Bills Associated with Family Planning Council of Iowa

Establishes that pregnant minors in Iowa can legally consent to receiving certain medical care—specifically prenatal, intrapartum, and postnatal care—if their parent, guardian, or legal custodian is not reasonably available. Health care providers are still required to obtain informed consent from the minor for such procedures.

Key Points & Impacts:

• Creates a new section (135.196) in Iowa law regarding minor consent for pregnancy care.

• Allows pregnant minors to consent to prenatal, intrapartum, and postnatal care if a parent, guardian, or custodian is not reasonably available.

• Applies to care provided by physicians, physician designees, advanced registered nurse practitioners, physician assistants, registered nurses, licensed practical nurses, and emergency medical care providers.

• Does not remove the requirement for health care providers to obtain informed consent from the pregnant minor.

• Clarifies legal authority for minors in situations where parental figures cannot be reached.

• Aims to ensure timely access to essential pregnancy-related medical care for minors.

Signed by Governor on April 9. 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.

Makes changes in the process for Iowans accessing medications that induce an abortion (mifepristone, misoprostol).  Division I: Redefines 'abortion' to exclude miscarriages, ectopic pregnancies, and loss of pregnancy where not all products of conception are expelled. Division II: Mandates in-person physician examinations and coercion screening before abortions are performed and requires the physician to refer a woman to an appropriate provider when coercion is detected.  Uses the term "chemical abortion" instead of "medication abortion" and adds the definition in Iowa Code.  Defines pregnancy as starting at fertilization. Establishes new consent and information disclosure requirements for chemical abortions, including a signed acknowledgement that they were informed of a list of risks (which are purportedly included in warning labels for the medication). Physicians must also advise the pregnant woman on how to access emergency surgical intervention if necessary. Does not require informed consent when chemical abortion is performed in response to a medical emergency. The Board of Medicine must adopt rules on this and physicians who fail to comply with this are subject to licensing discipline.  Division III: Restricts the dispensing of abortion-inducing drugs by an authorized provider directly to the pregnant woman in a healthcare setting (i.e. no telehealth). States that this does not apply to emergency situations. Introduces a broad private cause of action against unauthorized dispensing, sets statutory damages that includes attorney fees and court costs, and provides for disciplinary action against noncompliant licensees. States that the civil suit can be brought by any "interested party," defined as the woman who had the abortion or a personal representative of the woman.  Keeps the name of the woman receiving the abortion confidential in court proceedings and states that this is not to be construed to impose civil or criminal liability on the woman receiving the abortion care.  Division IV: Expands termination of pregnancy reporting requirements to include whether misoprostol was used (currently only mifepristone must be disclosed).  Includes new reporting requirement for miscarriages - but only if mifepristone or misoprostol were used with 14 days prior to miscarriage. Repeals 146C (fetal heartbeat law). 

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

Denies minors the right to consent to vaccinations for a sexually transmitted disease or infection.

Key Points & Impact:

• Adds language clarifying that minors cannot consent to vaccinations for sexually transmitted diseases or infections on their own.

• Minors still retain the ability to consent to other medical care or services (prevention, diagnosis, treatment) for sexually transmitted diseases or infections.

• The prohibition applies specifically to vaccinations, not to other forms of STD prevention, diagnosis, or treatment.

• Removes the blanket legal capacity previously granted to minors for all STD-related care, narrowing their medical autonomy.

• Consent for STD vaccinations must now be provided by a parent, guardian, or authorized adult.

• Other aspects of care (such as testing and medication) for STDs remain accessible to minors without parental consent.

Signed by Governor May 19, 2026. Takes 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.

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. 

Replaces the term "pregnant person" with "pregnant female" throughout multiple statutory sections dealing with the termination of pregnancy, feticide, and related offenses. No substantive changes are made to the criminal offenses or penalties themselves; the changes are strictly to the terminology used to refer to the pregnant individual in the law.

