All Roll Calls
Yes: 114 • No: 96
IowaHF 278291st 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, including aging and disability services, behavioral health, public health, and community access and eligibility; the medical assistance program, state supplementary assistance, Hawki, and other health-related programs; family well-being and protection; state-operated specialty care; administration and compliance; transfers, cash flow, and nonreversions; report on nonreversion of moneys; more options for maternal support program; reimbursement rates review; mental diseases exclusion waiver; full-time equivalent dashboard; comprehensive family support program; federal community mental health services block grant; behavioral health expenditure report; opioid settlement fund; emergency rules; graduate medical education; and special population nursing facilities; and including effective date and retroactive applicability provisions. (Formerly HSB 777.) Effective date: 06/02/2026, 07/01/2026. Applicability date: 07/01/2025.
Sponsored By: COMMITTEE ON APPROPRIATIONS
Signed by Governor
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Bill Overview
Analyzed Economic Effects
44 provisions identified: 38 benefits, 3 costs, 3 mixed.
New home support for disabled youth
Beginning June 2, 2026, Iowa creates a statewide Comprehensive Family Support Program with payments through vouchers or another suitable method. Families must live in Iowa and plan to keep a family member with a developmental disability under 22 at home. Family taxable income must be below $60,000 for the last completed tax year. Support must cover unmet needs, not replace other available help; the program also includes family support centers. The law allocates $949,282 beginning July 1, 2026, and unused program money remains available through the next fiscal year.
Iowa funds Medicaid and family planning
For July 1, 2026, through June 30, 2027, Iowa provides about $1.92 billion for medical assistance reimbursement and related costs. This includes about $3.384 million for state family planning administration, outreach, and enrollment, with administration capped at $200,000. Another approximately $111.216 million comes from the quality assurance trust fund, subject to available money, plus its remaining balance. The law also adds $234,193 from pharmaceutical settlements for medical assistance operations. Uncommitted Medicaid money above actual spending from the general fund and two specified trust funds remains available through June 30, 2028.
Adoptive families retain subsidy funding
For FY 2026–2027, Iowa allocates about $38.41 million for adoption subsidies and related costs. Remaining designated adoption savings must fund post-adoption services or other uses allowed by the specified federal adoption laws. The law does not set an individual family's subsidy amount.
Child protection funding gains spending flexibility
Iowa provides about $65.364 million in TANF funds for child protective services for July 1, 2026, through June 30, 2027. The health department can also transfer child protection appropriations to cover the nonfederal share of certain services. Those services are Medicaid, state child care assistance, and Family Investment Program services. Transfers apply only to children otherwise served using child protection money. The provisions do not set household payments or guarantee a specific service level.
Family assistance funds support self-sufficiency
Beginning July 1, 2026, Iowa provides $25 million in Temporary Assistance for Needy Families funds for program improvements. The money must serve one of the four federal TANF purposes. Goals include helping families become self-sufficient, easing sudden benefit losses as earnings rise, and making services simpler. Another approximately $3.014 million in TANF funds supports early intervention, child abuse prevention, and Family Development and Self-Sufficiency grants. These appropriations fund services and improvements, not a fixed payment to each family.
Family assistance money funds child care
Iowa provides about $42.282 million in TANF funds for state child care assistance. The funding covers July 1, 2026, through June 30, 2027. It supports assistance for families but does not specify different eligibility rules, payment amounts, or a number of families served.
Funding continues child care assistance
For July 1, 2026, through June 30, 2027, Iowa provides $32.723 million for state child care assistance. The law authorizes up to 53 full-time equivalent positions. As needed, state child development and at-risk program funding supplies part of the match for federal child care grants. This funding does not change who qualifies or set a family's award.
Funding supports children and growing families
For FY 2026–2027, Iowa provides about $36.5 million for early supports serving children through age 21 and their families. Allocations include $29.257 million for Early Childhood Iowa and $4.314 million for Family Development and Self-Sufficiency grants. They also include up to $734,000 for Healthy Families Iowa and $1.493 million for maternal support services and administration. No more than 5% of the family development grant allocation can fund grant administration. Uncommitted state and federal TANF money for those family development grants stays available through June 30, 2028.
Hawki funding supports children's health coverage
Iowa allocates about $68.475 million to maintain Hawki children's health coverage from July 1, 2026, through June 30, 2027. The funding includes supplemental dental services for eligible children. The allocation does not specify changes to eligibility or individual benefit amounts.
Higher Medicaid payments for senior care
Beginning October 1, 2026, Iowa allocates $3 million to raise payments for commonly used elderly waiver services. These include attendant care, homemaker help, and assisted living. Rates increase as far as the funding allows, compared with June 30, 2026 rates, for FY 2026–2027. The money goes toward provider payments, not a set cash benefit for each recipient.
