Bills Associated with Lutheran Services in Iowa

Requires commercial drivers demonstrate sufficient English language proficiency to receive or renew a CDL or CLP. The Department of Transportation must administer a computer-based English proficiency exam, and commercial motor carriers are prohibited from employing drivers who do not meet the standard. Civil penalties are imposed on carriers and drivers for violations, and criminal penalties apply to non-proficient drivers operating commercial vehicles. The bill also outlines procedures for handling vehicles and cargo when violations occur, and protects compliance with federal law.

Key Points & Impacts:

• Adds a new requirement that applicants for commercial driver’s licenses or learner’s permits must pass an English language proficiency exam administered by the Department of Transportation.

• Prohibits issuance or renewal of a CDL or CLP unless the applicant demonstrates sufficient English proficiency as defined under federal regulations (49 C.F.R §391.11(b)(2)).

• Allows applicants to retake the English proficiency exam, subject to availability.

• Prohibits commercial motor carriers from employing or contracting with commercial drivers who lack sufficient English proficiency; civil penalties of $3,000, $5,000, and $10,000 apply for first, second, and subsequent violations, respectively.

• Prohibits non-proficient individuals from operating commercial motor vehicles; violations result in a $1,000 civil penalty and a serious misdemeanor charge.

• Establishes procedures for the removal and transfer of vehicles and cargo when a violation is detected, and limits liability for related damages to the state, local authorities, and cargo owners.

• Requires payment of civil penalties before a carrier can reclaim a vehicle and mandates notification of cargo owners if the carrier fails to comply within 12 hours.

• Directs the Department of Transportation to waive provisions if compliance would jeopardize federal funds or violate federal law.

Signed by Governor May 2, 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.

Fuel: Increases the appropriation from the Renewable Fuel Infrastructure fund by $50,000 to DALS for administration to $150,000. Strikes the cap on using RF money to install retail biodiesel infrastructure. Marketing: Makes changes to Choose Iowa , Including an Iowa school food program and an Iowa food bank program, and to reporting dates. Strikes a cap of $200,000 for aggregate reimbursements to food banks. Allows DALS to adopt rules. Strikes the repeal date of Choose Iowa. Dairy: Makes beginning farmers a priority in the dairy innovation program. Butchery: Transfers the butchery innovation program to DALS. Animal Health: Allows DALS to lease buildings to control infectious diseases. Deems such information confidential but allows DALS to release information to protect public/animal health. Weights: Makes changes related to weights, including eliminating certain requirements to inspect weighing devices unless a complaint is made. Grain: Makes changes to restore grain indemnity fund provisions from 2024. Effective immediately. Vehicles: Limits an implement of husbandry to 57 feet when used with a semi. Tourism: Includes tree farms, Christmas trees, fungus, nuts, maple syrup and honey as crops in agricultural tourism. Includes zoning exemptions. Adds activities under agricultural tourism (recreational, dining, lodging and other activities). Makes these provisions effective immediately. Bees: Exempts honeybees from the sales tax. Veterinarians: Allows veterinarians participating in loan repayment programs to exclude some income attributable to the program and to relocate employment within a shortage area. Effective 7/1/2026.

Signed by Governor June 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.

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.

Spends $47.3 million Department of Agriculture and Land Stewardship, Department of Natural Resources, Iowa State University, and the University of Iowa. The appropriations support a wide array of activities, including regulatory functions, research initiatives, conservation, water quality, animal disease preparedness, and assistance for food and farm programs.  New funding for: Choose Iowa School Purchasing Program ($200,000); Iowa Geological Survey to support the Iowa Water Quality Information System at the University of Iowa ($300,000); rural Iowa infrastructure bank program fund to help small and medium sized communities (<11,000 population) upgrade their water and wastewater infrastructure ($10 million from RIIF). Transfers another $8 million into the water quality fund from RIIF and allocates $25 million for the Des Moines Waterworks for constructing and installing additional nutrient removal technology (funds remain through 6/30/2029). Increased funding for: Choose Iowa promotional program by $300,000 ($2,113,000 total) and water quality administration ($176,150). No change in funding for: Local Food & Farm Program ($125,000); Choose Iowa Food Bank Purchasing Program ($200,000); Farmers with Disabilities Program/Easterseals ($230,000); Loess Hills Development & Conservation Fund ($260,000 for Hungry Canyons; $40,000 for Loess Hills Alliance); Southern Iowa Development & Conservation Fund ($100,000); water quality ($3,455,850); flood plain/dam safety ($1.5 million); forestry management ($525,000); state park operations & maintenance ($1.3 million); Iowa Geological Survey for groundwater mapping ($200,000); watershed protection ($900,000); conservation buffer strips ($900,000). Also no change in funding from the Environment First Fund for: Hungry Canyons ($140,000); state parks ($6,235,000); water quality monitoring ($2,955,000); public water supply system ($500,000); regulation of animal feeding operations ($1,320,000); water quality ($2,375,000); and REAP ($12 million). Other changes: Increases the maximum grant from the Water Quality Financial Assistance Fund from $500,000 to $1 million. Changes standing appropriations from this fund ($500,000 to DNR for water quality continuous monitoring; 65% of remaining funds supports wastewater/drinking water; 15% goes to water quality urban infrastructure; 20% for technical assistance).  Effective 7/1/2026. For more detail go to: https://www.legis.iowa.gov/docs/publications/NOBA/1605091.pdf.

