By Stephen Gruber-Miller, Des Moines Register
- Gov. Kim Reynolds has signed a law implementing work requirements for 171,000 Iowans on Medicaid, the state receives approval from the Trump administration.
- Iowans on the state’s Medicaid expansion program, the Iowa Health and Wellness Plan, would have to work 80 hours per month to receive coverage.
- Reynolds is already seeking permission from the Trump administration to implement work requirements, but the law makes it more difficult for a future governor to undo the policy.
Gov. Kim Reynolds has signed into law a bill requiring thousands of Iowans to work or lose their Medicaid coverage, as she prepares to submit a final request to the federal government to allow Iowa to implement the new rules.
Reynolds, a Republican, announced June 6 that she signed Senate File 615 into law, which will affect about 171,000 people on the state’s Medicaid expansion program if the Trump administration approves it.
The legislation requires able-bodied adults on the Iowa Health and Wellness Plan to work at least 80 hours per month, or earn the equivalent based on the state’s minimum wage of $7.25 per hour, or to be enrolled in an educational or job skills program to qualify for health care.
“It is a priority of mine to ensure our government programs reflect a culture of work,” Reynolds said in a statement. “If you are an able-bodied adult who can work, you should work. We need to return Medicaid back to its intended purpose — to provide coverage to the people who truly need it.”
Reynolds has already submitted a preliminary request to the federal government for permission to institute work requirements. That request to the Trump administration would require enrollees to work at least 100 hours per month to receive Medicaid benefits.
She told reporters earlier on June 6 that the state is tweaking the details before it submits its final request.
“I truly believe it is the right thing to do. We want to make sure it stays solvent for those that truly need it, and it’s in danger of that not happening,” she said of Medicaid. “And so they’re sound, well-thought-out provisions. Able-bodied adults that are 19 to 64 that can work, should.”
Although Reynolds did not require legislation to ask the federal government for permission to implement Medicaid work requirements, her signature on the law means that the policy cannot easily be undone by a future governor.
The law also includes a clause stating that if the federal government ever rescinds its approval for work requirements, the state would be required to end the Iowa Health and Wellness Plan, subject to federal approval.
Democrats in the Iowa Legislature accused Republicans of gambling with Iowans’ health care.
“One hundred and eighty thousand Iowans have the possibility of losing their health insurance,” Rep. Beth Wessel-Kroeschell, D-Ames, said May 14. “That’s a gamble. Stop gambling with the lives of Iowans.”
The law also requires Iowa to work with the federal government to align the state’s work requirements for the Supplemental Nutrition Assistance Program and other public assistance programs with federal rules.
How many people are on the Iowa Health and Wellness Plan? How will work requirements change that?
Currently, about 182,000 Iowans are enrolled in the Iowa Health and Wellness Plan, or the Medicaid expansion plan that was implemented a decade ago to provide health care coverage for uninsured and low-income Iowans.
Those eligible include adult Iowans with incomes at or below 133% of the federal poverty level, or about $21,000 for an individual and $28,000 for a family of two.
Under the proposal Reynolds previously submitted to the Trump administration, state officials estimate the average monthly enrollment would fall from about 171,000 to about 131,000 enrollees by year five during the five-year implementation period of these work requirements, according to Iowa’s waiver request.
That drop in enrollment would result in about $49 million in cost savings for the state by 2030, per the state’s estimates.
Iowa is among a dozen other states that are considering or have submitted requests to implement work requirements as a condition of eligibility for Medicaid coverage, according to the health policy research organization KFF.
So far, one state — Georgia — has received federal approval for its program.
Arkansas implemented a similar work requirements program in 2018, which caused 18,000 people to be removed from the state’s Medicaid rolls before a federal judge halted the program.
Based on those results, the nonpartisan Legislative Services Agency has said 32,000 Iowans could lose coverage if the law’s 80-hour-a-month work requirements become law.
The Legislative Services Agency estimates that the law could reduce state spending on Medicaid by $2.5 million in fiscal year 2026 and by $14.4 million in fiscal year 2027.
Who would be exempted from the Medicaid work requirements?
Not all the people enrolled in the Iowa Health and Wellness Program will need to meet the proposed work requirements to continue receiving benefits.
The law requires the Iowa Department of Health and Human Services to exempt Iowans from the work requirements if:
- They are younger than 19 years old.
- They are 65 years old or older.
- They have been determined to be disabled by the U.S. Social Security Administration.
- They qualify as medically frail or medically exempt under Medicaid.
- They are a caretaker of a child under 6 years old.
- They have a high-risk pregnancy.
- They are receiving unemployment benefits.
- They are participating in a substance use disorder treatment for up to six months.
- The HHS director determines there is good cause to exempt them.
“There’s all kinds of exceptions,” Reynolds said. “So it’s the right thing to do for them and for the solvency of Medicaid so that those individuals that truly do need it will be able to utilize a system that that’s what it was designed for.”
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