising the legal standard for any challenge to these rights.

• Clarifies that healthcare providers and facilities are not obligated to provide treatment if they determine it is not appropriate or if admission criteria are not met.

• Removes statutory procedures involving appointment of an attorney, advocate, and hearing process in juvenile court when a minor objects to voluntary admission for mental health treatment.

• Amends statutory language to refer to these enhanced parental rights broadly, including medical care, education, and upbringing.

• Specifies that family counseling and therapy may still be ordered by the juvenile court when necessary to facilitate the minor's return to the family.

Requires subacute mental health treatment facilities to develop an initial treatment plan for residents within 24 hours of admission. Creates timelines for insurance preauthorization determinations for subacute mental health services. Establishes an electronic system to track psychiatric bed availability for children and mandates a collaborative review of administrative rules to eliminate barriers to facility access and workforce flexibility. The Department of Health and Human Services is tasked with reviewing the feasibility of expanding subacute and psychiatric inpatient services at the Independence MHI (report due . Effective 4/16/2026.

Key Points & Impacts

• Requires subacute care facilities to develop an initial treatment plan with a resident within 24 hours of admission.

• Establishes strict deadlines for insurance preauthorization requests for subacute mental health services (if submitted through portal designated by HHS): 48 hours for urgent, 5 days for nonurgent, and 10 days for nonurgent complex cases. MCOs also required to adhere to these timeframes.

• Directs Iowa HHS to create an electronic bed tracking system for psychiatric medical institutions for children (PMICs).

• Mandates interdepartmental review and elimination of administrative rules that impede establishment, expansion, or access to subacute mental health facilities unless a rule provides equal or greater benefit.

• Requires loosening of employment requirements at subacute mental health facilities, making them less stringent than those at state mental health institutes (MHIs).

• Directs Iowa HHS to assess the feasibility and costs of expanding subacute and psychiatric services at the Independence MHI, including the potential for private partnerships (report due 1/4/2027).

• Allows Iowa HHS to provide subacute mental health care services at the Independence MHI if it can do so within its budget, starting July 1, 2026, unless the Legislature directs otherwise.

Revises the Iowa Rules of Criminal Procedure regarding commitment hearings following an acquittal based on insanity. Ensures that the absence of recent overt acts of dangerousness cannot be the only determining factor in whether a defendant is a risk to themselves or others, especially if such absence is due to a highly structured environment. Courts must consider a comprehensive list of factors, including original offense, behavioral and psychiatric history, substance use, institutional behavior, environmental influences, and expert assessments. The revised rules must be submitted for legislative review by October 14, 2026.

Key Points & Impact:

• Mandates the Iowa Supreme Court to revise criminal procedure rules for post-insanity acquittal commitment hearings.

• Bars courts from using the absence of recent overt acts of dangerousness as the sole determining factor in risk assessments, especially when the defendant is in a highly structured environment.

• Requires courts to consider the nature and circumstances of the original offense leading to the insanity acquittal.

• Requires evaluation of the defendant's behavioral history, including prior violent or dangerous acts, regardless of recent conduct.

• Includes consideration of psychiatric history, current mental status, and treatment adherence.

• Mandates assessment of substance use disorder history, its relationship to dangerousness, risk of relapse, and engagement in treatment.

• Requires examination of institutional behavior, independent functioning, and adaptability to less structured environments.

• Directs consideration of expert testimony, validated risk assessments, and environmental influences on behavior.

Signed by Governor on April 9. Takes effect July 1, 2026.

Realigns the health and human services system by designating 'health and human services districts' (HHS districts) for the statewide delivery of programs and services, replacing previous behavioral health districts. It updates terminology and structure throughout the code, consolidates planning and service areas for aging and disability services to match HHS district boundaries, and creates a new volunteerism subunit within HHS to support and coordinate volunteer activities and the Iowa commission on volunteer service. Other changes include clarifying advisory council composition and duties, and formalizing processes for designation, review, and modification of districts.

Key Points & Impacts:

• Replaces 'behavioral health districts' with 'health and human services districts' (HHS districts) for program delivery; initial HHS districts mirror existing behavioral health districts.

• Adds and updates definitions throughout the code, including creation of 'behavioral health district advisory councils' and 'behavioral health service system district plans'.

• Removes language that allowed judicial review of district boundary modifications by HHS; such decisions are now not subject to judicial review.

• Aligns planning and service areas for aging and disability services to exactly match new HHS district boundaries, contingent on federal approval.

• Revises the structure and duties of advisory councils for behavioral health districts, specifying membership requirements and functions.

• Creates a subunit for volunteerism within HHS to manage volunteer programs and provide support to the Iowa commission on volunteer service, including appointment of an executive director and staff.

• Clarifies that registered volunteers are considered state employees for liability purposes, with exceptions for volunteer guardians/conservators.

• Authorizes the commission on volunteer service to delegate non-policymaking administrative duties to the new subunit for volunteerism.

Signed by Governor April 30, 2026. Provisions related to behavioral health districts takes effect April 30, 2026. Other provisions take effect July 1, 2026.