Appropriates $38.9 million for fiscal year 2027 (which begins on July 1, 2026) for the Economic Development Authority, Iowa Finance Authority, Department of Workforce Development, and economic development activities of the state universities. This is a decrease of $1.4 million compared to current spending.  New funding for: UNI nursing program ($600,000) and extending UNI in-state tuition to out-of-state students ($1 million). Increases funding for: Manufacturing 4.0 by $333,325 ($2.35 million total). No change in funding for: tourism ($1.05 million); tourism marketing ($1.4 million); HCBS rent subsidies ($873,000); housing renewal program ($550,000); vocational rehabilitation ($6,226,739); entrepreneurs with disabilities program ($138,506); community college grants for adult literacy for English Language Learners ($500,000); registered apprenticeships ($760,000); BIG Program ($11.7 million); Main Street Iowa ($1 million); Empower Rural Iowa ($700,000); Regents economic development ($3 million); and RefugeeRISE ($210,000). Cuts funding for: Iowa Arts Council by $170,000; international trade by $143,000; adult education and literacy in community colleges by $1 million; and World Food Prize by $50,000 ($450,000 total). Eliminates funding for: Councils of Governments ($350,000).  Other changes: Codifies the Housing Renewal Program. Effective 7/1/2026. For more information go to: https://www.legis.iowa.gov/docs/publications/NOBA/1604867.pdf. 

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.

Requires a court to prioritize an individual who provided foster care to a child for at least nine months immediately preceding the dispositional hearing when determining a child's placement.

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

Establishes that children of parents, guardians, or custodians who work at participating child care facilities or homes are eligible for the state child care assistance program, provided certain conditions are met. These include hours worked, employment role, facility participation in the program, and other restrictions. The bill also addresses copayment requirements and directs the department to adopt administrative rules.

Key Points & Impact:

• Creates a new section (237A.13A) making children of child care workers eligible for the state child care assistance program, regardless of other eligibility provisions.

• Parent/guardian/custodian must work at a state-reimbursed child care facility or home, averaging at least 32 hours per week in direct child care duties and be counted in child-to-staff ratios.

• Eligibility excludes owners of the facility/home, substitutes, and assistants at child care homes or development homes.

• Parents working at child care homes/development homes cannot provide care to their own children under this provision, except for qualifying co-providers.

• Directors or administrative staff may qualify if regularly counted in the minimum child-to-staff ratio.

• Eligible participants must have their need for child care determined by the department and make copayments as set by departmental rules.

• Requires the Department of Health and Human Services to adopt rules to administer the new eligibility pathway.

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

Protects the confidentiality of foster parents' residential addresses. It prohibits anyone from knowingly providing a document containing an unredacted foster parent address to a biological parent of a foster child unless the foster parent gives prior written consent. 

Key Points & Impact:

• Defines 'address,' 'child foster care,' 'foster child,' and 'foster parent' for clarity in application.

• Prohibits knowingly providing or making available documents containing a foster parent's unredacted address to a foster child's biological parent.

• Allows for exception if the foster parent provides prior written consent to disclose their address to the biological parent.

• Applies only to the current foster parent providing child foster care to the foster child.

• Aims to increase privacy and safety for foster parents.

• Does not restrict disclosure to parties other than biological parents, unless otherwise specified by law.

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

Prevents the Iowa Department of Health and Human Services from requiring foster parents, kinship caregivers, or prospective adoptive parents to affirm or support policies related to sexual orientation or gender identity that conflict with their sincerely held religious or moral beliefs. It prohibits discrimination against these individuals or entities based on such beliefs in foster care or adoption placements. The bill also allows individuals to take legal action if their rights under this law are violated and enables the attorney general to enforce these provisions. Religious organizations contracting with the state for foster care or adoption services cannot be compelled to provide services contrary to their beliefs, though the department must still determine the child's best interests in placements.

Key Points & Impacts

• Prohibits the Department of Health and Human Services from requiring foster care licensees, kinship caregivers, or prospective adoptive parents to affirm or support policies on sexual orientation or gender identity that conflict with their sincerely held religious or moral beliefs.

