Several bills important to long-term care providers and IHCA members have advanced past the first funnel of the 2026 Iowa legislative session. While many proposals will continue to evolve, the following measures remain active and could have meaningful operational, workforce and reimbursement implications for skilled nursing, assisted living and other care providers. The Elderly Waiver and Certified Medication Aides bills are efforts at the top of IHCA’s 2026 Legislative and Policy agenda.
Elderly Waiver – HF 2641
This bill focuses on Iowa’s Medicaid elderly waiver program and includes provisions aimed at strengthening access to home- and community-based services. Potential changes may affect eligibility, service delivery and coordination between waiver services and facility-based care. This also includes definition changes to assisted living service, creating a more usable service to reimburse providers for scheduled and unscheduled visits with tenants.
Certified Medication Aides – HSB 729 / SF 2366
Legislation to expand and clarify the role of certified medication aides (CMAs) continues to move forward. The proposal addresses training, scope of duties and oversight, with the goal of supporting workforce capacity while maintaining resident safety and compliance.
Claims Payment and Audits – HF 2635
This bill addresses Medicaid and payer claims processes, including timelines for payment and audit practices. The intent is to improve predictability and transparency for providers while ensuring appropriate program integrity measures remain in place.
Guardianship – SSB 3096 / HF 2562
Proposed updates to Iowa’s guardianship statutes would modernize processes, clarify responsibilities and strengthen protections for individuals under guardianship. Long-term care providers may see impacts related to consent, decision-making and coordination with guardians and families. This bill includes language that maintains a facility’s ability to determine whether or not to admit an individual.
Property Tax – SSB 3001 and SSB 3034
Property tax proposals advancing this session could affect assessment methods, levy limits and funding structures. While broader in scope than health care alone, these changes may influence operating costs for provider organizations and local funding streams that support services. We are closely monitoring how this could impact our care continuum providers who experience different ownership structures within their communities and how any changes to property tax for individuals 65 and over may affect them.
Certificate of Need – HSB 694 / SSB 3130 / SSB 3084
Multiple Certificate of Need (CON) proposals remain active. These bills examine potential reforms to planning and approval processes for health care facilities and services, which could shape future expansion, bed capacity and market dynamics across Iowa. The suggested changes vary, but in their current form have minimal impact on health care facilities.
Medicaid and Rural Access Package – HSB 696
This comprehensive proposal includes several provisions relevant to long-term care, including:
- Rural waiver rate considerations to include travel time and expenses
- Retroactive Medicaid eligibility/payment policies conforming to federal changes
- Special population nursing facilities reimbursement modifications
- Creation of a high-acuity pediatric workgroup with IHCA as a group member
Together, these elements are aimed at stabilizing access to care in rural areas and ensuring that reimbursement and policy structures better reflect the needs of complex populations.
IHCA will continue monitoring these bills as they progress and will engage with lawmakers and stakeholders to advocate for policies that support providers, strengthen the workforce and ensure Iowans have access to high-quality long-term care services.
Further updates will be shared as amendments are adopted and final legislative outcomes become clearer. For questions, please reach out to IHCA’s SVP, Reimbursement and Policy Advisor Brandon Hagen, or COO Merea Bentrott.