Appropriates $2.56 billion to fund various health, veterans, and human services (including Medicaid) for fiscal year 2027, which begins on July 1, 2026. This is a $3.1 million increase. Veterans: No change in funding for Veterans Home, Department of Veterans Affairs and Veteran Homeownership Program. Disability & Aging Services: Funding for the Statewide Independent Living Councils and Centers for Independent Living that had been funded in the Economic Development Budget are moved here ($171,351). Re-establishes and level funds ($949,282) the Comprehensive Family Support Program that was accidentally eliminated in 2024 (HF 2673), allowing the children at home program to continue (this change is effective back to July 1, 2025). No change in the Office of Long Term Care Ombudsman ($1,148,959).  Behavioral Health:  Eliminates funding for tobacco use and gambling prevention marketing materials ($580,200), Quitline ($500,000), and Iowa Students for Tobacco Education and Prevention (STEP) Summit ($120,000). Iowa HHS says Quitline will be paid for with federal funds. Eliminates funding for the Center for Excellence in Behavioral Health ($100,000). No change in funding for the children's behavioral health system ($300,000).  Transfers $5.6 million payment from the Behavioral Health Fund to Medicaid.  Requires HHS to provide the Legislature with a report on behavioral health expenditures to children and adults annually on December 15 (to include a summary of funding sources used). Public Health: Adds back line item for child vision screening ($191,000) and epilepsy education and support ($144,000), which were eliminated in 2023 (FY 2024). While the line items were eliminated, HHS continued to fund them. No change in funding for prescription drug donation program/SafeNetRX ($600,000), free clinics ($374,000), rural health clinics ($25,000), free radon test kits ($20,000), and state poison control center ($750,000). Eliminates funding for the volunteer specialty care provider network managed by Polk County Medical Society ($225,000), and the survey of Adverse Childhood Experiences/ACES ($40,000). Adds $1,171,999 to pay for the summer EBT program to help with childhood food insecurity. Adds new $1.5 million appropriation for medical residency grants outside of Johnson County (not to include family practice).  Medicaid: Level funds Medicaid, but includes transfers in funds that cover the expected $151.9 million shortfall.  Increases rates for elderly waiver ($3 million), ambulatory surgical centers ($1.2 million), and special population nursing facilities ($333,000). Continues HHS' recommended cost containment (savings noted): allowing dispensing of 90-day prescriptions ($150,000), shifting some behavioral services to Medicare ($308,000), cutting rates for telehealth-delivered services/site of service differential ($491,000), adjusting codes for venipuncture and therapy rehabilitation ($602,000), 30-day readmission for same diagnosis policy changes ($1.1 million), speech/language pathology service adjustments ($1.2 million), Medicaid paying lowest available price ($2.2 million), and facility and provider based billing adjustments ($5.4 million). Codifies current reimbursement structure for On With Life and ChildServe (special population nursing facilities), ending their need to go through an exception to policy. No change in funding for family planning program ($3,383,880). Increases funding for the children's health insurance program (Hawki) by $7.2 million, for total of $68,474,831 appropriation.  Shifts $6.5 million in costs to MCOs and reduces general fund spending because of influx of revenues from the temporary HMO tax ($132.9 million). Requires HHS to annually review all Medicaid provider reimbursement rates that are on a fee schedule and compare those rates to Medicare (for dental, rates are compared to neighboring state Medicaid rates), with a report due to the Legislature on January 15. Child Welfare: Increases child welfare provider rates ($1,590,842 for shelter, $3,245,594 for QRTP). Requires HHS to review child welfare provider (shelter care, QRTP) rates every two years, based on their cost reports, and report findings to Legislature by October 1.  Ends contracts for Treatment Outcome Package (TOP) protocols and instead use existing lower-cost tool ($1.4 million). Reduces state funding for childcare by $3 million ($32.7 million total appropriation) and federal block grant funding for childcare by $4.9 million ($42.3 million total appropriation). Increases funding for the More Options for Maternal Health (MOMS) Program by $1,493,299 and allows any remaining unspent funds at the end of the year to carry forward. Reduces funding for Eldora by $673,000. Eliminates "duplicative" funding for child abuse prevention administrator ($300,000). No change in funding for Early Childhood Iowa/ECI ($29,256,799) but eliminates funding for decategorization projects ($1.7 million). Reduces state funding by $1 million because of the "establishment of a central consulting model that is expected to decrease overtime hours for social workers." No change in funding for court-ordered juvenile services ($748,000) and child protection center grants ($1,658,000).  State Institutions: Reduces funding for MHIs by $1.75 million and Woodward by $1.9 million. Continues to fund the now-vacant Glenwood at $942,000 (a decrease of $648,000).  Directs HHS to apply for a waiver of Medicaid's "Institution for Mental Diseases" (IMD) exclusion, which would allow HHS to draw down federal matching funds to offset the costs of the state's two Mental Health Institutes (MHIs). This will increase Medicaid costs between $300,000-$350,000 but will reduce costs for MHIs (for an overall state budget savings). Other Appropriations: Allows automatic appropriation to continue for Child Abuse Prevention ($233,000), Center for Congenital & Inherited Disorders Registry ($224,000), and Behavioral Health Fund ($1 million). Appropriates $3 million in opioid settlement funds for the Renewal Falls Recovery Center in Cedar Falls. Transfers $9.9 million in funds left in funds eliminated last year in HF 972 (Health Care Workforce Shortage Interest Account, Medical Residency Training Account, Family Medicine Obstetrics Fellowship Program Fund, Rural Psychiatry Residency and Fellowships) to fund graduate medical education (GME) for residencies other than family medicine. Adds a new (additional) $1.5 million appropriation to support GME.  Other: Continues allocating 70% of community mental health block grant funds to designated community mental health centers (this formula was to expire September 30, 2026). Requires HHS to make staffing (FTE) information available on a public website. Gives HHS the ability to adopt emergency rules to implement federal changes (but must let Legislature know if those emergency rules increase costs to the state). Cuts 9.5 staff positions from the Bureau of Refugee Services due to reorganization. Increased expenses due to One Big Beautiful Bill Act (OBBA) and Senate File 2422 (Eligibility Verification/Public Assistance): Increases funding for the administration of the Supplemental Nutrition Assistance Program (SNAP) by $10,122,527 as required by OBBBA (there are two different line items in the budget for this - $8,738,907 and $1,383,620).  Adds $859,200 in funding to pay for the increased costs of public assistance eligibility determination as a result of OBBBA.  Adds a total of $123,444 to pay for the cost of determining Medicaid waiver neutrality per SF 2422 (there are two line items for this as well - $58,874 and $64,570). Adds $670,333 to Medicaid to pay for eligibility verification changes in SF 2422. You can read more details at: https://www.legis.iowa.gov/docs/publications/NOBA/1605124.pdf. Effective 7/1/2026. LINE ITEM VETO: The Governor vetoed the requirement that 70% of the mental health block grant continue to go to CMHCs and the $3 million opioid settlement earmark for Renewal Falls Recovery Center in Cedar Falls. You can read the Governor's veto message here.

Appropriates $1.042 billion to the Department for the Blind, Department of Education, Board of Regents, and Department of Workforce Development for fiscal year 2027, which begins July 1, 2026. This is an increase of $10.5 million.  New funding for: dyslexia specialist program to offset costs to teachers getting this endorsement ($335,000) and school district electronic mail security to protect from cyber threats ($500,000). Increases funding for: school food service by $76,000; Iowa School for the Deaf by $764,000; educational services for the blind and visually impaired by $100,243; and community colleges by $3.5 million. No change in funding for: special education ($10 million); Department for the Blind ($3.2 million); Iowa Public Television ($8.2 million); IDEA required birth to age 3 services ($1.7 million); early head start ($574,500); work-based learning clearinghouse ($300,000); reading research center ($1.5 million); Best Buddies ($35,000); therapeutic classrooms ($2.4 million); Language Equality and Acquisition for Deaf Kids/LEAD-K ($200,000); Health Care Professional Incentive Program ($7,985,911); Iowa Workforce Grant and Incentive Fund ($6.5 million); Future Ready Iowa Skilled Workforce Grant ($425,000); capital projects for community colleges ($6 million); STEM Best ($700,000); Child Health Specialty Clinics ($634,502); statewide cancer registry ($143,410); substance abuse consortium ($53,427); birth defects registry ($36,839); Iowa Flood Center ($1.2 million); UI College of Nursing ($2.8 million); and UI Center for Intellectual Freedom ($1 million); UNI Center for Civic Education ($1 million). Decreases funding for: training teachers to address children's mental health by $1.5 million (leaving $1.9 million). Other changes: Eliminates the Iowa Special Education Council and limits the automatic appropriation for at-risk student programs to $10.5 million (reducing funding by $2.6 million). Suspends the automatic "standing" appropriation for college work study programs, repeals tuition grants for for-profit colleges, and removes the requirement that 25% of educator licensing fees be sent to the state general fund (instead 100% will be retained by board of educational examiners). Requires state universities to mandate undergraduate completion of both American history and American government survey courses (minimum 3 credits each) as part of general education for students enrolling (beginning July 2028). Freezes tuitions for resident undergraduates at state universities (tuition charged in a student's first academic year cannot increase for up to three consecutive years of undergraduate enrollment) and caps annual tuition increases at the average Higher Education Price Index growth for the past three years. Reforms dropout prevention funding. Requires the Department of Education to submit an annual report to on all incidents of violence in schools, referrals to therapeutic classrooms, and department antibullying programming and expenditures.Eliminates the separate Iowa Tuition Grant for for-profit institutions and allows students at eligible for-profit schools (notably barbering/cosmetology) to access the vocational-technical tuition grant, with new matching aid requirements and increased maximum grant amounts. You can read more about the budget at: https://www.legis.iowa.gov/docs/publications/NOBA/1605130.pdf. Effective 7/1/2026.  LINE ITEM VETO: The Governor vetoed the $500,000 earmark for school district email security. You can read the Governor's veto message here.

