IowaHF 104991st General Assembly (2025–2026)HouseWALLET

A bill for an act relating to and making appropriations to the department of veterans affairs and the department of health and human services, and related provisions and appropriations, including aging and disability services; behavioral health, public health, community access and eligibility; the medical assistance program, state supplementary assistance, Hawki, and other health-related programs; sex reassignment surgeries or associated procedures; family well-being and protection; state-operated specialty care, administration and compliance; transfers, cash flows, and nonreversions; prior appropriations; the beer and liquor control fund, and the behavioral health fund; report on nonreversion of moneys; emergency rules; and a hospital directed payment program; and including effective date and retroactive applicability provisions. (Formerly HSB 342.) Effective date: 06/11/2025, 07/01/2025. Applicability date: 07/01/2024.

Sponsored By: COMMITTEE ON APPROPRIATIONS

Signed by Governor

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Bill Overview

Analyzed Economic Effects

43 provisions identified: 37 benefits, 3 costs, 3 mixed.

Medicaid limits gender-related care payments

Beginning June 11, 2025, Iowa Medicaid cannot use state general funds to reimburse sex reassignment surgery or associated procedures. This includes hormone therapy and medical interventions intended to change sex characteristics related to a gender dysphoria diagnosis. Other services that Medicaid otherwise covers remain eligible for payment if they fall outside this ban.

Funding helps families pay for child care

From July 1, 2025, through June 30, 2026, Iowa provides $34.98 million for state child care assistance. The law also provides $47.17 million in federal Temporary Assistance for Needy Families funds for child care assistance. It allows up to 53 full-time-equivalent staff positions for the state-funded appropriation. Lawmakers state an intent to add money if needed to avoid waiting lists, but do not guarantee that extra funding. The appropriations do not set a new per-family payment amount.

Higher adoption subsidies for eligible families

For July 1, 2025, through June 30, 2026, Iowa provides about $39.824 million for adoption payments and related costs. This includes $148,232 to raise subsidies for eligible children adopted after July 1, 2025. The law does not state the increase per child. Remaining designated savings can support post-adoption services and other uses allowed by federal child welfare law.

More community support for disabled people

For July 1, 2025, through June 30, 2026, Iowa sets aside $3.05 million to expand community-based service capacity. Services include employment support, hourly supported community living, respite, and day programs. Another $33,632 supports community training and coordination under the Conner v. Branstad consent decree. The funding does not set individual payment amounts.

Funding for foster and adoptive families

For July 2025 through June 2026, Iowa provides about $165.56 million for child, family, and adoption services, plus $65.36 million in TANF funds for child protection. Services include foster care, shelters, residential treatment, supervised apartments, and medical assistance costs, with up to 977 full-time-equivalent positions. Allocations include about $1.72 million for local service funding pools and boards, and $4.36 million for preparation for adult living. Qualifying uncommitted 2025–2026 child protection, adoption subsidy, and post-adoption funds remain available for designated uses through June 30, 2027. Effective June 11, 2025, qualifying uncommitted 2024–2025 child protection funds remain available through June 30, 2026.

Funding keeps state specialty care running

For fiscal year 2025–2026, Iowa provides $102.34 million for state-operated specialty care and allows up to 756 full-time-equivalent staff positions. Funding covers the Cherokee and Independence mental health institutes and Cherokee’s civil commitment unit. It also covers the Woodward and Glenwood resource centers and Eldora’s state training school. The health department must use the money as needed to maximize bed capacity and meet the needs of people served.

Public abortion payments face tight limits

From July 1, 2025, through June 30, 2026, the covered program funds cannot pay for abortions unless the section authorizes payment. The abortion rules also apply to the Iowa Health and Wellness Plan. The governor must approve each abortion reimbursement under Medicaid.