• Prevents the department from denying foster care or adoption licenses or approvals based on an individual’s sincerely held religious or moral beliefs regarding sexual orientation or gender identity.

• Bars the department from adopting standards or rules that would exclude individuals from consideration as caregivers or adoptive parents due to such beliefs.

• Allows individuals and kinship caregivers to bring legal action for violations, with courts able to grant injunctive, declaratory, or other relief, including attorney fees and costs.

• Authorizes the attorney general to enforce these provisions.

• Requires the department to consider the sincerely held beliefs of the child and family of origin when making placement decisions, to ensure the best interests of the child.

• Protects religious organizations with state contracts for foster care or adoption from being required to provide services contrary to their beliefs, unless federal law dictates otherwise.

• Affirms that the department must still prioritize the best interests of the child in all placement decisions.

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

Removes the fixed hourly requirements for initial and renewal foster parent training, granting the Department of Health and Human Services (HHS) authority to determine suitable training based on the individual’s relevant experience and the circumstances of both the foster child and the provider. Specifies required training topics, updates the content structure, and eliminates the automatic military exemption. The bill also clarifies rulemaking authority for implementation.

Key Points & Impact:

• Eliminates the 30-hour initial and 6-hour annual foster parent training requirements, allowing training duration and content to be determined by HHS based on individual experience and circumstances.

• Requires HHS to consider both the licensee’s relevant training/experience and the specific needs of the foster child and licensee when determining appropriate training.

• Specifies core training content areas for foster parents, including child welfare overview, biological parent contact, behavior management, trauma, and attachment/grief/loss.

• Removes the department's authority to waive all or part of the training requirement solely based on prior experience or 'good cause.'

• Eliminates the automatic compliance exemption for licensees on active military duty who are unable to complete training for renewal.

• Allows training requirements to be fulfilled through approved programs offered by public/private agencies with relevant expertise.

• Mandates that the department notify licensees of any additional beneficial training in a timely manner.

• Requires the department to adopt rules for implementation and enforcement of the revised training standards.

Signed by Governor on April 7, 2026. Takes effect July 1, 2026.

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.

Requires, starting July 1, 2027, that all higher education institutions offering teacher preparation must include targeted clinical experiences and preparation for serving students with disabilities and English learners. It sets new practicum hour requirements and differentiated standards for endorsements in special education and English learner instruction. The bill also introduces a mandatory end-of-program assessment for all practitioner candidates, to be identified and scored by the Department of Education, with accompanying data reporting and remediation requirements. Additionally, it requires a new self-paced special education law course for those seeking certain teaching licenses in special education. Effective 7/1/2027.

Key Points & Impacts:

• Requires all practitioner preparation programs to include clinical experiences and preparation for serving students with disabilities and English learners, effective July 1, 2027.

• Sets minimum practicum hour requirements: 15 hours for all students (focused on instruction for special populations) and 40 hours for students seeking an English learner endorsement.

• Mandates the Department of Education to establish differentiated standards for clinical and practicum experiences based on student endorsement goals (general, special education, English learner instruction).

• Requires a summative end-of-program assessment, designed and scored by the Department of Education, for all practitioner candidates before completing their programs, effective July 1, 2027.

• Institutions must analyze and provide remediation opportunities for students who do not meet the minimum assessment score set by the Department.

• Beginning August 1, 2028, the Department must publicly report program-level passage rates, support efforts, and remediation plans related to the assessments.

• Defines 'English learner' as per existing state code for clarity and consistency in application.

• Requires completion of a Department-created, self-paced special education law course as a condition for awarding class B or conditional licenses to individuals applying to teach in special education settings.

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.

Requires the Department of Education and schools to distribute and train staff on federal guidance about constitutionally protected prayer and religious expression. Mandates model policies for compliance and extends protections for religious, political, and ideological student speech and club activities. Removes prohibitions against sectarian or religious content/materials in certain funding, program, and tax definitions. Establishes new civil penalties for violations and waives sovereign immunity for school districts in related lawsuits. The act also expands the authority and autonomy of community-based preschool providers and alters tax code provisions regarding educational expenses for religious content, with retroactive effect for tax years starting January 1, 2026.  Effective7/1/2026 (tax provisions retroactive to 1/1/2026).

Key Points & Impacts

• Requires annual distribution of U.S. Department of Education guidance on protected prayer/religious expression to all superintendents, principals, and teachers in public and charter schools, and publication of the guidance online.

• Mandates professional development and model policies for school staff regarding constitutionally protected religious expression, and annual certification of compliance to the Department of Education.