Changes standing (automatic) appropriations, makes other appropriations left out of other budgets, fixes mistakes in other bills, and drops in changes that were part of last-minute negotiations. Education: Maintains current reductions in standing appropriations - AEAs ($7.5 million) and non-public school transportation ($9 million). Requires state universities require all undergraduates to complete two three-credit courses as part of their general education requirement (American History and American Government), but this does not apply to any degree that is completed in three years or less. Applies to students beginning college on or after July 1, 2028. Requires the ISU Center for Cyclone Civics and the UI Center for Intellectual Freedom are to designate which courses meet these requirements. Continues incentives for school mergers through July 1, 2035 (expired July 1, 2024). Makes an exception for a school district to increase their cash reserve levy if a single property in their district's change in valuation caused a loss of more than $100 million (effective upon enactment).  Health/Human Services: Appropriates $1 million from the sports wagering fund for Double Up Food Bucks. Appropriates $3 million to the University of Iowa for pediatric cancer research. Requires a report detailing how funds were used to be filed with Legislature by 10/1/2027. Prohibits funding provide for pediatric cancer research from being used for administrative/overhead costs not directly related to research. Makes public assistance reforms enacted in SF 2422 effective when new eligibility systems go live. Requires a trained child protection worker to screen a child for commercial sex abuse if HHS identifies known risk factors in the child's background. Changes the effective date of moving victim restitution from category "B" to "A" in HF 1036 (Human Trafficking) from July 1, 2026 to July 1, 2027.  Fund Balance Transfers: Allows use of $12 million in federal incentive payments from FY26 to be used for administering the unemployment compensation insurance program and for modernization efforts. Transfers COVID funding balances in HHS to the HHS Information Technology Fund and appropriates the following from that fund: $31 million for the Medicaid management information system, $30.5 million for the eligibility determination system, $34 million for child welfare IT projects, and $5 million for implementation of SF 2422 (public assistance reforms). Allows special funds (gambling enforcement, road use tax fund, fish and game, IPERS, etc) to be used for salary adjustments. Allows funds remaining in the Future Ready Iowa Apprenticeship Fund to be used to support the Iowa Office of Apprenticeships. Requires state agencies and the judicial branch to notify the House and Senate Appropriations Committee Chairs and Ranking Members and the Chair and Ranking Member of the House Federal Funds Appropriations Subcommittee of any federal grant or loan in excess of $5 million received or applied for in the previous month (but exempts the Iowa Department of Defense & Board of Regents) and any grant or loan applied for or received that requires a state match.  Other: Adopts national electrical code. Amends Civil Rights legislation (SF 579) to not only prohibit the enactment of civil rights ordinances/regulations that go further than the state law, but also prohibit enforcement of existing ordinances and regulations. Prohibits a state political party's platform from prohibiting an elected official from serving on the state party central committee, and requires each party's state central committee to adopt a Chair, Vice Chair, Treasurer, and Secretary. Makes Japanese Knotweed a noxious weed. Requires the Iowa State Fair Foundation to issue 126 (instead of 125) nonresident deer hunting licenses, with the 126th license to be used at the discretion of the fair. Regulates proprietary water treatment systems. Renames the poultry association. Eliminates cap on full-time county attorney salaries (currently 45-100% of district court judge salary). Creates a new civil cause of action for "civil litigation abuse," defined as filing lawsuits between two private parties intended to harass, cause financial harm, or interfere with business relationships in done for "ulterior purposes." Corrections: Makes technical corrections for a number of bills passed earlier in session (non substantive). You can read more detail at: https://www.legis.iowa.gov/docs/publications/NOBA/1605279.pdf. Effective 7/1/2026. LINE ITEM VETO:  The Governor vetoed the transfer of remaining COVID relief funds to the Information Technology Fund, limitations on use of information technology funds by HHS, changes to the HMO tax that would have held Wellmark harmless (and risked $120 million in federal funding coming into Medicaid next year fiscal year), and the new civil cause for "litigation abuse."  You can read the Governor's veto message here. 

Allocates $193.6 million from the Rebuild Iowa Infrastructure Fund (RIIF) and Technology Reinvestment Fund for fiscal year 2027, which begins on July 1, 2026. Money in these funds comes from taxes on gambling.  New funding for: On With Life to build a wing at their Polk City location to accommodate young adults aging out of ChildServe ($4 million); strategic infrastructure program ($10 million); hosting national junior olympics ($250,000); sports entertainment venue in Newton ($7 million); railway tracks overpass and underpass fund ($5 million/year for five years); interactive museum exhibit at the Hoover Presidential Library ($1 million); and Iowa HHS' new eligibility determination system ($10 million), data integration into the new system ($1,633,361), and costs associated with implementing new Medicaid work requirements and other requirements of the One Big Beautiful Bill/HR 1 ($3,473,690). Ongoing funding (no change) for: water quality ($8.2 million); water quality/nitrogen modeling ($1 million); community attractions and tourism/CAT grants ($10 million); Destination Iowa Fund ($10 million); lake restoration projects ($9.6 million); state park infrastructure ($5 million); low head dams ($1.5 million); recreational trails ($2.5 million); railroad revolving fund ($2 million); derelict building fund ($1 million); and general aviation airports ($1 million). Increases funding for: regional sports authorities by $250,000 ($1 million) and commercial service airports by $600,000 ($2.5 million). Other Changes: Eliminates $1.2 million appropriation for public transit infrastructure and replaces it with a one-time $1.6 million appropriation to be used as partial federal match for approved grants (total of $3 million was needed). Prohibits Iowa HHS from entering into technology purchase agreements that cost more than $5 million or committed the state to multi-year obligations in its IT systems (the current system being funded by this bill, in response to the One Big Beautiful Bill changes, is exempt from this requirement).  Iowa HHS, Legislative Services Agency, and Department of Management are to set up an Information Technology Modernization Study Committee before 8/1/2026 to review Iowa HHS' technology systems, data architecture, and modernization strategy. The committee is also to include six ex-officio members of the Senate and House and allows others in private sector firms, academic experts, and subject matter experts to participate. The committee will identify redundancies and interoperability gaps, assess HHS' ability to integrate data across programs and databases, evaluate options for developing/purchasing an integrated architecture system; and consider existing vendors supporting current systems. Requires prioritizing long-term solutions that integrate systems, detect eligibility errors, improper payments, and fraudulent activities while deducting duplication (report due 1/1/2027).  Establishes the Railway Overpass & Underpass Fund to provide cities/counties with grants to construct overpasses and underpasses. Allows awardees of the Iowa Major Events & Tourism Fund to also receive regional sports authority funds. Effective 7/1/2026. More details can be found at:https://www.legis.iowa.gov/docs/publications/NOBA/1605200.pdf.  LINE ITEM VETO: The Governor vetoed the $5 million limit on HHS information technology contract obligations without legislative approval. You can read the Governor's veto message here.

Exempts situations in which a parent or legal guardian is unable to access appropriate behavioral or mental health care for their child from being classified as child abuse when declaring a "child in need of assistance," provided reasonable attempts have been made to secure such care. The Department of Health and Human Services must incorporate this exemption into its child abuse assessment policies and manuals. However, the department retains the authority to assess the child's situation and facilitate interventions as necessary. Effective 7/1/2026.

Key Points & Impacts

• Adds a new provision to Iowa Code Section 232.68 explicitly exempting a parent's or guardian's inability to access behavioral or mental health treatment from the definition of child abuse if reasonable efforts are made.

• Clarifies that lack of access to behavioral or mental health treatment alone cannot be the basis for a child abuse determination.

• Requires the Department of Health and Human Services to update its child abuse assessment policies and manuals to reflect this exemption.

• Preserves the department's authority to assess and intervene in a child's situation if deemed necessary for the child's best interests.

• Focuses on protecting parents and guardians from child abuse accusations solely due to systemic barriers to mental health care access for their children.

• Targets cases involving children with diagnosed behavioral health conditions.

• Stipulates that reasonable attempts to secure treatment must be demonstrated for exemption to apply.

• Ensures departmental intervention remains available in cases where other issues may be present.

The bill strikes numerous provisions from Iowa law that require or reference affirmative action, race, gender, or citizenship in state employment, contracting, and educational programs. It removes the obligation to develop affirmative action plans, report on minority or gender representation, and utilize minority, women’s, or disadvantaged business enterprises. Instead, emphasis is placed on equal opportunity and the use of Iowa-based businesses. Several grant and educational programs targeting minorities are redefined or repealed. The bill also eliminates citizenship as a protected status for purposes of eligibility for professional licensing. Effective 7/1/2026.

Key Points & Impacts

• Eliminates all state-mandated affirmative action planning, reporting, and related administrative positions/responsibilities within state agencies, Board of Regents, and education entities.

• Removes requirements to track or report on minority, gender, or disadvantaged status in state employment and contracting; reporting shifts to focus on Iowa-based businesses only.

• Strikes requirements that state agencies or educational institutions develop or report on affirmative action or minority recruitment/retention standards.

• Repeals or redefines several grant and education programs previously limited to or focused on minorities, removing race-based eligibility and references.

• Removes explicit protections based on citizenship status for applicants for professional licenses (health care, architecture, engineering, real estate, accounting, etc.), though still requires non-discrimination on other bases.

• Removes race/ethnic minority considerations from certificate of need review for health services and other state program eligibility criteria.

• Repeals requirements for minority impact statements in state grant applications and eliminates related reporting and compliance mandates.

• Directs code editors to update Iowa Code accordingly and to transfer certain code sections as a result of these changes.