Iowa funds autism support and operations
Iowa provides about $40.343 million for health program operations and its autism support program. The funding covers July 1, 2026, through June 30, 2027. This is a combined appropriation, not an autism-only allocation. It does not specify an individual payment or eligibility change.
Funding sustains child and family care
For FY 2026–2027, Iowa provides about $164.53 million for child, family, and adoption services and up to 977 full-time equivalent positions. Services include foster care, shelter, family preservation, and reunification, with some added resources based on client need. The funding includes $4.3595 million for preparation for adult living. Federal receipts from earlier state spending add to child protection funding; those unspent receipts and uncommitted state funds stay available through June 30, 2028. Within FY 2026–2027, the department can shift state allocations when another funding source reduces the need for state money.
Funding sustains state specialty care facilities
For FY 2026–2027, Iowa provides about $100.23 million for state-run specialty care institutions. The law authorizes up to 1,304.45 full-time equivalent positions. Funding covers the Cherokee and Independence mental health institutes, Cherokee civil commitment unit, Woodward resource center, and Eldora training school. It also covers obligations tied to the Glenwood resource center closure.
Limits on publicly funded abortion care
Beginning July 1, 2026, agencies cannot use these appropriations for abortions unless the law's abortion funding provision allows it. The Governor must approve reimbursement for each abortion under medical assistance. These abortion funding rules also apply to the Iowa Health and Wellness Plan. The restriction governs public spending; it does not itself require patients to pay.
Adoption support money stays available
Uncommitted adoption support money remains available after the fiscal year ending June 30, 2027. The carryover covers general fund money for adoption subsidies, related costs, post-adoption services, and allowed related uses. The law does not specify a carryover amount or a larger payment for any family.
Iowa continues young children's developmental screening
Beginning July 1, 2026, Iowa allocates $3.075 million for developmental monitoring and screening during children's first five years. Participating counties must receive full operating funding before remaining money expands the program to additional counties. The work includes collaboration with child health specialty clinics and Medicaid. As much funding as possible must serve as matching money for Medicaid reimbursement.
Iowa funds state supplementary assistance
Iowa allocates about $4.48 million to state supplementary assistance for July 1, 2026, through June 30, 2027. The money supports the existing program. This allocation does not specify new eligibility rules or a different payment amount for recipients.
Maternal support money lasts another year
Effective June 2, 2026, Iowa extends the use of money for its More Options for Maternal Support Program. General fund money left uncommitted on June 30, 2026, remains available through June 30, 2027. It must still serve the program's designated purposes. The law does not state how much money carries over.
Homebuying help and services for veterans
Beginning July 1, 2026, Iowa provides $2.2 million to continue homeownership help through the Iowa Finance Authority. Veterans and service members must meet the service eligibility rules in Iowa Code section 16.54. The law does not set an individual award. It also provides about $1.37 million for Veterans Affairs agency operations through June 30, 2027.
Funding supports child support and visitation
Iowa provides about $15.64 million for child support services in FY 2026–2027. Federal access and visitation grants must help families follow court-ordered child access terms, including through neutral visitation sites and mediation. This does not change a parent's child support amount.
Grants support child abuse victims
For FY 2026–2027, Iowa provides $1.658 million in child protection center grants. Each center receives $245,000, with remaining money divided by the number of children served. Eligible grantees developing and maintaining satellite centers in underserved regions can receive extra funding. Up to $227,000 continues a grant to a nonprofit serving multiple locations in southwest Iowa and Nebraska. That grant supports child abuse victims and nonoffending family members with interviews, medical exams, immediate help, needs assessments, and referrals.
Volunteer programs receive funding and carryover
Beginning July 1, 2026, Iowa allocates about $1.145 million to the Iowa Commission on Volunteer Service for programs and grants. Uncommitted FY 2026–2027 state funding stays available for its designated uses in later fiscal years. The law does not set a final carryover deadline or an individual payment.
Community training receives disability services funding
Beginning July 1, 2026, Iowa allocates $33,632 from aging and disability services funding for coordinated community training. Training must follow the Conner v. Branstad consent decree. This funds community capacity, not direct household payments.
Cost-based payments for specialized nursing homes
Beginning July 1, 2026, designated special-population nursing facilities receive Medicaid payments based on their average allowable daily costs. Facilities must meet the law's population and care criteria involving age, neurological disorders, mental illness, or medical complexity. Payments remain subject to federal law, including upper payment limits. The rate also covers beds or services added on or after July 1, 2026.
