Iowa Senate File 2399: What Medical Releases Mean for Health Care Providers

On June 2, 2026, Iowa Governor Kim Reynolds signed Senate File 2399, amending Iowa Code Chapter 804, which addresses the arrest and disposition of prisoners. Although the bill initially focused on pretrial bond requirements and did not gain the attention of health care lobbyists, an April 7 amendment added language allowing defendants to be released on their own recognizance to receive necessary medical attention. That change, which was effective July 1, 2026, raises important payment, safety and privacy questions for health care providers.

As revised, § 804.21(4) now reads: “A defendant is only eligible to be released on the defendant’s own recognizance if the defendant has been charged with a nonviolent, nondrug simple or serious misdemeanor or to receive necessary medical attention. A defendant released for necessary medical attention shall be returned to the custody of a law enforcement agency once the defendant is medically cleared and fit for confinement.”

Prior to the amendment adding the medical care language, there was debate on the Senate floor about anticipated added cost to counties due to more individuals remaining in jails because of the higher bonds and the restrictions on which individuals could be released on their own recognizance. When adding the amendment for release for medical care, Sen. Mike Bousselot, R-Ankeny, stated that the change was “a recognizance piece for an important component of how our counties manage inmates in their custody when they are injured or in need of medical attention.” 

This change resets the well-established statutory responsibility for payment of medical expenses of individuals in custody of the county. Iowa Code § 356.5 requires jail keepers to furnish each prisoner with necessary medical aid and § 356.15A establishes the payment waterfall for that aid: the prisoner’s own insurance or benefits first, then the governmental entity as a reimbursement backstop at a negotiated or Medicaid rate. Section 356.15a(3) expressly cuts off the governmental entity’s payment responsibility once the prisoner is “released from the custody of the governmental entity,” with no exception for a release granted specifically to obtain medical care. With the amendment to § 804.21(4), the defendant is no longer in custody which places the provider of that medical care at risk for the financial cost of providing such care if the individual cannot pay.

But that is not the only risk facing the health care provider. If the defendant is no longer in custody of law enforcement and has been released on the defendant’s own recognizance, the provider now faces the potential risk of treating violent offenders without protection for their staff or other patients or risk violating federal privacy laws by allowing law enforcement access to the defendant. If law enforcement intends to remain with the defendant, it is important to remember that when a patient is not in custody, the provider generally has no authority under HIPAA to disclose protected health information of the individual to the law enforcement officer. This generally prevents law enforcement from accessing the clinical areas where the individual is receiving care. Providers should clarify the patient’s custody status and carefully assess the legal basis for any disclosure to law enforcement. Providers should develop a plan now for how they will deal with these individuals being brought to the health care facility for treatment, including what communication and access by law enforcement will be permitted. 

Providers should also consider contacting their legislators to explain how medical releases affect not only payment for care, but also patient and staff safety.