NEWS

Since this was originally posted on February 15, there have been several updates to the Iowa House and Senate's public assistance reform bills.  The Iowa Senate passed their bill (SF 2422) on a party-line vote.  The bill now goes the House Health and Human Services Committee for consideration.  This bill makes a number of changes, but the most concerning are:

• Stopping any future Governor from ending Medicaid managed care without legislative approval. It is important to note that legislative approval was not required to start managed care.  Governor Terry Branstad did it through Executive Order.

• Removing flexibility in the Medicaid program to do new waivers and plan amendments that might improve access to care or save money in the long run.  Legislators would be required to approve any changes that cannot show a cost savings or cost neutrality.

During Senate floor debate, Sen. Matt Blake said the following:

“MCOs have not been a net benefit to our state at all. They have created problems for providers. They have made it more expensive to provide services…and if you ask any one of your LTSS [long term services and supports] providers in your districts how we could help with their bottom line, the first they would say is get rid of the MCOs. The duplication of the bureaucracy that comes with them only adds cost and not benefit to the people that need it most…Why are we taking steps to codify a system that isn’t working for Iowans?  Why after ten years of having this process in place we are we doing this now? We’ve had ten years to  put this in place, but it seems there is a particular reason, and a particular election potentially, that this becomes an issue now. You are tying the hands of the Governor that comes after us. The MCOS were put in place by Executive Order. They were created by a Governor. And now we’re telling future Governors that they can’t make that decision anymore.”

The Iowa House of Representatives is getting ready to debate is own version of public assistance reform (HF 2716). It is a much broader bill and adds in some "sugar" to sweeten the sour parts of the bill.  The House plans to debate the bill sometime during the week of March 2.   Thing to note in this bill :

• Expands the income cap for the Medicaid for Employed Persons with Disabilities (MEPD) Program to 300% of the federal poverty level. That's up from 250%. Pensions are added to the list of other retirement plans that are exempt from asset limits, and Iowa HHS would be required to allow online payment of MEPD premiums.

• Home and community based services (HCBS) providers are given a bump in reimbursement for serving people with disabilities in rural areas. It should be noted that the amount of this increase is not determined and the funding is not appropriated in this bill.

• Severe public assistance barriers are put in place, including kicking off undocumented and some other immigrant pregnant women and infants from the program that provides them with nutrition assistance and baby formula (WIC).  Teens who work while living at home will have their income exempted from eligibility for food assistance (SNAP).
  
  
• Removing flexibility in the Medicaid program to do new waivers that might improve access to care or save money in the long run.  Legislators would be required to approve any changes that cannot show a cost savings or cost neutrality.

Both bills require citizenship checks for most public assistance programs. The House includes child care assistance in this list; the Senate does not. During a House subcommittee, the HHS Committee Chair (Rep. Austin Harris) said, “Iowa is not going to be a sanctuary state for waste, fraud, and, for your security, this bill will move forward today.”   

• You can read the SF 2422 bill of the week here.
• You can read the HF 2716 bill of the week here.
• You can read the updated comparison (2/28/2026) between the bills here.