Strengthens Iowa’s response to human trafficking by requiring annual stakeholder meetings for the next five years to develop legislative proposals to combat human trafficking (report due annually on 12/1).  Defines “commercial sexual exploitation” to juvenile justice code section. Establishes new screening and referral protocols for children potentially subject to commercial sexual exploitation (when referred for child abuse or during intake for juvenile delinquency). Extends some civil statute of limitations for sexual assault and adds human trafficking.  Minors will have up to five years after turning age 18 to file a civil action (or up to five years following the discovery of the sexual assault/human trafficking, if they were adult when they realized it happened). Gives more discretion to prosecutors to allow them to waive arrest and prosecution of a victim of human trafficking and instead refer them to Iowa HHS as a “child in need of assistance.” Moves victim compensation orders in human trafficking cases up to “category A,” which means they will be paid first before other restitution (this was done in the victim rights bill below for all other sexual assault and domestic violence cases). Finally, the bill directs the Iowa HHS to develop a plan for increased restoration facilities, and clarifies that minors engaged in sex work are not to be prosecuted but referred for protective services.

Key Points & Impacts

• Creates an annual stakeholder meeting and report to the governor and legislature on human trafficking, involving representatives from law enforcement, legal, advocacy, and survivor communities.

• Defines 'commercial sexual exploitation' and mandates that all juvenile complaints must be screened with a standardized human trafficking indicator list, and if indicators are present, children must be further screened using evidence-based, trauma-informed tools.

• Requires the Department of Health and Human Services to screen all children subject to child abuse allegations for commercial sexual exploitation using trauma-informed tools.

• Extends the civil statute of limitations for actions related to child sexual abuse or human trafficking from one year to five years after reaching majority, and from four to five years after discovery of injury for adults.

• Expands the definition of human trafficking to include 'patronizing' and 'soliciting.'

• Prohibits prosecution or charging of minors under 18 engaged in prostitution, instead requiring referral to protective services and/or temporary custody.

• Modifies restitution categories by moving crime victim compensation program reimbursements from 'Category B' to 'Category A' and clarifies eligible restitution recipients.

• Directs the Department of Health and Human Services to develop a plan (with nonprofit input) to increase restoration facilities and protective services for juvenile trafficking victims, including those not involved in the court system, and to report to the governor and legislature by December 15, 2025.

Revises the Iowa Rules of Criminal Procedure regarding commitment hearings following an acquittal based on insanity. Ensures that the absence of recent overt acts of dangerousness cannot be the only determining factor in whether a defendant is a risk to themselves or others, especially if such absence is due to a highly structured environment. Courts must consider a comprehensive list of factors, including original offense, behavioral and psychiatric history, substance use, institutional behavior, environmental influences, and expert assessments. The revised rules must be submitted for legislative review by October 14, 2026.

Key Points & Impact:

• Mandates the Iowa Supreme Court to revise criminal procedure rules for post-insanity acquittal commitment hearings.

• Bars courts from using the absence of recent overt acts of dangerousness as the sole determining factor in risk assessments, especially when the defendant is in a highly structured environment.

• Requires courts to consider the nature and circumstances of the original offense leading to the insanity acquittal.

• Requires evaluation of the defendant's behavioral history, including prior violent or dangerous acts, regardless of recent conduct.

• Includes consideration of psychiatric history, current mental status, and treatment adherence.

• Mandates assessment of substance use disorder history, its relationship to dangerousness, risk of relapse, and engagement in treatment.

• Requires examination of institutional behavior, independent functioning, and adaptability to less structured environments.

• Directs consideration of expert testimony, validated risk assessments, and environmental influences on behavior.

Signed by Governor on April 9. Takes effect July 1, 2026.

Establishes a grant program to fund a nonprofit Sexual Assault Forensic Examination Center, administered by the Department of Justice. Contingent upon funding, the Attorney General is authorized to contract with an eligible nonprofit organization to operate and maintain sexual assault forensic examination centers across Iowa. Eligible nonprofits must be independent from hospitals or health systems, employ or make available sexual assault nurse examiners, maintain treatment facilities focused on serving sexual assault survivors, and have survivor services as their primary purpose. Contracting organizations must provide medical forensic services to diverse populations (including adults, persons with disabilities, and rural Iowans), offer training to law enforcement and health professionals, use a cooperative team approach, consult with multidisciplinary experts on complex sexual assault cases, and submit annual reports to the Attorney General and General Assembly by January 15 each year.The bill also authorizes the Department of Justice to accept gifts, grants, bequests, private contributions, and state or federal moneys. Takes effect July 1, 2026.  Funding is provided in the Justice Systems Budget.

Key Points & Impacts

• Creates new Iowa Code Section 915.47 establishing the Sexual Assault Forensic Examination Center Grant Program in the Department of Justice

• Authorizes the Attorney General, contingent upon funding, to contract with an eligible nonprofit to operate sexual assault forensic examination centers statewide

• Requires eligible nonprofits to be Iowa-incorporated under chapter 504, independent of hospitals/health systems, and employ sexual assault nurse examiners

• Mandates contracting organizations serve diverse populations including adults, persons with disabilities, rural Iowans, and other underserved groups

• Requires training for law enforcement, prosecutors, health care professionals, and the public on sexual assault services and prevention

• Mandates a multidisciplinary cooperative team approach addressing complex cases involving intimate partner violence, human trafficking, incest, and drug-facilitated sexual assault

• Requires annual reports by January 15 to the Attorney General and General Assembly with aggregated, anonymized client demographics, services, referrals, and identified service gaps

• Creates a Sexual Assault Forensic Examination Center Grant Program Trust Fund, appropriating all deposited moneys (gifts, grants, state/federal funds) to the Department of Justice with interest retained in the fund.

Makes it a fraudulent practice to falsely claim academic degrees or credentials for purposes of employment or personal gain. Effective 7/1/2026.

Key Points & Impact:

• Makes falsely claiming academic degrees, licenses, and credentials for employment or personal gain a fraudulent practice.

• Targets individuals who use false academic credentials to obtain jobs or other personal benefits.

• Falsely claiming professional or occupational licensure for the purposes of employment or personal gain is considered 3rd degree fraud (aggravated misdemeanor).

• Falsely claiming academic credentials or degrees for the purposes of employment or personal gain is considered 5th degree fraud (simple misdemeanor).

This bill makes substantial changes to Iowa's education code, particularly regarding summative assessment administration, curriculum content for K-12 (including kindergarten and health education), and requirements for both public and nonpublic schools. Notable changes include the restructuring of required assessments, expansion and clarification of health curriculum requirements, removal of certain equity and diversity mandates, and changes to school compliance procedures. It also clarifies that funding for state mandates will come from existing state aid, with no new appropriations. Some provisions apply to charter and innovation schools to ensure parity with public school requirements. Effective 7/1/2026 (social studies requirement effective 7/1/2027).

Key Points & Impacts

• Restructures statewide assessment requirements: clarifies grades and subjects for math, ELA, science, and adds social studies assessments in grades 8 and 11.

• Removes language requiring assessment alignment with the 'Iowa common core' and instead references Iowa standards; clarifies federal compliance applies only 'if applicable.'

• Removes state rules mandating multicultural, gender-fair, and global perspectives in curriculum and instruction across all grades; eliminates requirement to develop and distribute standards of practice for equity coordinators.

• Expands and specifies required content in health curriculum for grades 1-12, now listing explicit topics (e.g., communicable diseases, physical fitness, nutrition, substance use, CPR, and prevention/control of disease).

• Allows additional mathematics units to include agriculture and clarifies inclusion of applied sciences, technology, engineering, and manufacturing, broadening curricular options.

• Adjusts guidance counselor requirements to mandate collaborative work with parents/guardians and specifies goals for academic, career, and social development.

• Mandates that students may not serve on committees related to school library material removal decisions, applying this to charter and innovation schools as well.

• Specifies that school district compliance costs for new mandates are to be covered by existing state foundation aid; no new appropriations are provided.

The Act mandates use of federal e-verify and SAVE systems for employment and professional licensure eligibility verification across multiple sectors, including education, public employment, and professional licensing. It establishes criminal and civil penalties for knowingly providing or accepting false social security numbers, prohibits issuance or renewal of professional licenses to individuals unlawfully present in the U.S., and adds strict requirements for voter registration and citizenship verification. Additionally, it imposes stricter pretrial detention standards for unauthorized aliens and those charged with forcible felonies. The law provides severability and contingent implementation clauses in case parts are found invalid or federal verification systems become inaccessible.