• Expands student speech protections, prohibiting discrimination or penalty for religious, political, or ideological expression in schoolwork, clubs, clothing, and assemblies, with clear enforcement and civil penalties for violations.

• Removes statutory prohibitions on the use of public funds and participation in certain programs for materials or courses with sectarian or religious content (e.g., textbooks, tuition, concurrent enrollment).

• Preserves maximum autonomy and freedom for community-based preschool providers, limits state authority to only what is necessary for program participation, and invalidates burdensome rules.

• Extends protected speech requirements to charter and innovation zone schools, making them subject to the same standards as school districts.

• Waives school district sovereign immunity for protected speech violations, allowing federal lawsuits and establishing a minimum $5,000 civil penalty per violation, payable to prevailing students or clubs.

• Retroactively applies changes to tax definitions and credits for education expenses, allowing religious materials and programs to qualify for state tax benefits starting January 1, 2026.

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.

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.

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.

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.

Prohibits local governments from issuing county- or city-specific identification cards to residents. Exceptions are made for counties authorized to issue state-regulated IDs (driver’s licenses, nonoperator IDs, and disability identification devices), and for the issuance of identification to county or city employees and elected officials in relation to their job duties.

Key Points & Impact:

• Counties are prohibited from issuing county-specific identification cards to residents except as explicitly allowed.

• Counties authorized under chapter 321M may still issue driver’s licenses, nonoperator’s identification cards, and persons with disabilities identification devices.

• Counties may issue identification cards to their employees or elected officials for job-related purposes.

• Cities are prohibited from issuing city-specific identification cards to residents except as explicitly allowed.

• Cities are permitted to issue identification cards to their employees or elected officials for job-related purposes.

• Bill targets the elimination of locally issued resident IDs, with the intent to standardize identification issuance statewide.

• No changes are made to the processes for issuing state-regulated forms of identification or employee/elected official IDs.

• The bill does not impact the issuance of identification for employment or official government duties.

Signed by Governor on April 16. 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.

Requires the Iowa Department of Transportation (DOT) verify the citizenship and immigration status of all applicants for driver's licenses or nonoperator identification cards who do not provide proof of U.S. citizenship. The verification must be conducted using the federal SAVE (Systematic Alien Verification for Entitlements) program or a similar federal system. The DOT is prohibited from issuing or renewing these documents if the applicant does not provide proof of citizenship and cannot be verified as lawfully present in the U.S. Effective 3/1/2027 or when the Iowa DOT submits administrative code sections upon implementation of its new records system.

Key Points & Impact:

• Requires DOT to use the federal SAVE program (or successor system) to verify citizenship or immigration status for applicants lacking proof of U.S. citizenship.

• Applies to both issuance and renewal of driver’s licenses and nonoperator identification cards.

• DOT cannot issue or renew licenses or IDs if the applicant cannot prove U.S. citizenship and cannot be verified as lawfully present.

• Defines the SAVE program as the Systematic Alien Verification for Entitlements system operated by the U.S. Department of Homeland Security.

• Applies to all new applicants and renewals where citizenship proof is not provided.

• Establishes a legal requirement for verification before granting state identification documents.

Requires commercial drivers demonstrate sufficient English language proficiency to receive or renew a CDL or CLP. The Department of Transportation must administer a computer-based English proficiency exam, and commercial motor carriers are prohibited from employing drivers who do not meet the standard. Civil penalties are imposed on carriers and drivers for violations, and criminal penalties apply to non-proficient drivers operating commercial vehicles. The bill also outlines procedures for handling vehicles and cargo when violations occur, and protects compliance with federal law.

Key Points & Impacts:

• Adds a new requirement that applicants for commercial driver’s licenses or learner’s permits must pass an English language proficiency exam administered by the Department of Transportation.

• Prohibits issuance or renewal of a CDL or CLP unless the applicant demonstrates sufficient English proficiency as defined under federal regulations (49 C.F.R §391.11(b)(2)).

• Allows applicants to retake the English proficiency exam, subject to availability.

• Prohibits commercial motor carriers from employing or contracting with commercial drivers who lack sufficient English proficiency; civil penalties of $3,000, $5,000, and $10,000 apply for first, second, and subsequent violations, respectively.

• Prohibits non-proficient individuals from operating commercial motor vehicles; violations result in a $1,000 civil penalty and a serious misdemeanor charge.

• Establishes procedures for the removal and transfer of vehicles and cargo when a violation is detected, and limits liability for related damages to the state, local authorities, and cargo owners.

• Requires payment of civil penalties before a carrier can reclaim a vehicle and mandates notification of cargo owners if the carrier fails to comply within 12 hours.

• Directs the Department of Transportation to waive provisions if compliance would jeopardize federal funds or violate federal law.

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

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.