Key Points & Impact:

• Replaces the term 'pregnant person' with 'pregnant female' in all references within the affected statutes.

• Amends Section 707.7 (Feticide) and Section 707.8 (Nonconsensual termination of pregnancy and related offenses) to use 'pregnant female'.

• Adjusts language in provisions concerning obtaining consent, knowledge, and voluntary consent of the pregnant individual to specify 'female'.

• Clarifies that exceptions for medical procedures and acts or omissions by the pregnant individual now refer to 'pregnant female'.

• Updates Section 708.2(4), related to assault against a pregnant individual, to refer to 'pregnant female'.

• No changes to the criminal definitions, penalties, or exceptions—this is strictly a terminology update.

• Ensures consistency in gendered language across statutes concerning pregnancy.

• Does not impact the application or scope of the offenses—only the phrasing is changed.

Signed by Governor on April 16. Takes effect July 1, 2026.

Eliminates the requirement that only state employees eligible for leave under the federal Family and Medical Leave Act of 1993 can receive paid parental leave. Instead, all state employees will be provided paid leave for the birth or adoption of a child, as long as the leave is taken within twelve months of the event.

Key Points & Impacts:

• Removes the requirement that state employees must be eligible for leave under the federal FMLA to receive paid parental leave.

• Expands eligibility for paid parental leave to all state employees, regardless of FMLA eligibility.

• Paid leave is available for both the birth and adoption of a child.

• The paid parental leave must be taken within twelve months following the birth or adoption.

Signed by Governor April 30, 2026. Takes effect April 30, 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.

Appropriates $714.3 million for the public safety, public defense, emergency management, justice, and victim services programs and agencies for fiscal year 2027, which begins July 1, 2026. This is an increase of $11.2 million. Attorney General: Increases funding for victim services by $365,115 (total appropriation $5,541,708) - $75,000 of these new funds are used to boost services to human trafficking victims (total appropriation $225,000). Adds $165,000 to fund business specialty courts (if SF 638 is signed into law). Maintains $150,000 transfer from victim compensation fund to victim services. No change for Office of Consumer Advocate ($3.8 million). Prisons/Community Based Corrections: Increases funding for prisons by $3,214,000 and Department of Corrections' administration by $1,854,222.  Increases community based corrections by $706,778 and continues requirement for drug courts. Other: Increases funding for the Office of Drug Control Policy by $21,327 ($249,219 total). No change in funding for the office to combat human trafficking ($200,742). Reduces indigent defense funding for the public defender's office by $1,150,000. Increases court-appointed counsel rates by $5/case ($93/hour for class A felonies; $88;/hour for class B felonies; $83/hour for all other cases). Creates an Attorney Loan Repayment Program in the Iowa College Student Aid Commission to encourage lawyers to stay and practice in Iowa (must have gone to a law school in Iowa, be practicing in Iowa, have graduated law school within five years of applying for loan repayment, and agree to provide a base number of hours for indigent defense, with priority for those practicing in rural areas). Repayment of up to $10,000/year is available for up to 25 attorneys/year (not to exceed a total of 150 in the program at one time). Ends the program on July 1, 2041.  Increases civil filing fees, divorce filing fees, small claims appeals, motions to show cause, liens, real estate titles, and other similar court documents by $20. The revenues from the $20 fee increase for all but divorce filings goes to indigent defense (50%) and attorney loan repayment program (50%).  Beginning July 1, 2026, 20% of the entire divorce filing fee goes to sexual assault and domestic violence programs (victim services), which was supposed to be happening but all was going to the general fund. Beginning July 1, 2027 and each year after, the 20% of divorce filing fees shifts to the Sexual Assault Forensic Exam (SAFE) Center grant program (contingent upon passage of HF 2794). You can read more detail at: https://www.legis.iowa.gov/docs/publications/NOBA/1605165.pdf. Effective 7/1/2026.

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.

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.