Funding supports care advocates and oversight
For FY 2026–2027, Iowa provides about $23.15 million for health department oversight and authorizes up to 382 full-time equivalent positions. This includes $2.602 million for foster care review and court-appointed special advocates. Another $1.149 million supports the long-term care ombudsman. Beginning July 1, 2026, a separate $3.534 million in TANF funds supports oversight, technology, reporting, tracking, and case management. These funds do not create household payments or eligibility rules.
Grant share reserved for mental health centers
Each federal fiscal year, 70% of the specified community mental health block-grant allocation must go to designated, accredited centers. Centers must use the money for staff training or services for adults with serious mental illness or children with serious emotional disturbance. Related treatment dollars must be billed through the department's claims system. Centers must also submit quarterly performance reports.
Iowa funds abstinence-focused pregnancy prevention grants
Beginning July 1, 2026, Iowa provides about $1.913 million in TANF pregnancy prevention grants, provided family planning services receive funding. Programs existing on or before that date must show positive outcomes; newer programs must use models with demonstrated positive outcomes. Grant recipients must emphasize sexual abstinence. Priority goes to areas with the highest share of unplanned pregnancies among females of childbearing age.
Iowa funds aging and disability help
Beginning July 1, 2026, Iowa provides about $19.38 million for aging and disability services. Services include case management for people 60 and older, resource centers, return-to-community help, abuse response, and independent-living support. Local aging agencies must match state funds using other money under department rules. Services outside the listed uses require department approval through an agency's area plan.
Iowa funds care at Veterans Home
Iowa provides about $8.146 million for the Iowa Veterans Home from July 1, 2026, through June 30, 2027. The money covers salaries, support, maintenance, and other operating needs. The appropriation does not set residents' payments or individual benefit amounts.
Iowa funds emergency poison treatment help
Beginning July 1, 2026, Iowa allocates $750,000 to a nonprofit providing access to emergency poison information and treatment. The money supports that service. It is not a direct household payment and does not specify a service amount for each person.
Iowa funds mental health and recovery
For July 1, 2026, through June 30, 2027, Iowa provides about $23.127 million for behavioral health services. Another $1.75 million comes from sports wagering receipts for prevention, treatment, crisis care, and recovery support. Funded services include a 24-hour helpline, youth prevention, and professional training, and must follow accepted best-practice guidance. The main appropriation includes $300,000 for children's behavioral health and $950,000 for an integrated substance use managed care system. The department must maintain contractors' mental health and substance use treatment service levels and continue needed federal waivers.
Iowa must review provider payment gaps
Iowa must annually review statewide health fee-schedule rates that are not otherwise regularly updated, reporting to lawmakers by January 15. Non-dental rates are compared with Medicare; dental rates are compared with Medicaid in states bordering Iowa. After implementing uniform cost reports, the department must review shelter care and qualified residential treatment costs against rates every two years. Findings and rate recommendations go to the Governor and lawmakers by October 1 of the calendar year following each review. Neither review requirement automatically raises rates.
Iowa must seek mental health waiver
Iowa's health department must apply by July 1, 2027, to waive Medicaid's exclusion for institutions for mental diseases. The law provides $298,000 from the medical residency training account for waiver implementation. Federal approval is not guaranteed. The application requirement does not itself give patients new coverage or direct payments.
Settlement money supports opioid treatment
For July 1, 2026, through June 30, 2027, Iowa provides $3 million from its opioid settlement fund. The money goes to a treatment program with a facility holding at least 150 licensed beds. It must provide medical detoxification and stabilization, residential substance use treatment, and medication-assisted treatment. The recipient must follow settlement and state spending rules, assess specified outcomes, and report findings to the health department. This is provider funding, not a direct patient payment.
Specialty care funds support bed capacity
For July 1, 2026, through June 30, 2027, Iowa's health department must use specialty care funding to maximize bed capacity. Spending must also meet the needs of people served as effectively as possible. Uncommitted general fund money for state-operated specialty care remains available for its designated uses in later fiscal years. These rules do not guarantee a bed count or an individual's admission.
Funding helps families access public benefits
Beginning July 1, 2026, Iowa provides about $76.37 million for community access and eligibility services. Covered programs include family cash assistance, maternal and child health, job programs, family planning, and rent reimbursement. The money also supports eligibility decisions for Medicaid, food assistance, and Hawki children's health coverage. This appropriation does not change benefit amounts or who qualifies.
Higher Medicaid payments for surgery centers
Beginning October 1, 2026, Iowa allocates about $1.168 million to raise Medicaid payments to ambulatory surgery centers. Rates increase as far as possible compared with June 30, 2026 rates, for FY 2026–2027. The law does not promise a specific rate increase or lower patient costs.
