All Roll Calls
Yes: 124 • No: 104
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
28 provisions identified: 23 benefits, 1 costs, 4 mixed.
More behavioral health help statewide
Beginning July 1, 2025, the state funds more behavioral health care. It provides $24.4 million from the general fund, plus $1.75 million from sports wagering receipts. It adds $950,000 to support substance use disorder managed care and keep federal waivers in place. It also sets aside $300,000 for children’s behavioral health services, including prevention and treatment. This includes a 24-hour helpline, youth prevention, training, and other services statewide.
More funding for child protection and adoption
Starting July 1, 2025, $165,558,031 funds child protective, adoption, and foster care services, with up to 977 staff. It includes $39,823,955 for adoption subsidies (with $148,232 to increase post‑July 1, 2025 adoptions) and $308,765 to raise foster care reimbursements. It also funds child protection centers with equal base grants and added amounts by volume and satellite use, and supports youth preparing for adult living.
Funding for state mental health and oversight
For FY 2025–2026, $102,343,507 funds state‑operated specialty care institutions and up to 756 staff. The department can use funds to maximize bed capacity and meet patient needs. Another $21,904,214 funds accountability and compliance and up to 409 staff. This includes a $200,000 transfer to the Iowa ABLE plan admin fund, $2,602,312 for foster care review/CASA, and $1,148,959 for the Long‑Term Care Ombudsman.
Keeping benefit access and eligibility staffed
Beginning July 1, 2025, $68,542,456 funds community access and eligibility operations with up to 870.40 staff. This supports FIP assistance, PROMISE JOBS, SNAP employment and training, family planning, rent reimbursement, and eligibility processing. The money keeps offices running so households can apply for and keep benefits.
More funding for child care and early support
For FY 2025–2026, the state sets aside $34,983,000 for child care assistance. Lawmakers state they will add funds during the year to avoid waiting lists if needed. It also provides $35,301,904 for child and adolescent health and support, including up to 29 staff. That includes up to $734,000 for HOPES‑HFI, $4,313,854 for FaDSS (up to 5% for admin), and $29,256,799 for the Early Childhood Iowa Fund.
More help for seniors and caregivers
Starting July 1, 2025, the state provides $19,208,180 for aging services and up to 88 staff. Local area agencies must match funds to receive the state dollars. It also allocates $949,282 for family support centers and $33,632 for training tied to the Conner v. Branstad consent decree. Services include case management, resource centers, return‑to‑community help, and abuse prevention.
More support for Iowa veterans services
Starting July 1, 2025, $1,369,205 funds the Iowa Department of Veterans Affairs for administration and up to 15 staff. The law also gives $8,145,736 to the Iowa Veterans Home for operations. The Home must send billings to the health department at least monthly and submit a monthly spending report to the legislature.
Program funds stay available longer
Beginning July 1, 2025, unspent money for certain programs does not revert at year‑end. It stays available through the next fiscal year. This applies to FaDSS, some medical assistance payments, state specialty care, rural psychiatric residencies, adoption subsidy and post‑adoption services, and child protective services.
Support for free and public health clinics
Starting July 1, 2025, the state funds public health programs with $22.4 million and up to 348.6 staff. It gives $600,000 to the statewide drug donation repository and $374,000 to free clinics (including $40,000 to cut e‑prescribing fees). It provides $225,000 to a county medical society to keep specialty care access for safety‑net patients. It also gives $25,000 to an organization that supports rural health clinics. Several of these grants are paid out in full on July 1, 2025.
More help for veteran homebuyers
Beginning July 1, 2025, the state transfers $2.2 million to the Iowa Finance Authority. The money continues the homeownership assistance program for people eligible under Iowa law as current or former service members. You must meet Iowa Code section 16.54 eligibility to get help.
DHHS can move funds to keep services going
Beginning July 1, 2025, DHHS can transfer money among its budgets to align services, maximize federal support, and manage cash flow. The department must report transfers to the legislature. It may shift TANF funds to other federal block grants when allowed. Unencumbered funds may be used later in the same year for any allowed purpose.
Planning future pay and beds for nursing homes
By December 15, 2025, DHHS reviews how it sets special population nursing facility rate limits. By April 1, 2026, it must propose a new Medicaid pay method with a base rate, a pass‑through for quality assessments, and a quality add‑on, using stakeholder metrics and staying within appropriated dollars. By July 1, 2026, it must create and use a nursing bed forecasting formula in certificate‑of‑need reviews.
Nursing home pay reset and allowances
Beginning July 1, 2025, the state rebases nursing facility case‑mix rates using cost reports through December 31, 2024. Up to $20 million from Medicaid funds can support this change in FY 2025–2026. Also starting July 1, 2025, residents in nursing homes and similar institutions get a higher personal needs allowance: $55 per month, up from $50. The state tops up income so each eligible resident receives the full $55 each month.
Provider payment freeze, home health rate changes
For the year starting July 1, 2025, most Medicaid and related payment rates and methods stay the same as on June 30, 2025, unless contracts or updated fee schedules apply or the Act says otherwise. For home health agencies, Medicaid payments use Medicare’s LUPA method with state wage adjustments, and the department must raise those rates to the extent possible.
