HF 405 requires most health insurance plans in Iowa to cap out-of-pocket costs for prescription insulin at $25 per prescription for up to a 31-day supply. It directly affects people with diabetes who use insulin and are covered under health insurance plans that provide prescription drug coverage. The bill sets this $25 limit for four types of insulin (rapid-acting, short-acting, intermediate-acting, and long-acting) and applies to plans issued or renewed on or after January 1, 2026. It excludes certain insurance types like Medicare supplements, workers’ compensation, and dental/vision plans. The Iowa Insurance Commissioner will implement rules to enforce this requirement.
This bill (HF 663) seeks to continue Iowa's Medicaid-funded family planning services by requiring the state to request federal approval for a new "Iowa Family Planning Network." It would replace the current state program (Section 217.41B of the Iowa Code) with a network operating under the same benefits and rules as a federal waiver approved in 2017. The repeal of the old program takes effect only after the federal Centers for Medicare and Medicaid Services (CMS) approves the new state plan amendment. This change directly affects Iowans who use Medicaid for family planning services and the state program providing those services.
HF 658 requires most health insurance plans in Iowa to cap out-of-pocket costs for prescription insulin at $25 per prescription for up to a 31-day supply. It applies to all covered insulin types (rapid-acting, short-acting, intermediate-acting, and long-acting) and affects people with diabetes who have insulin-covered plans. The cap takes effect for new or renewed policies starting January 1, 2026, but excludes specialized coverage like Medicare supplements, dental, or workers’ compensation plans. Plans may offer lower costs than $25 but cannot exceed this limit. This directly reduces financial burdens for Iowans managing diabetes through their insurance.
HF 735 requires health insurers and pharmacy benefits managers in Iowa to include all payments made by a plan participant (or others on their behalf) when calculating their total out-of-pocket cost-sharing under health plans. It specifically protects Health Savings Account (HSA) eligibility by delaying HSA contribution calculations until after a participant meets the federal minimum deductible, except for preventive care services. The bill applies to most health benefit plans issued or renewed in Iowa on or after January 1, 2026, but excludes accident-only, Medicare supplement, dental, vision, and other specialized coverage. It directs Iowa’s insurance commissioner to create implementing rules under Chapter 17A.
This bill requires Iowa's children's health insurance program (CHIP) to cover applied behavior analysis (ABA) services for eligible children. It directs the Department of Health and Human Services to seek federal approval for this coverage expansion by submitting a state plan amendment to Medicare and Medicaid services. The change would directly affect children enrolled in CHIP who require ABA therapy, commonly used for developmental conditions like autism. The bill mandates that the medical assistance advisory council adopt rules to include ABA as a covered benefit in qualifying health plans under federal guidelines. It does not create new funding but modifies existing CHIP coverage to add this service.
This bill requires Iowa's Department of Health to hold semiannual joint training sessions for nursing home inspectors and facilities. The sessions must cover the top three federal citation issues from the previous year and include information about the federal Jimmo v. Sebelius settlement, which clarifies that Medicare coverage for skilled nursing/therapy depends on a patient's need for care - not their potential to improve. The training must involve the state long-term care ombudsman and nursing facility provider associations. This policy change directly affects nursing home inspectors, facilities, and Medicare beneficiaries by aligning state inspections with federal coverage policy.
SF 559 would allow speech language pathologist assistants (SLPAs) working under licensed speech pathologists to be reimbursed for services provided to medical assistance program recipients (Iowa's Medicaid program). The bill requires Iowa's Department of Health and Human Services (HHS) to adopt rules enabling this reimbursement and to seek federal approval via a waiver or amendment to Medicare/Medicaid rules. This change would directly affect SLPAs and medical assistance recipients by expanding covered services, but only takes effect after HHS receives federal approval. The bill does not change current reimbursement for licensed speech pathologists.
HF 308 establishes an annual 31-day open enrollment period for Medicare supplement insurance, beginning March 1 each year starting January 1, 2026. It directly affects individuals seeking Medicare supplement policies, including those under 65 who qualify for Medicare due to disability, end-stage renal disease, or environmental hazard exposure. During this period, insurers must offer at least one policy without denying coverage, charging higher premiums based on health status, or excluding preexisting conditions. Insurers are also required to provide applicants with notice of this enrollment period as directed by the Iowa Insurance Commissioner.