Health coverage funding includes abortion payment limits

From July 1, 2025, through June 30, 2026, Iowa provides about $1.90 billion for health assistance. This includes $61.27 million for Hawki children’s coverage and supplemental dental services, plus $4.48 million for State Supplementary Assistance. Subject to available funds, Medicaid gets another $111.22 million from the quality assurance trust and $33.92 million from the hospital access trust. Medicaid generally keeps June 30, 2025, payment methods, subject to federal law and other legal exceptions. The governor must approve Medicaid reimbursement for each abortion.

Free radon tests for Iowa households

Iowa provides $20,000 for free radon test kits for homeowners and renters. The department provides an online link to order the kits. The funding covers July 1, 2025, through June 30, 2026.

Care residents keep more personal money

Beginning July 1, 2025, the monthly personal needs allowance rises from $50 to $55. It covers residents of nursing facilities, intermediate care facilities for intellectual disability or mental illness, and psychiatric medical institutions for children. Residents with monthly income below $55 receive a state supplement that brings their allowance to $55. The law also provides about $1.15 million for the long-term care ombudsman office for July 2025 through June 2026.

Developmental screening expands for young children

For July 1, 2025, through June 30, 2026, Iowa provides about $3.08 million for developmental screening during children's first five years. Current participating counties must become fully operational before funds support expansion to additional counties. The money also supports clinical consultation, training, and coordination. Funds must serve as Medicaid matching money to the maximum extent possible.

Homebuying help continues for eligible veterans

Iowa transfers $2.2 million to the Iowa Finance Authority to continue homeownership assistance for July 1, 2025, through June 30, 2026. The program serves eligible current and former armed forces members and other eligible service members under Iowa law. The law does not state how much help each person receives.

Child support and visitation services funded

For July 1, 2025, through June 30, 2026, Iowa provides about $15.64 million for child support services. Federal access and visitation grants fund services that help families follow court-ordered child access arrangements. Supported services include neutral visitation sites and mediation. These provisions do not set new child support payment amounts.

Grants support child protection center services

For fiscal year 2025–2026, Iowa provides $1.66 million for child protection center grants. Each Iowa center receives a $245,000 base grant. Remaining money is divided based on the number of children served. Eligible grantees developing and maintaining satellite centers in underserved regions may receive extra funding.

Higher payments for children's care providers

For July 1, 2025, through June 30, 2026, Iowa funds higher payments for foster, residential treatment, and shelter care. Foster care rate increases get $308,765 and cannot exceed the existing legal maximum. Qualified residential treatment programs get about $3.246 million for rate increases; shelter care providers get about $1.591 million. Treatment and shelter rates must rise as far as funding allows, compared with rates in effect June 30, 2025.

Support for abused and foster children

For July 2025 through June 2026, Iowa provides about $2.60 million for foster care review and court-appointed special advocates. Up to $227,000 continues a nonprofit project serving child abuse victims and nonoffending family members. The project must serve multiple locations in southwest Iowa and Nebraska. Services include immediate support, forensic interviews, medical exams, needs assessments, and referrals.

Volunteer programs gain funding and carryover

For July 2025 through June 2026, Iowa allocates about $1.15 million to the Iowa Commission on Volunteer Service. The money supports programs and grants. Qualifying uncommitted 2025–2026 general fund money for these purposes remains available in later fiscal years instead of expiring.

Emergency poison information services receive funding

For July 1, 2025, through June 30, 2026, Iowa allocates $750,000 to a nonprofit providing emergency poison information and treatment access. Any federal matching funds follow the applicable 10% federal administrative cap and count toward the department's cap calculations. The allocation funds a safety service, not individual household payments.

Funding for family planning and pregnancy prevention

For fiscal year 2025–2026, Iowa sets aside $3.38 million for state family planning administration, outreach, and enrollment. Administrative expenses are capped at $200,000. The law also provides $1.91 million in federal Temporary Assistance for Needy Families funds for pregnancy prevention, provided family planning services receive funding. Programs existing by July 1, 2025, must show positive results; later programs must follow proven models, and all must emphasize abstinence. Priority goes to areas with the highest share of unplanned pregnancies among females of childbearing age.