Key Points & Impacts

• Requires the Board of Educational Examiners to verify legal authorization to work in the U.S. for all initial and renewing applicants, as well as periodic verification for those not subject to renewal.

• Prohibits employers from hiring or continuing to employ individuals known to have provided false social security numbers; imposes civil penalties and mandatory compliance training for repeat violations.

• Defines and criminalizes the act of providing or accepting a false social security number for employment purposes.

• Mandates use of the federal e-verify system for employment eligibility verification by the legislature, state agencies, cities, counties, school districts, nonpublic schools, charter schools, and certain higher education institutions; results must be reported to federal immigration authorities if a lack of legal status is found.

• Establishes a SAVE program clearinghouse for professional licensing boards to verify the citizenship and immigration status of license applicants, and prohibits issuance or renewal of licenses to those unlawfully present.

• Requires voter registration forms to include a new oath affirming U.S. citizenship, mandates monthly/annual systematic verification of voter citizenship, and establishes procedures for deregistration of unconfirmed registrants.

• Imposes a rebuttable presumption against bail for unauthorized aliens charged with indictable offenses and for all defendants charged with forcible felonies, with specific appeal and challenge procedures.

• Contains detailed severability and suspension clauses to address federal court rulings or loss of access to verification systems, ensuring continued effect of unaffected provisions.

Signed by Governor June 2, 2026. Takes effect July 1, 2026.

Create the "medical ethics defense act," creating new legal protections for medical practitioners and health care institutions who refuse to participate in or pay for health care services that violate their ethical, moral, or religious beliefs ('conscience'). The law prohibits discrimination for exercising these rights, shields practitioners and institutions from liability for such refusals, and grants whistleblower protections for reporting violations. It also protects free speech and expressive activities related to medical ethics, sets procedures and penalties for regulatory agencies, and provides remedies for unlawful interference. The Act explicitly maintains emergency medical care requirements and upholds confidentiality laws.  Effective July 1, 2026.

Key Points & Impacts

• Defines 'conscience' for both individuals and entities, and prohibits discrimination against practitioners or institutions refusing services based on conscience objections.

• Prohibits civil, criminal, and administrative liability for good-faith exercise of conscience by practitioners or health care institutions, including for actions by employees or contractors.

• Provides whistleblower protections for practitioners or institutions who report suspected violations, participate in proceedings, or disclose information about legal or ethical violations, mismanagement, or patient safety concerns.

• Prohibits state agencies and licensing boards from reprimanding or revoking licenses/certifications for protected speech or expressive activity unless direct patient harm is proven by clear and convincing evidence.

• Requires agencies to notify practitioners/institutions within 21 days of complaints regarding protected speech, with a $500/day penalty for noncompliance.

• Allows civil actions and remedies for unlawful interference with conscience rights, whistleblower protections, or free speech, including injunctive relief, damages, and attorney fees.

• Clarifies that no additional burden or expense to other providers or institutions is a defense to violating these protections, and that other legal rights and remedies remain intact.

• Explicitly excludes appropriations, focusing on legal rights, liabilities, and penalties, not on funding or budget allocations.

• Includes severability clause (so if part of the bill is struck down in the courts, the rest of the bill remains in effect).

Signed by Governor May 19, 2026. Takes effect July 1, 2026.

Regulates how cost sharing (copayments, coinsurance, deductibles) is applied for enrollees in group insurance and accident/health insurance who have HSAs and qualified HDHPs. If the cost sharing could jeopardize HSA eligibility under federal law, it must only be applied to the HDHP after the enrollee meets the required minimum deductible, except for preventive care as defined by federal law. The bill aligns state requirements with federal tax code provisions for HSAs.

Key Points & Impacts:

• Adds new sections to Iowa law specifically addressing cost sharing for HSAs and qualified HDHPs.

• Prohibits application of copayments, coinsurance, or deductibles before the enrollee's minimum deductible is satisfied, unless for preventive care.

• Ensures state law does not cause enrollees to lose HSA eligibility due to improper cost sharing practices.

• Defines preventive care according to the federal Internal Revenue Code, Section 223(c)(2)(C).

• Applies to both group insurance and accident/health insurance policies.

• Aligns Iowa’s insurance cost sharing requirements with federal HSA eligibility standards.

• Provides clarification for insurers and enrollees regarding when cost sharing can be applied under qualified HDHPs.

• Does not alter cost sharing for preventive care, which can be covered before the deductible is met.

Signed by Governor May 15, 2026. Takes effect July 1, 2026.

Requires the Board of Regents to create a policy banning noncompete clauses in employment contracts between physicians and the University of Iowa Hospitals and Clinics. These clauses, which restrict a physician's right to practice after leaving employment, will be prohibited in new, renewed, or extended contracts from the bill's effective date onward. Effective 6/2/2026.

Key Points & Impacts:

• Requires the Board of Regents to develop a policy prohibiting noncompete clauses in employment contracts for physicians at University of Iowa Hospitals and Clinics (UIHC).

• Defines 'noncompete clause' as any restriction on a physician's right to practice in any geographic area or for a defined period following contract termination with UIHC.

• Defines 'physician' as an individual licensed under chapter 148.

• Applies the prohibition to all relevant employment contracts entered into, extended, or renewed on or after the effective date of the Act.

• The Act takes effect immediately upon enactment.

• Aims to increase physician mobility by preventing UIHC from using noncompete agreements.

Establishes new standards and restrictions for health insurers and utilization review organizations, including limitations on the use of artificial intelligence in medical necessity decisions, deadlines and appeal processes for audits, and insurer actions against providers. It creates new requirements for electronic prior authorization submission (beginning 7/1/2027), strengthens peer-review standards for denials, and exempts specific cancer screenings and emergency care from prior authorization in both private insurance and Medicaid. The bill also significantly revises the certificate of need process, increasing expenditure thresholds, removing some services from CON requirements, and adjusting related procedures, notifications, and fee structures.  Multiple effective dates.

Key Points & Impacts

• Defines and limits the use of artificial intelligence by utilization review organizations (UROs) in initial prior authorization reviews, prohibiting sole reliance on AI for medical necessity denials or downgrades.

• Mandates tight timelines for URO audits (15 days to notify, 45 days to complete, 30 days for provider appeals, 30 days for appeal determinations), with penalties for violations including mandatory payment with interest.

• Prohibits health carriers from penalizing providers for out-of-network referrals, interfering with provider staffing/referral decisions, or imposing/amending agreements without negotiation.

• Requires all prior authorization requests to be submitted electronically through federally compliant systems by July 1, 2027, for both private plans and Medicaid/managed care.

• Establishes peer review standards: only clinical peers or qualified physician reviewers (with specialty and expertise) may deny or downgrade prior authorization requests; detailed written explanations and attestation of reviewer qualifications are required.

• Exempts from prior authorization: (a) cancer screenings recommended by clinical guidelines (category 2A or lower), and (b) diagnosis/treatment of life-threatening emergency medical conditions that arise during inpatient care, across both private insurance and Medicaid/Hawki programs.

• Substantially raises the financial thresholds for what constitutes a new/changed institutional health service under the certificate of need (CON) law (from ~$1.5M to $4M, escalating in future years), and removes numerous services and certain expenditures from CON requirements, including open heart surgery, organ transplants, radiation therapy, and cardiac catheterization.

• Modifies CON application, notification, and review procedures: new refund structure for withdrawn applications, switch to electronic notifications, alters comment/hearing processes, and limits extension deferrals to 30 days (unless mutually agreed).

Signed by Governor May 13, 2026. Takes effect July 1, 2026.

The legislation enacts wide-ranging reforms across healthcare, education, and nutrition. Notable changes include mandatory nutrition/metabolic health continuing education for physicians, required nutrition coursework for all medical school graduates, new restrictions on food dyes and additives in school meals, over-the-counter access to ivermectin, digital device time limits in elementary schools, and Iowa's adoption of the Psychology Interjurisdictional Compact.

Key Points & Impacts

• Requires at least 1 hour of continuing education on nutrition and metabolic health every 4 years for physicians as a license renewal condition.

