Bills Associated with Area Agencies on Aging

Governs the placement of adult patients in care facilities when the patient is unable to consent and does not have an available authorized representative. It defines key terms, establishes a hierarchy for individuals who may make decisions on the patient's behalf, and outlines procedures for physician certification of incapacity. If no authorized person can be found, the bill allows for a court petition to order placement, including the potential for a facility employee to apply for public assistance on the patient's behalf. The bill also provides civil and criminal immunity for good faith actions under these provisions and directs the Department of Health and Human Services to promulgate necessary rules.

Key Points & Impacts:

• Defines 'authorized representative' and 'person authorized to consent,' establishing a hierarchy for who may consent to placement decisions for incapacitated adults.

• Allows a physician to certify in the patient's record that the patient is unable to consent, no authorized representative can be found, and a placement is in the patient's best interest.

• Empowers a 'person authorized to consent' to make placement decisions and assist with applications for health insurance or public assistance, with authority expiring upon completion of placement or identification of a higher-priority decision-maker.

• Requires care facility staff to inform the authorized person of their powers/duties and assist in finding the least restrictive, appropriate care facility for placement.

• Allows for court-ordered placement if no authorized representative or person authorized to consent is found after good faith efforts, with specific petition and affidavit requirements from medical and facility staff.

• Permits court orders to authorize a qualified employee of the receiving facility to apply for public assistance on behalf of the patient if necessary.

• Provides immunity from civil/criminal liability and professional discipline for individuals acting in good faith under these provisions.

• Requires the Department of Health and Human Services to adopt rules for implementation

Signed by Governor May 15, 2026. 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.

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.

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. 

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.

Amends and expands Iowa law regarding life insurance, focusing on preventing financial exploitation of eligible adults. It extends the permissible delay period for disbursements suspected of exploitation, allows insurers and financial professionals to notify third parties and the insurance commissioner, and creates legal immunities for good-faith actions. The bill defines key terms, mandates specialized training for insurer personnel, and establishes protocols for sharing relevant records with authorities. Conforming changes are made to law enforcement authority in insurance fraud investigations.

Key Points & Impacts:

• Strikes old law limiting disbursement delay extensions and replaces it with new, tiered delay periods: up to 15 days, extendable to 25 days, and further to 55 days, with procedural safeguards for suspected financial exploitation.

• Adds new authority for broker-dealers, investment advisers, and insurers to extend disbursement or transaction delays based on ongoing internal reviews supporting reasonable suspicion of financial exploitation.

• Defines key terms including 'disbursement,' 'eligible adult,' 'financial exploitation,' 'permissible third party,' and 'qualified individual' for clarity and uniform application.

• Creates a process for insurers or qualified individuals to notify the insurance commissioner and/or a permissible third party if exploitation is suspected, with immunity for good-faith disclosures.

• Specifies that notification to permissible third parties is not required before investigations and is prohibited if the third party is suspected of exploitation or abuse.

• Mandates that insurers provide specialized training to relevant staff by June 30, 2027, on identifying and reporting financial exploitation, except for those already deemed qualified individuals.

• Requires insurers to provide access to relevant records to regulators or law enforcement during investigations, with confidentiality protections for such records.

• Allows courts to terminate, extend, or modify disbursement delays and to provide other protective relief as needed.

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.

Removes current requirement that a hospice program must provide palliative care to be eligible for a license. Requires a hospice program to provide care directed at symptom management to be eligible for a license.

Signed by Governor May 2, 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.

Modifies procedures for certifying medication aides, especially for those certified in other states, by easing requirements and creating a new online certification registry. It directs the Department of Inspections, Appeals, and Licensing to establish and maintain this registry, including a no-fee policy for submission or access of certification proof. The bill also mandates updated administrative rules to standardize and clarify medication aide qualifications, training, and examination procedures, and it rescinds numerous existing administrative rules to align with these changes.

Key Points & Impacts:

• Allows medication aides certified in another state to become certified in Iowa by passing only the Iowa medication aide challenge examination, removing the requirement to pass both nurse aide and medication aide exams, and eliminating any required in-state employment prior to certification.

• Directs the Department of Inspections, Appeals, and Licensing to create an online medication aide certification registry, which will allow submission and access of proof of exam completion, with no fees for these services.

• Requires the Department to adopt new rules governing the administration of medications by certified aides in various care facilities, including community colleges and other competency evaluation programs as exam administrators.

• Mandates that individuals seeking to take the challenge exam (in lieu of a course) provide a specified written statement, and that all approved programs can receive this statement.

• Eliminates the requirement that out-of-state certified medication aides pass a nurse aide competency exam to be certified in Iowa.

• Requires the Department to adopt any necessary rules to ensure consistency in all provisions relating to medication aide training and qualifications.

• Rescinds specific Iowa Administrative Code rules relating to medication aide certification and training as of July 1, 2026, and directs their removal from the code.