Funding helps residents access public benefits

For fiscal year 2025–2026, Iowa provides $68.54 million for community access and eligibility services. Another $12.99 million comes from federal Temporary Assistance for Needy Families funds. The funding supports Family Investment Program assistance, employment programs, family planning, rent reimbursement, and eligibility reviews for health and food assistance. These appropriations do not create new household eligibility rules or payment amounts.

Funding supports addiction and behavioral health care

For fiscal year 2025–2026, Iowa provides $24.44 million for behavioral health prevention, treatment, and recovery, including a 24-hour helpline. Activities must follow accepted best practices. This includes $300,000 for children’s evidence-based behavioral health services and $950,000 for an integrated substance use treatment system. The health department must maintain contractors’ mental health and substance use treatment levels and continue federal waivers as needed. Another $1.75 million from sports wagering receipts supports prevention, treatment, and recovery for alcohol, tobacco, drug use, gambling, and related addictions.

Funding supports aging and disability services

For fiscal year 2025–2026, Iowa provides $19.21 million for aging and disability services. Services include case management for people age 60 and older, resource centers, help returning to community living, and abuse prevention and response. Within this amount, $949,282 supports family support centers. Local aging agencies must provide matching funds under department rules. Services outside the listed uses need department approval in the agency’s area plan.

Funding supports disease prevention and public health

For fiscal year 2025–2026, Iowa provides $22.43 million for public health programs. The money supports disease tracking and investigations, chronic condition services, and the Iowa donor registry. It also supports health care delivery and workforce efforts. This funding supports programs rather than direct household payments.

Funding supports early childhood and family services

For fiscal year 2025–2026, Iowa provides $35.30 million for programs serving children from birth through age 21 and their families. This includes up to $734,000 for HOPES-HFI, $4.31 million for Family Development and Self-Sufficiency, and $29.26 million for Early Childhood Iowa. No more than 5% of the Family Development and Self-Sufficiency grants may pay administrative costs. Another $3.01 million in federal Temporary Assistance for Needy Families funds supports child abuse prevention and Family Development and Self-Sufficiency grants. Those federal funds must follow Iowa’s designated grant-program rules.

Funding supports family assistance program improvements

For fiscal year 2025–2026, Iowa provides $25 million in federal Temporary Assistance for Needy Families funds for activities meeting the program’s four federal purposes. Work may promote self-sufficiency, address benefit cliffs, support healthy families, and simplify services. Another $3.53 million supports administration, technology, reporting, case management, program integrity, and related department needs. The law does not set a new family payment or eligibility formula.

Grants support free clinics and donated medicines

From the public health appropriation, $600,000 goes to the nonprofit that established Iowa’s first statewide drug donation repository. Free clinics and a clinic-support nonprofit receive $374,000, including $40,000 to lower electronic prescribing fees. A rural health clinic advocacy organization receives $25,000 for clinic infrastructure and service changes. The oldest continuously operating medical society in Iowa’s most populous county, based on the latest census, receives $225,000 for safety-net patients’ specialty care. All four allocations must be paid in full on July 1, 2025.

Thrive Iowa referral system receives funding

Effective June 11, 2025, Iowa health and human services can use up to $3 million from specified 2024 funds for Thrive Iowa. The money supports development and operation of its closed-loop service referral system. The department must find that the money will remain uncommitted at year-end or that services will not be affected. Money used for Thrive Iowa remains available for its designated purposes instead of expiring.

Veterans home and agency operations funded

For July 1, 2025, through June 30, 2026, Iowa provides about $8.15 million for Iowa Veterans Home operations. Another $1.37 million funds Department of Veterans Affairs operations and up to 15 full-time-equivalent positions. These funds support the facility and agency, rather than creating new household payments.