• Mandates at least 40 hours of nutrition and metabolic health coursework for graduation from Iowa medical schools, effective July 1, 2028.

• Establishes strict prohibitions on specific food dyes and additives (e.g., Blue 1/2, Green 3, Potassium bromate, Propylparaben, Red 40, Yellow 5/6) in school meals and sales during the school day, applying to public, charter, innovation zone, and nonpublic schools receiving state funds (beginning July 1, 2027).

• Directs HHS to apply for a waiver to apply the same food restrictions to the 'summer electronic benefits transfer for children program' (summer EBT).

• Expands permissible epinephrine delivery systems (including nasal sprays, not just auto-injectors) in schools and public facilities, updating liability protections and staff training requirements accordingly.

• Allows pharmacists to distribute ivermectin as an over-the-counter medicine for human use without a prescription, and protects them from professional discipline or legal penalties for such distribution.

• Limits digital instruction to 60 minutes per day for K-5 students (with exceptions), requires technology use policies in elementary schools, and establishes a working group to study technology's cognitive impact on grades 6-12.

• Reintroduces the Presidential Fitness Test in schools, requires K-4 students to have at least 40 minutes of physical activity each day and 5th graders have at least 30 minutes per day.

• Adopts the Psychology Interjurisdictional Compact, enabling licensed psychologists to provide telepsychology and temporary in-person services across state lines under uniform rules and mutual recognition.

Signed by Governor May 20, 2026. Takes effect July 1, 2026; applicable July 1, 2027.

Realigns the health and human services system by designating 'health and human services districts' (HHS districts) for the statewide delivery of programs and services, replacing previous behavioral health districts. It updates terminology and structure throughout the code, consolidates planning and service areas for aging and disability services to match HHS district boundaries, and creates a new volunteerism subunit within HHS to support and coordinate volunteer activities and the Iowa commission on volunteer service. Other changes include clarifying advisory council composition and duties, and formalizing processes for designation, review, and modification of districts.

Key Points & Impacts:

• Replaces 'behavioral health districts' with 'health and human services districts' (HHS districts) for program delivery; initial HHS districts mirror existing behavioral health districts.

• Adds and updates definitions throughout the code, including creation of 'behavioral health district advisory councils' and 'behavioral health service system district plans'.

• Removes language that allowed judicial review of district boundary modifications by HHS; such decisions are now not subject to judicial review.

• Aligns planning and service areas for aging and disability services to exactly match new HHS district boundaries, contingent on federal approval.

• Revises the structure and duties of advisory councils for behavioral health districts, specifying membership requirements and functions.

• Creates a subunit for volunteerism within HHS to manage volunteer programs and provide support to the Iowa commission on volunteer service, including appointment of an executive director and staff.

• Clarifies that registered volunteers are considered state employees for liability purposes, with exceptions for volunteer guardians/conservators.

• Authorizes the commission on volunteer service to delegate non-policymaking administrative duties to the new subunit for volunteerism.

Signed by Governor April 30, 2026. Provisions related to behavioral health districts takes effect April 30, 2026. Other provisions take effect July 1, 2026.

Eliminates the current premium tax on HMOs and establishes a new health care-related tax on taxable funds of HMOs, with revised rates and definitions. It removes HMOs from the list of entities subject to the insurance premium tax, and creates a new Code chapter governing their taxation. The bill also enables a substantial one-time transfer from the taxpayer relief fund to the general fund, in response to federal tax law changes, and adjusts the calculation of the state general fund expenditure limitation accordingly. Additionally, it provides a supplemental appropriation to the Department of Health and Human Services for the medical assistance program and modifies rules regarding credits for assessments paid by insurers and HMOs. Appropriations and tax changes are contingent upon federal approval, with some provisions applying retroactively to January 1, 2026.

Key Points & Impacts

• Eliminates the premium tax on HMOs under Code section 432.1 and instead imposes a new health care-related tax under newly created Code chapter 432B.

• Defines 'taxable funds' for HMOs as payments received for health care services and payments made to providers and certain insurers, with specific federal exclusions.

• Sets the health care-related tax rates for HMOs: 3.5% for Jan 1–Sep 30, 2026; 0.95% for Oct 1–Dec 31, 2026; and 0.95% for subsequent years.

• Establishes new tax payment and prepayment schedules for HMOs, including special deadlines for the first year, and provides for credits and cash refunds under certain conditions.

• Repeals Section 432.1B and removes HMOs from the premium tax structure, moving them to the new tax regime.

• Allows insurers and HMOs to offset certain assessments against either premium or health care-related tax liabilities, and clarifies treatment for entities ceasing business.

• Authorizes a $296.2 million transfer from the taxpayer relief fund to the general fund in response to federal tax changes, and adjusts the state expenditure limitation to include this amount.

• Appropriates $70.3 million from the general fund to the Department of Health and Human Services for medical assistance reimbursements, with funds remaining available for an additional fiscal year if unspent.

The Act mandates use of federal e-verify and SAVE systems for employment and professional licensure eligibility verification across multiple sectors, including education, public employment, and professional licensing. It establishes criminal and civil penalties for knowingly providing or accepting false social security numbers, prohibits issuance or renewal of professional licenses to individuals unlawfully present in the U.S., and adds strict requirements for voter registration and citizenship verification. Additionally, it imposes stricter pretrial detention standards for unauthorized aliens and those charged with forcible felonies. The law provides severability and contingent implementation clauses in case parts are found invalid or federal verification systems become inaccessible.

Key Points & Impacts

• Requires the Board of Educational Examiners to verify legal authorization to work in the U.S. for all initial and renewing applicants, as well as periodic verification for those not subject to renewal.

• Prohibits employers from hiring or continuing to employ individuals known to have provided false social security numbers; imposes civil penalties and mandatory compliance training for repeat violations.

• Defines and criminalizes the act of providing or accepting a false social security number for employment purposes.

• Mandates use of the federal e-verify system for employment eligibility verification by the legislature, state agencies, cities, counties, school districts, nonpublic schools, charter schools, and certain higher education institutions; results must be reported to federal immigration authorities if a lack of legal status is found.

• Establishes a SAVE program clearinghouse for professional licensing boards to verify the citizenship and immigration status of license applicants, and prohibits issuance or renewal of licenses to those unlawfully present.

• Requires voter registration forms to include a new oath affirming U.S. citizenship, mandates monthly/annual systematic verification of voter citizenship, and establishes procedures for deregistration of unconfirmed registrants.

• Imposes a rebuttable presumption against bail for unauthorized aliens charged with indictable offenses and for all defendants charged with forcible felonies, with specific appeal and challenge procedures.

• Contains detailed severability and suspension clauses to address federal court rulings or loss of access to verification systems, ensuring continued effect of unaffected provisions.

Signed by Governor June 2, 2026. Takes effect July 1, 2026.

Regulates how cost sharing (copayments, coinsurance, deductibles) is applied for enrollees in group insurance and accident/health insurance who have HSAs and qualified HDHPs. If the cost sharing could jeopardize HSA eligibility under federal law, it must only be applied to the HDHP after the enrollee meets the required minimum deductible, except for preventive care as defined by federal law. The bill aligns state requirements with federal tax code provisions for HSAs.

Key Points & Impacts:

• Adds new sections to Iowa law specifically addressing cost sharing for HSAs and qualified HDHPs.

• Prohibits application of copayments, coinsurance, or deductibles before the enrollee's minimum deductible is satisfied, unless for preventive care.

• Ensures state law does not cause enrollees to lose HSA eligibility due to improper cost sharing practices.

• Defines preventive care according to the federal Internal Revenue Code, Section 223(c)(2)(C).

• Applies to both group insurance and accident/health insurance policies.

• Aligns Iowa’s insurance cost sharing requirements with federal HSA eligibility standards.

• Provides clarification for insurers and enrollees regarding when cost sharing can be applied under qualified HDHPs.

• Does not alter cost sharing for preventive care, which can be covered before the deductible is met.

Signed by Governor May 15, 2026. Takes effect July 1, 2026.