• Mandates conforming rulemaking by the Department to implement the provisions of this bill.

Signed by Governor on April 16. 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.

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.

Makes changes to an attorney's duty under a health care durable power of attorney.  Requires the attorney to give preference to the desires of the individual as expressed in the power of attorney, a declaration relating to life-sustaining procedures, or made known to the attorney by the individual.

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

Under this bill, insurance companies would not be allowed to deny, cancel, or increase premiums for life insurance, disability insurance, and long-term care insurance policies because the person has donated an organ or part of an organ.  Effective 7/1/2026.

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.

Requires the Iowa Board of Pharmacy to adopt rules ensuring that, by January 1, 2027, individuals who are blind, visually impaired, or have other print disabilities can request and receive accessible prescription drug labels, bag tags, and medical guides from pharmacies. Pharmacies must provide these accessibility measures at no additional cost, or refer individuals to another pharmacy within a reasonable distance that does. Health carriers are required to compensate pharmacies with an enhanced dispensing fee to cover the associated costs. The Board must annually publish a list of compliant pharmacies and submit a progress report to the governor and legislature by January 1, 2028. The bill exempts institutional pharmacies, certain repository programs, and correctional facility pharmacies.

Key Points & Impact:

• Authorizes alternative ratemaking mechanisms for water/wastewater utilities to recover infrastructure costs via a 'system enhancement charge.'

• Defines eligible utilities, costs, and improvements—including only those projects not already in the utility’s rate base and excluding fines or penalties.

• Requires commission approval of a multi-year plan before utilities may recover costs; plan must include detailed financial, regulatory, and engineering documentation.

• Mandates annual applications for charge adjustments and revenue reconciliations; charges are based on meter size and exclude costs already recovered through other contributions.

• If project costs exceed initial estimates by over 25%, utilities must provide justification and obtain commission approval in the next rate case.

• Prohibits commission from approving charge adjustments if the utility has not had a general rate case order in the previous five years.

• Allows deferral and later recovery of eligible costs incurred before plan approval, as long as included in a subsequently approved plan.

• Exempts these petitions from public notice requirements and resets the charge to zero when new base rates are set in a general rate case.

Signed by Governor May 19, 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.

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.

SF 2472 – Property Tax Reform  (Final version)

Limit on Annual Revenue Increases

• 2% hard cap on all general levies (includes EMS, Agricultural property, Public Transit)
• 3% hard cap on DART
• 4% hard cap on county hospitals
• New construction is realized as it comes online

No limitation on the following:

• Debt Service Levies
• School funding
• City Special revenue levies (insurance, employee benefits, etc.)
• Most County supplemental levies (insurance, employee benefits, etc.)
• Community college variable levies (insurance, unemployment, etc.)

Extends the previous law of the land, HF 718, by 2 years.

_________

Residential Property Tax Relief

Converts homestead credit to an exemption (currently equal to $4,850 exemption)

• Phases state funding out over 3 years.
• Year 1 Exemption of 10% with a minimum of $5500 and maximum of $20,000
• Maximum rises with CPI

Current military and senior exemptions stay in place

Homestead credit currently costs the State $175M/year. Funds from the conversion of homestead credit to exemption go toward buying the $5.40 uniform levy down to $4.90 over 3 years.

Multi-residential rollback (currently equal to residential) is increased by 3% in Year 2, and 6% in Year 3.

_____

Transparency and Data

• Shifts the burden of proof to the assessor if a property value increases by more than 10 percent over 2 years.
• Requires parcel level reporting
• New taxpayer statement – ISAC and League of Cities tasked with working on this with Department of Management
• Allows online posting of tax notices

______

Bonding/Debt

• Restricts the use of debt service funds for operating expenses
• Caps local government reserves at 35%
• Creates new restricted fund account for funds that are budgeted for specific infrastructure uses

_______

Tax Increment Financing

$5.40 Uniform levy

• Pulls the $5.40 levy out of the increment for new TIF projects
• Holds existing debt for cities harmless
• Allows the school district to opt that levy in to a project with no state backfill
• Phases the $5.40 levy down to $4.90 over 3 years

Perpetual TIFS

• Limits increment usage to 60% after 20 years – No new debt allowed above the 60% threshold
• Pulls the $5.40 out of increment after 20 years
• Holds existing debt harmless

Eliminates the Low-Moderate Income restrictions from TIF usage for housing

Final bill DID NOT contain a restriction on the use of TIF revenues for staff and salaries

_____

Creates First Iowa Home Accounts

Raises the EMS levy cap to $1.50 (from $.75) with a vote

Signed by Governor 5/18/2026. Effective dates: 05/18/2026, 07/01/2026, 01/01/2027. Applicability dates: 01/01/2026, 07/01/2026, 01/01/2027, 07/01/2027, 07/01/2028.