Funding for doctors' training in Iowa

For July 1, 2025, through June 30, 2026, Iowa sets aside $600,000 for rural psychiatric residencies. Residents must have been selected by June 30, 2025. Another $2.3 million supports Medicaid graduate medical education and seeks to maximize federal funding. Those efforts must follow the department's request for a Medicaid supplemental enhanced payment or successor legislation. These funds support medical training rather than direct household payments.

Alcohol revenue supports behavioral health funding

Effective June 11, 2025, Iowa transfers beer and liquor control fund revenue after the transfer required by existing law. At least 7% of monthly gross sales, and at least $9 million annually, goes to a special revenue account. Of that money, $1 million goes to the Behavioral Health Fund; the remainder becomes part of the general fund balance. For the fiscal year beginning July 1, 2024, the division's substance-use and addiction treatment and prevention funding replaces the standing appropriation. That replacement does not establish whether total program funding rises or falls.

Disability savings plan administration receives funding

Beginning July 1, 2025, Iowa transfers $200,000 to the Iowa ABLE savings plan trust administrative fund. The money supports implementation and administration through June 30, 2026. It does not change who qualifies, account terms, or individual account balances.

Family support funds get longer availability

Beginning July 1, 2025, qualifying uncommitted 2025–2026 FaDSS family support funds remain available through June 30, 2027. This covers both general fund money and federal Temporary Assistance for Needy Families block grant money. Funds must serve their designated purposes. The extension does not change eligibility or establish household payment amounts.

Funding keeps health assistance programs operating

For fiscal year 2025–2026, Iowa provides $39.67 million for health program operations, including the autism support program. The law allows up to 82 full-time-equivalent staff positions. Enough money must support administration of the health insurance premium payment program. Another $234,193 from a pharmaceutical settlement account supplements medical assistance health program operations. These funds do not set individual benefit amounts.

Health agency oversight and improvements funded

For July 2025 through June 2026, Iowa provides about $21.90 million for health and human services oversight and program integrity. The appropriation supports no more than 409 full-time-equivalent positions. Effective June 11, 2025, qualifying uncommitted 2024–2025 community access and eligibility funds remain available through June 30, 2026. They can fund designated uses, purposes listed in the division, or needed accountability, compliance, program integrity, and efficiency improvements.

Health department gains flexibility to fund services

Beginning July 1, 2025, Iowa’s health department can transfer this law’s appropriations to align programs, maximize federal support under its cost-allocation plan, or administer funded services; it must report transfers to lawmakers. Medicaid savings from ongoing cost-management efforts can cover related operations and oversight costs when appropriations exceed program costs. Child protective services funds can cover state shares of Medicaid, child care, or Family Investment Program services for children otherwise served with child protection funds. Federal law governs transfers from Temporary Assistance for Needy Families to social services and child care block grants. Money expected to remain uncommitted at year-end can be redirected during that year, but only within the appropriation’s authorized uses or allocations.

Higher Medicaid payments for home health

From July 1, 2025, through June 30, 2026, Iowa keeps its Medicaid home health payment method. Rates use Medicare's low-use payment method, called LUPA, with state geographic wage adjustments. The law directs the state to raise rates as far as possible. It does not set a specific increase.

Higher Medicaid payments for selected care

For July 2025 through June 2026, covered Medicaid, state supplementary assistance, and social service rates generally retain June 30, 2025 levels or methods. Negotiated contracts, updated fee schedules, or another part of the law can set different rates or methods. The law allocates about $2.14 million for dentist rate increases, excluding orthodontics. It also allocates $420,000 for maternal health rate increases and $100,000 for prosthetics rate increases. These increases apply as far as the money allows; no new rate amounts are specified.

Maternal support funds stay available longer

Effective June 11, 2025, qualifying uncommitted 2024–2025 funds for More Options for Maternal Support remain available through June 30, 2026. The money must serve its designated purposes. This preserves program funding without changing household eligibility or setting individual benefit amounts.

