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3 • A monthly average of approximately 400 infants in future years will no longer be eligible to receive Medicaid coverage due to the Bill, causing a decrease in total infant costs under Medicaid of $1.5 million in FY 2025 ($540,000 decrease in State costs), $9.0 million in FY 2026 ($3.3 million decrease in State costs), and $10.1 million in FY 2027 ($3.7 million decrease in State costs). State savings equal 36.75% of total savings beginning in FY 2025, and any savings are anticipated to be applied to the Medicaid General Fund appropriation. • The coverage for approximately 1,100 infants may shift from Medicaid to Hawki due to the Bill, causing an increase in total costs of $801,000 in FY 2025 ($206,000 increase in State costs), $4.9 million in FY 2026 ($1.3 million increase in State costs), and $5.5 million in FY 2027 ($1.4 million increase in State costs). Costs are anticipated to be funded from the CHIP General Fund appropriation. • According to the HHS, one-time MCO recovery moneys will be available for expenses outlined in the Bill. Fiscal Impact Senate File 2251 is estimated to increase State costs by approximately $1.1 million in FY 2025, $3.3 million in FY 2026, and $388,000 in FY 2027.

Figure 1 — Medicaid Postpartum Coverage Fiscal Impact

Beginning in FY 2028, annual State costs are expected to increase by $286,000. Sources Iowa Department of Health and Human Services Centers for Medicare and Medicaid Services Legislative Services Agency analysis

/s/ Jennifer Acton April 17, 2024

Doc ID 1449063

The fiscal note for this Bill was prepared pursuant to Joint Rule 17 and the Iowa Code. Data used in developing this fiscal note is available from the Fiscal Services Division of the Legislative Services Agency upon request.

www.legis.iowa.gov Total State Total State Total State Information Technology 1,187,000 $ 297,000 $ 0 $ 0 $ 0 $ 0 $ Medicaid — Pregnant Women 1,821,000 1,182,000 7,051,000 5,375,000 -685,000 2,679,000 Medicaid — Infants -1,470,000 -540,000 -9,032,000 -3,319,000 -10,083,000 -3,705,000 Hawki — Infants 801,000 206,000 4,923,000 1,266,000 5,496,000 1,414,000 Total Fiscal Impact 2,339,000 $ 1,145,000 $ 2,942,000 $ 3,322,000 $ -5,272,000 $ 388,000 $ FY 2027 Expense Category FY 2025 FY 2026