New hospital payments and hospital assessments
The law creates a hospital directed payment program for inpatient and outpatient services. DHHS must get federal CMS approval before running it. The department can assess hospitals to fund the state’s nonfederal share, but only up to what federal rules allow. It will set payment deadlines and penalties, and unpaid assessments are a debt that can be collected. DHHS can end the program if federal policy changes, and it must adopt rules to run it. A hospital is defined as a nonstate‑owned, state‑licensed hospital.
Free radon test kits for homes
Beginning July 1, 2025, homeowners and renters can order free radon test kits. The state sets aside $20,000 to buy and send kits. The health department will post an online order link on its website.
More early checkups for kids under five
Starting July 1, 2025, $3,075,000 continues and expands developmental screening for children from birth to age five. Current counties are fully funded first, and remaining funds can add new counties. The work includes child health specialty clinics and uses Medicaid matching when possible.
Higher Medicaid rates for key providers
Beginning July 1, 2025, Medicaid raises dental payment rates (not orthodontics) with $2.14 million for FY 2025–2026. The state also adds $420,000 to raise payments for maternal health providers. Another $100,000 raises prosthetics reimbursement. The law does not set a formula for how these funds are split among providers.
Higher pay for youth care providers
For FY 2025–2026, the state sets aside $3,245,594 to raise payments to qualified residential treatment program providers and $1,590,842 for shelter care providers. The department must work with providers and juvenile court services to design a reimbursement method for the year starting July 1, 2026.
Funding for state volunteer programs
Starting July 1, 2025, the state provides $1.15 million to the Iowa Commission on Volunteer Service for FY 2025–2026. The money supports volunteer programs and grants to community groups.
Child support and visitation funds
Starting July 1, 2025, the federal share of child support collected under FIP is credited to child support services. Other collections can support community access, recovery efforts, a refund account, or needed technology. Also beginning July 1, 2025, federal access and visitation grants must fund services that help families follow court‑ordered visitation, like neutral visitation sites and mediation.
Funding and cash‑flow help for child support
Beginning July 1, 2025, $15,644,114 and up to 464 staff fund child support services. The department may temporarily draw more during the year to manage cash flow, as long as the total used does not exceed the appropriation at year‑end.
Guardrails on hospital payment program
The state caps administrative fees on hospital assessments at 4% of each assessment. Money from assessments and penalties can only fund the hospital directed payment program. The program and any hospital assessments cannot start unless the federal government pays its share and CMS approves it.
Liquor sales fund behavioral health
Beginning June 11, 2025, at least 7% of monthly liquor sales moves into a special state account, with at least $9 million a year in total transfers. At least $2 million goes to the health department for staff for the substance use disorder program and to the behavioral health fund. Any extra money after these transfers counts toward the state’s general fund balance.
More training funds for doctors‑in‑training
Beginning July 1, 2025, $600,000 supports rural psychiatric residency slots for residents selected by June 30, 2025. Another $2,300,000 supports Medicaid graduate medical education and seeks federal matching under a CMS request. These funds help train and place more clinicians, especially in rural areas.
Yearly review of home health and pharmacy fees
Starting July 1, 2026, the health department must review Medicaid rates for home health agencies and pharmacy dispensing fees every year. This rule creates an annual check on rates. It does not itself raise payments.
Limits on University of Iowa overhead
Starting July 1, 2025, the University of Iowa Hospitals and Clinics cannot take indirect cost reimbursements from public health or from community access and eligibility appropriations. The University must bill the department at least every three months for these funds.
Faster health department rules with budget notice
The health department can adopt emergency rules to carry out this law and meet federal deadlines. These rules take effect when filed unless a later date is listed. If an emergency rule would cost more than the budget expects or was not budgeted, the department must notify lawmakers and the budget office at least 30 days before filing.
Sponsors & Cosponsors
Sponsor
COMMITTEE ON APPROPRIATIONS
Affiliation unavailable
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
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.
6/27/2025legislatureExplanation of vote.
6/27/2025legislatureSigned by Governor.
6/11/2025GovernorNOBA: Final
6/3/2025legislatureReported correctly enrolled, signed by Speaker and President, and sent to Governor.
5/22/2025SenateMessage from Senate.
5/14/2025SenateImmediate message.
5/14/2025legislaturePassed Senate, yeas 31, nays 15.
5/14/2025SenateSubstituted for SF 649.
5/14/2025legislatureRead first time, attached to SF 649.
5/13/2025legislatureMessage from House.
5/13/2025HouseImmediate message.
5/13/2025legislatureExplanation of vote.
5/13/2025legislaturePassed House, yeas 63, nays 28.
5/13/2025HouseMotion to suspend rules failed.
5/13/2025legislatureNOBA: House Floor
5/13/2025HouseMotion to suspend rules for immediate consideration of amendment H-1334, yeas 30, nays 61.
5/13/2025legislaturePoint of order raised on amendment H-1334, ruled not germane.
5/13/2025legislatureAmendment H-1334 filed.
5/13/2025legislaturePoint of order raised on amendment H-1333, ruled not germane.
5/13/2025legislatureAmendment H-1333 filed.
5/13/2025legislatureNOBA: House Full Approps
5/12/2025HouseIntroduced, placed on Appropriations calendar.
5/12/2025legislature
Bill Text
As Introduced
Enrolled
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