Unused health care funds stay available

Beginning July 1, 2025, qualifying unused 2025–2026 Medicaid funds remain available for Medicaid through June 30, 2027. This covers general fund, quality assurance trust fund, and hospital health care access trust fund appropriations exceeding actual spending and remaining uncommitted. Uncommitted 2025–2026 rural psychiatric residency funds also remain available for designated uses through June 30, 2027. Uncommitted 2025–2026 general fund money for state-operated specialty care remains available for designated uses in later fiscal years. These changes preserve funding without changing individual eligibility or benefit amounts.

Updated nursing home payments and planning

Beginning July 1, 2025, Iowa updates Medicaid nursing facility rates using cost reports for the period ending December 31, 2024. The update must fit available state funding and can use no more than $20 million from the specified Medicaid allocation. Iowa must also develop and implement a nursing facility bed forecasting formula by July 1, 2026. The department must consult stakeholders, use prior workgroup recommendations, and consider the formula during formal certificate-of-need reviews.

Health contractors and university face spending limits

The law caps annual service-cost increases for health program operations contracts first signed from July 1, 2025, through June 30, 2026. Increases cannot exceed the prior calendar year’s increase in the Consumer Price Index for All Urban Consumers. Contracts signed by June 30, 2025, for terms longer than one year are exempt. For fiscal year 2025–2026, University of Iowa Hospitals and Clinics cannot receive indirect costs from the covered public health or community access appropriations. These limits govern state payments, not household prices.

Funding caps limit court-ordered child services

For fiscal year 2025–2026, Iowa sets aside $748,000 for court-ordered services for children under health department supervision. District and juvenile courts cannot order covered services charged to the state when this allocation cannot pay for them. The limit applies to services covered by Iowa Code section 232.141(4). Funding supports services, but the cap can limit access for affected children.

New nursing home payment plan required

By April 1, 2026, Iowa’s health department must develop a proposed Medicaid nursing home payment method. It must include a base rate, reimbursement for the quality assurance assessment, and an add-on with fixed-fee and quality-based payments. The department must consult stakeholders, including the Iowa Health Care Association and LeadingAge Iowa. It must recommend measures for qualifying for some or all quality-based payments. State spending under the proposed method cannot exceed the applicable yearly appropriation; this requirement does not itself set final rates.

Sponsors & Cosponsors

Sponsor

COMMITTEE ON APPROPRIATIONS
Affiliation unavailable

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 124 • No: 104

Senate vote • 5/14/2025

Passed Senate

Yes: 31 • No: 15

legislature vote • 5/13/2025

Motion to suspend rules for immediate consideration of amendment H-1334

Yes: 30 • No: 61

House vote • 5/13/2025

Passed House

Yes: 63 • No: 28

Actions Timeline

Explanations of votes.
6/27/2025House
Explanation of vote.
6/27/2025House
Signed by Governor.
6/11/2025House
NOBA: Final
6/3/2025legislature
Reported correctly enrolled, signed by Speaker and President, and sent to Governor.
5/22/2025House
Message from Senate.
5/14/2025House
Immediate message.
5/14/2025Senate
Passed Senate, yeas 31, nays 15.
5/14/2025Senate
Substituted for SF 649.
5/14/2025Senate
Read first time, attached to SF 649.
5/13/2025Senate
Message from House.
5/13/2025Senate
Immediate message.
5/13/2025House
Explanation of vote.
5/13/2025House
Passed House, yeas 63, nays 28.
5/13/2025House
Motion to suspend rules failed.
5/13/2025House
NOBA: House Floor
5/13/2025House
Motion to suspend rules for immediate consideration of amendment H-1334, yeas 30, nays 61.
5/13/2025House
Point of order raised on amendment H-1334, ruled not germane.
5/13/2025House
Amendment H-1334 filed.
5/13/2025House
Point of order raised on amendment H-1333, ruled not germane.
5/13/2025House
Amendment H-1333 filed.
5/13/2025House
NOBA: House Full Approps
5/12/2025House
Introduced, placed on Appropriations calendar.
5/12/2025House

Bill Text

As Introduced
PDF
Enrolled
PDF

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