Trust funds add money to Medicaid
For FY 2026–2027, Iowa adds about $33.92 million from the hospital health care access trust fund to Medicaid. Any remaining money in that trust fund also goes to Medicaid, subject to availability. Another $5.581 million comes from the behavioral health fund, also subject to available money. These appropriations do not set individual benefits or expand eligibility.
Medical residency grants gain funding flexibility
The law makes uncommitted money in specified accounts available for grants to start medical residency programs in Iowa. Grants cannot support family medicine programs. A program is excluded only if its county both has at least 150,000 residents and contains a Regents institution's main campus. Population is measured using the latest federal decennial census. Separately, uncommitted FY 2026–2027 state funding for rural psychiatric residencies stays available through June 30, 2028.
Funding limits court-ordered services for children
For July 1, 2026, through June 30, 2027, the law allocates $748,000 for court-ordered services for children under department supervision. District and juvenile courts cannot order a service charging the state when that allocation cannot cover its cost. The restriction limits court orders; it does not itself require families to pay.
Inflation caps new health contract increases
Covered service contracts first signed from July 1, 2026, through June 30, 2027, face limits on annual cost increases. Increases cannot exceed the prior calendar year's increase in the Consumer Price Index for All Urban Consumers. The cap does not affect contracts lasting more than one year that were signed on or before June 30, 2026. It limits contract payment growth, not household prices.
Health department gains funding transfer flexibility
For FY 2026–2027, Iowa's health department can shift Act funding to support service administration, agency alignment, and federal funding. Medicaid savings can cover ongoing cost-management work only when appropriations exceed that year's associated Medicaid costs. TANF money can move to social services or child care block grants, following federal law. Money expected to remain uncommitted at year-end can fund another authorized purpose during the same year. These powers can add resources to receiving programs while reducing funds available for their original allocations.
Nursing home payments use updated data
For July 1, 2026, through June 30, 2027, nursing facility payments use the method in effect June 30, 2026. Rates starting July 1, 2026, use resident care-need data from July through December 2025. Rates starting January 1, 2027, use data from January through June 2026. Adjustments must be budget neutral, so updated data do not create an overall payment increase.
Provider rate limits with Medicaid floors
For July 1, 2026, through June 30, 2027, medical assistance, supplementary assistance, and social service rates generally stay at June 30, 2026 levels. The same applies to payment calculation methods, with exceptions for negotiated contracts, updated fee schedules, and expressly authorized changes. Beginning October 1, 2026, Medicaid payments for all provider and service types cannot fall below the department's minimum fee schedule. Cost-report adjustments start on the date in the provider's rate letter. These rules govern provider payments, not household benefit amounts.
Sponsors & Cosponsors
Sponsor
COMMITTEE ON APPROPRIATIONS
Affiliation unavailable
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
Senate vote • 5/2/2026
Passed Senate
Yes: 30 • No: 14
legislature vote • 5/1/2026
Motion to suspend rules for immediate consideration of amendment H-8466 to amendment H-8461
Yes: 25 • No: 58
House vote • 5/1/2026
Passed House
Yes: 59 • No: 24
Actions Timeline
Item vetoed, signed by Governor.
6/2/2026HouseReported correctly enrolled, signed by Speaker and President, and sent to Governor.
5/18/2026HouseNOBA: Final
5/12/2026legislatureNOBA: House Floor
5/2/2026HouseMessage from Senate.
5/2/2026HouseImmediate message.
5/2/2026SenatePassed Senate, yeas 30, nays 14.
5/2/2026SenateSubstituted for SF 2483.
5/2/2026SenateRead first time, attached to SF 2483.
5/2/2026SenateMessage from House.
5/2/2026SenateImmediate message.
5/1/2026HousePassed House, yeas 59, nays 24.
5/1/2026HouseAmendment H-8461 adopted.
5/1/2026HouseMotion to suspend rules failed.
5/1/2026HouseMotion to suspend rules for immediate consideration of amendment H-8466 to amendment H-8461, yeas 25, nays 58.
5/1/2026HousePoint of order raised on amendment H-8466 to amendment H-8461, ruled not germane.
5/1/2026HouseAmendment H-8466 filed.
5/1/2026HouseAmendment H-8465 to amendment H-8461, yeas 24, nays 59, filed, lost.
5/1/2026HouseAmendment H-8461 filed.
5/1/2026HouseNOBA: House Full Approps
4/21/2026HouseIntroduced, placed on Appropriations calendar.
4/21/2026House
Bill Text
As Introduced
Enrolled
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