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HF 509 – Hawki, Applied Behavior Analysis and Autism Support (LSB1843HV)
Staff Contact: Lindsey Ingraham (515.281.6764) lindsey.ingraham@legis.iowa.gov
Fiscal Note Version – New
Description
House File 509 repeals the Autism Support Program on July 1, 2027, and requires the Medical
Assistance Advisory Council to adopt administrative rules to include applied behavior analysis
services for the treatment of autism as benefits covered under the Healthy and Well Kids in
Iowa (Hawki) program. The Bill prohibits the Department of Health and Human Services (HHS)
from approving new applications for the Autism Support Program on or after July 1, 2025. The
HHS will continue to provide treatment and make payments pursuant to the Program for an
individual whose application is approved on or before June 30, 2025, if the individual remains
eligible for the Program.
The Bill requires, upon the repeal of Iowa Code chapter 225D on July 1, 2027, any
unencumbered and unobligated moneys remaining in the Autism Support Fund be transferred to
the Hawki Trust Fund.
Background
The Autism Support Program, established in Iowa Code chapter 225D, provides payments to
eligible individuals to receive applied behavioral analysis treatment. An eligible individual, as
defined in the Iowa Code section 225D.1(8), is a child less than 14 years of age who has been
diagnosed with autism, is not otherwise eligible for coverage for applied behavioral analysis
treatment or applied behavioral analysis treatment under the medical assistance program or
other private insurance coverage, and whose household income does not exceed 500.0% of the
federal poverty level (FPL). The maximum annual benefit amount for an eligible individual is set
at $36,000, with the program providing a maximum of 24 months of applied behavioral analysis
treatment.
Iowa Code section 225D.2(5) establishes the Autism Support Fund to be used for the purposes
of funding the Autism Support Program. Currently, the HHS transfers $188,000 from the Health
Program Operations appropriation to the Autism Support Fund annually. In FY 2023, Program
expenditures were approximately $260,000, and in FY 2024, the expenditures were
approximately $310,000. As of March 19, 2025, the balance in the Autism Support Fund was
approximately $106,000.
Assumptions
• There are currently 678 children with an autism diagnosis in the Hawki program.
• The HHS estimates that there will be an 18.0% utilization rate for applied behavioral
analysis under the Hawki program.
• Actual applied behavior analysis expenditures under the Medicaid program from FY 2023
were used to estimate the annual cost per member.
• The annual cost per member is estimated to be approximately $24,000.
• The State will pay 26.01% of Hawki costs for applied behavior analysis, while the federal
government will pay 73.99% for FY 2026.
Fiscal Note
Fiscal Services Division 2
• After the Autism Support Fund is repealed in FY 2028, the $188,000 allocation from the
Health Program Operations appropriation in the Health and Human Services Appropriations
Bill will no longer be needed.
Fiscal Impact
House File 509 is estimated to increase State Hawki expenditures by approximately $753,000 in
FY 2026 and approximately $756,000 in FY 2027 to add applied behavioral analysis treatment
to the Hawki program. Total Hawki provider rate reimbursement expenditures will increase by
$2.9 million annually. Figure 1 shows the annual breakdown of State and federal costs.
Beginning in FY 2028, there will be no more expenditures for the Autism Support Program. Any
unencumbered or unobligated moneys remaining in the Autism Support Fund will be transferred
to the Hawki Trust Fund.
Figure 1 — Estimated Annual Costs of HF 509
Sources
Department of Health and Human Services
Legislative Services Agency
/s/ Jennifer Acton
March 19, 2025
Doc ID 1524770
The fiscal note for this Bill was prepared pursuant to Joint Rule 17 and the Iowa Code. Data used in developing this
fiscal note is available from the Fiscal Services Division of the Legislative Services Agency upon request.
www.legis.iowa.gov FY 2026 FY 2027
State 753,000$ 756,000$
Federal 2,142,0002,139,000
Total 2,895,000$ 2,895,000$