Establishes new standards and restrictions for health insurers and utilization review organizations, including limitations on the use of artificial intelligence in medical necessity decisions, deadlines and appeal processes for audits, and insurer actions against providers. It creates new requirements for electronic prior authorization submission (beginning 7/1/2027), strengthens peer-review standards for denials, and exempts specific cancer screenings and emergency care from prior authorization in both private insurance and Medicaid. The bill also significantly revises the certificate of need process, increasing expenditure thresholds, removing some services from CON requirements, and adjusting related procedures, notifications, and fee structures.  Multiple effective dates.

Key Points & Impacts

• Defines and limits the use of artificial intelligence by utilization review organizations (UROs) in initial prior authorization reviews, prohibiting sole reliance on AI for medical necessity denials or downgrades.

• Mandates tight timelines for URO audits (15 days to notify, 45 days to complete, 30 days for provider appeals, 30 days for appeal determinations), with penalties for violations including mandatory payment with interest.

• Prohibits health carriers from penalizing providers for out-of-network referrals, interfering with provider staffing/referral decisions, or imposing/amending agreements without negotiation.

• Requires all prior authorization requests to be submitted electronically through federally compliant systems by July 1, 2027, for both private plans and Medicaid/managed care.

• Establishes peer review standards: only clinical peers or qualified physician reviewers (with specialty and expertise) may deny or downgrade prior authorization requests; detailed written explanations and attestation of reviewer qualifications are required.

• Exempts from prior authorization: (a) cancer screenings recommended by clinical guidelines (category 2A or lower), and (b) diagnosis/treatment of life-threatening emergency medical conditions that arise during inpatient care, across both private insurance and Medicaid/Hawki programs.

• Substantially raises the financial thresholds for what constitutes a new/changed institutional health service under the certificate of need (CON) law (from ~$1.5M to $4M, escalating in future years), and removes numerous services and certain expenditures from CON requirements, including open heart surgery, organ transplants, radiation therapy, and cardiac catheterization.

• Modifies CON application, notification, and review procedures: new refund structure for withdrawn applications, switch to electronic notifications, alters comment/hearing processes, and limits extension deferrals to 30 days (unless mutually agreed).

Signed by Governor May 13, 2026. Takes effect July 1, 2026.

Eliminates the current premium tax on HMOs and establishes a new health care-related tax on taxable funds of HMOs, with revised rates and definitions. It removes HMOs from the list of entities subject to the insurance premium tax, and creates a new Code chapter governing their taxation. The bill also enables a substantial one-time transfer from the taxpayer relief fund to the general fund, in response to federal tax law changes, and adjusts the calculation of the state general fund expenditure limitation accordingly. Additionally, it provides a supplemental appropriation to the Department of Health and Human Services for the medical assistance program and modifies rules regarding credits for assessments paid by insurers and HMOs. Appropriations and tax changes are contingent upon federal approval, with some provisions applying retroactively to January 1, 2026.

Key Points & Impacts

• Eliminates the premium tax on HMOs under Code section 432.1 and instead imposes a new health care-related tax under newly created Code chapter 432B.

• Defines 'taxable funds' for HMOs as payments received for health care services and payments made to providers and certain insurers, with specific federal exclusions.

• Sets the health care-related tax rates for HMOs: 3.5% for Jan 1–Sep 30, 2026; 0.95% for Oct 1–Dec 31, 2026; and 0.95% for subsequent years.

• Establishes new tax payment and prepayment schedules for HMOs, including special deadlines for the first year, and provides for credits and cash refunds under certain conditions.

• Repeals Section 432.1B and removes HMOs from the premium tax structure, moving them to the new tax regime.

• Allows insurers and HMOs to offset certain assessments against either premium or health care-related tax liabilities, and clarifies treatment for entities ceasing business.

• Authorizes a $296.2 million transfer from the taxpayer relief fund to the general fund in response to federal tax changes, and adjusts the state expenditure limitation to include this amount.

• Appropriates $70.3 million from the general fund to the Department of Health and Human Services for medical assistance reimbursements, with funds remaining available for an additional fiscal year if unspent.

Requires all public assistance programs (childcare assistance, food assistance/SNAP, Family Investment Program/FIP, and Medicaid) use the Systematic Alien Verification for Entitlements (SAVE) online service to determine if a person has the legal status or citizenship to be eligible. Puts the definition of "alien" in Iowa law (meaning a person not a citizen or national of the US).  Supplemental Nutrition Assistance Program (SNAP) Changes: Requires Iowa HHS to consider the income and financial resources of ALL household members in determining eligibility, including those that are otherwise not eligible for SNAP.  Requires SNAP recipients to be a legal resident of the US (citizen/national, lawfully admitted alien, Cuban/Haitian, Marshallese/Compact of Free Association). Requires quarterly SNAP error rate reports be sent to Legislature (as well as USDA).  Requires Iowa HHS to submit a waiver to allow all unused SNAP benefits to be taken out of a person's account if not used within 3 months (91 days). Requires Iowa HHS to also submit a waiver to allow SNAP administrators to use other databases to confirm eligibility (including third party automated asset verification services and  automated employment verification services). Medicaid/Iowa Health & Wellness Plan Changes: Eliminates all retroactive eligibility for individuals who are not pregnant, a child, or a nursing home resident (and requires Iowa HHS to submit a waiver to do this).  Pregnant persons, children, and nursing home residents are allowed up to 2 months retroactive eligibility (effective 1/1/2027).  This latter part aligns with federal law (OBBB/HR 1).  Prohibits Iowa HHS from asking for a waiver or state plan amendment to enact retroactive eligibility for any group other than those noted above.  Medicaid Managed Care: Does not codify managed care, but does make it next to impossible for a new administration to get rid of it.  All MCOs in Iowa are health maintenance organizations (aka "HMOs").  They pay an HMO tax that goes into the Medicaid fund and is matched by federal funds. The bill expressly prohibits Iowa HHS from taking any action that would reduce the HMO tax going into Medicaid (without legislative approval).  If the state were to get rid of MCOs, they would no longer be paying the HMO tax, which would reduce the HMO tax going to Medicaid.  That would be against this new law.  So in effect, this change would stop any move Medicaid back to a fully fee-for-service system.  Medicaid Waivers & State Plan Amendments: Requires all future changes to Medicaid (state plan amendments and waivers) be expenditure neutral, meaning they do not increase spending for Medicaid, unless the Legislature directs this change to be made.  So this limits the ability of a new administration from making any changes without legislative approval, unless they either save money or do not cost the state more. This exempts changes and request  made prior to 1/1/2026 (even if not approved before the bill goes into effect).  So this should not impact the state's efforts to consolidate HCBS waivers.  Medicaid Exceptions to Policy: Requires Iowa HHS to make the following information public: 1) number of exceptions to policy granted; 2) types of exceptions to policy granted; 3) total cost of exceptions to policy granted; and 4) identifiable trends (number of exceptions in a particular geographic area; type of Medicaid services; and classification of individuals granted exceptions to policy.  This part of the bill is effective 1/1/2027.  Other Changes: Requires Iowa HHS to continue the "hospital directed payment program" (provider tax that brings in more federal matching funds). Requires Iowa HHS to set up an online system that allows Medicaid for Employed Persons with Disabilities (MEPD) members to pay their premiums electronically. Makes the bill effective upon enactment.

Signed by Governor June 2, 2026. Takes effect January 1, 2027.

The Act creates a statewide ECFS system to provide primary prevention, early intervention, and ongoing family and community resources for families with children under 19, administered by the Department of Health and Human Services. It establishes a new ECFS system fund, district advisory councils, and new policies for data collection and program oversight. The Act repeals various existing programs and statutes, transitions funding and contracts to the new system, and includes provisions for continuity of services and the redistribution of federal funds. It also convenes an interim study committee to guide future transitions and mandates conforming Code changes. Several appropriations and fund transfers are authorized to support the new system and its transition.

Key Points & Impacts

• Establishes the Early Childhood and Family Services (ECFS) system under the Department of Health and Human Services, with statewide, district-level administration and advisory councils.

• Creates the ECFS system fund with appropriated state and transferred funds, which are non-reverting and accrue interest for ECFS purposes.

• Repeals and consolidates multiple programs and statutes (including sections 135.106, 232.188, 235A.1, 235A.2, 235A.3) into the new ECFS structure, and mandates the transfer of unexpended funds to the ECFS system fund.

• Transitions child abuse prevention funding, contracts, and associated administration from old programs to the ECFS system, with explicit provisions for contract review and continuity of care.

• Modifies income tax checkoff and birth registration fee designations, directing proceeds to the new ECFS system fund for child abuse prevention.

• Phases out decategorization initiatives, reallocates remaining funding, and details procedures for contract evaluation, termination, and assumption by the department or juvenile court services.

• Provides for the transition of home visiting services from Early Childhood Iowa boards to the ECFS system upon request, with safeguards for uninterrupted service and stakeholder involvement.

• Convenes a legislative interim study committee to review and advise on transition strategies, with a final report or bill draft due by January 8, 2027.

Signed by Governor June 2, 2026. 

The legislation enacts wide-ranging reforms across healthcare, education, and nutrition. Notable changes include mandatory nutrition/metabolic health continuing education for physicians, required nutrition coursework for all medical school graduates, new restrictions on food dyes and additives in school meals, over-the-counter access to ivermectin, digital device time limits in elementary schools, and Iowa's adoption of the Psychology Interjurisdictional Compact.

Key Points & Impacts

• Requires at least 1 hour of continuing education on nutrition and metabolic health every 4 years for physicians as a license renewal condition.

• Mandates at least 40 hours of nutrition and metabolic health coursework for graduation from Iowa medical schools, effective July 1, 2028.

• Establishes strict prohibitions on specific food dyes and additives (e.g., Blue 1/2, Green 3, Potassium bromate, Propylparaben, Red 40, Yellow 5/6) in school meals and sales during the school day, applying to public, charter, innovation zone, and nonpublic schools receiving state funds (beginning July 1, 2027).

• Directs HHS to apply for a waiver to apply the same food restrictions to the 'summer electronic benefits transfer for children program' (summer EBT).

• Expands permissible epinephrine delivery systems (including nasal sprays, not just auto-injectors) in schools and public facilities, updating liability protections and staff training requirements accordingly.

• Allows pharmacists to distribute ivermectin as an over-the-counter medicine for human use without a prescription, and protects them from professional discipline or legal penalties for such distribution.

• Limits digital instruction to 60 minutes per day for K-5 students (with exceptions), requires technology use policies in elementary schools, and establishes a working group to study technology's cognitive impact on grades 6-12.

• Reintroduces the Presidential Fitness Test in schools, requires K-4 students to have at least 40 minutes of physical activity each day and 5th graders have at least 30 minutes per day.

• Adopts the Psychology Interjurisdictional Compact, enabling licensed psychologists to provide telepsychology and temporary in-person services across state lines under uniform rules and mutual recognition.

Signed by Governor May 20, 2026. Takes effect July 1, 2026; applicable July 1, 2027.

The Act mandates use of federal e-verify and SAVE systems for employment and professional licensure eligibility verification across multiple sectors, including education, public employment, and professional licensing. It establishes criminal and civil penalties for knowingly providing or accepting false social security numbers, prohibits issuance or renewal of professional licenses to individuals unlawfully present in the U.S., and adds strict requirements for voter registration and citizenship verification. Additionally, it imposes stricter pretrial detention standards for unauthorized aliens and those charged with forcible felonies. The law provides severability and contingent implementation clauses in case parts are found invalid or federal verification systems become inaccessible.

Key Points & Impacts

• Requires the Board of Educational Examiners to verify legal authorization to work in the U.S. for all initial and renewing applicants, as well as periodic verification for those not subject to renewal.

• Prohibits employers from hiring or continuing to employ individuals known to have provided false social security numbers; imposes civil penalties and mandatory compliance training for repeat violations.

• Defines and criminalizes the act of providing or accepting a false social security number for employment purposes.

• Mandates use of the federal e-verify system for employment eligibility verification by the legislature, state agencies, cities, counties, school districts, nonpublic schools, charter schools, and certain higher education institutions; results must be reported to federal immigration authorities if a lack of legal status is found.

• Establishes a SAVE program clearinghouse for professional licensing boards to verify the citizenship and immigration status of license applicants, and prohibits issuance or renewal of licenses to those unlawfully present.

• Requires voter registration forms to include a new oath affirming U.S. citizenship, mandates monthly/annual systematic verification of voter citizenship, and establishes procedures for deregistration of unconfirmed registrants.

• Imposes a rebuttable presumption against bail for unauthorized aliens charged with indictable offenses and for all defendants charged with forcible felonies, with specific appeal and challenge procedures.

• Contains detailed severability and suspension clauses to address federal court rulings or loss of access to verification systems, ensuring continued effect of unaffected provisions.

Signed by Governor June 2, 2026. Takes effect July 1, 2026.

Eliminates the current premium tax on HMOs and establishes a new health care-related tax on taxable funds of HMOs, with revised rates and definitions. It removes HMOs from the list of entities subject to the insurance premium tax, and creates a new Code chapter governing their taxation. The bill also enables a substantial one-time transfer from the taxpayer relief fund to the general fund, in response to federal tax law changes, and adjusts the calculation of the state general fund expenditure limitation accordingly. Additionally, it provides a supplemental appropriation to the Department of Health and Human Services for the medical assistance program and modifies rules regarding credits for assessments paid by insurers and HMOs. Appropriations and tax changes are contingent upon federal approval, with some provisions applying retroactively to January 1, 2026.

Key Points & Impacts

• Eliminates the premium tax on HMOs under Code section 432.1 and instead imposes a new health care-related tax under newly created Code chapter 432B.

• Defines 'taxable funds' for HMOs as payments received for health care services and payments made to providers and certain insurers, with specific federal exclusions.

• Sets the health care-related tax rates for HMOs: 3.5% for Jan 1–Sep 30, 2026; 0.95% for Oct 1–Dec 31, 2026; and 0.95% for subsequent years.

• Establishes new tax payment and prepayment schedules for HMOs, including special deadlines for the first year, and provides for credits and cash refunds under certain conditions.

• Repeals Section 432.1B and removes HMOs from the premium tax structure, moving them to the new tax regime.

• Allows insurers and HMOs to offset certain assessments against either premium or health care-related tax liabilities, and clarifies treatment for entities ceasing business.

• Authorizes a $296.2 million transfer from the taxpayer relief fund to the general fund in response to federal tax changes, and adjusts the state expenditure limitation to include this amount.

• Appropriates $70.3 million from the general fund to the Department of Health and Human Services for medical assistance reimbursements, with funds remaining available for an additional fiscal year if unspent.

The Act mandates use of federal e-verify and SAVE systems for employment and professional licensure eligibility verification across multiple sectors, including education, public employment, and professional licensing. It establishes criminal and civil penalties for knowingly providing or accepting false social security numbers, prohibits issuance or renewal of professional licenses to individuals unlawfully present in the U.S., and adds strict requirements for voter registration and citizenship verification. Additionally, it imposes stricter pretrial detention standards for unauthorized aliens and those charged with forcible felonies. The law provides severability and contingent implementation clauses in case parts are found invalid or federal verification systems become inaccessible.

Key Points & Impacts

• Requires the Board of Educational Examiners to verify legal authorization to work in the U.S. for all initial and renewing applicants, as well as periodic verification for those not subject to renewal.

• Prohibits employers from hiring or continuing to employ individuals known to have provided false social security numbers; imposes civil penalties and mandatory compliance training for repeat violations.

• Defines and criminalizes the act of providing or accepting a false social security number for employment purposes.

• Mandates use of the federal e-verify system for employment eligibility verification by the legislature, state agencies, cities, counties, school districts, nonpublic schools, charter schools, and certain higher education institutions; results must be reported to federal immigration authorities if a lack of legal status is found.

• Establishes a SAVE program clearinghouse for professional licensing boards to verify the citizenship and immigration status of license applicants, and prohibits issuance or renewal of licenses to those unlawfully present.

• Requires voter registration forms to include a new oath affirming U.S. citizenship, mandates monthly/annual systematic verification of voter citizenship, and establishes procedures for deregistration of unconfirmed registrants.

• Imposes a rebuttable presumption against bail for unauthorized aliens charged with indictable offenses and for all defendants charged with forcible felonies, with specific appeal and challenge procedures.

• Contains detailed severability and suspension clauses to address federal court rulings or loss of access to verification systems, ensuring continued effect of unaffected provisions.

Signed by Governor June 2, 2026. Takes effect July 1, 2026.