Gov. Kim Reynolds seeks federal waiver for Medicaid work requirements
Gov. Kim Reynolds announced April 15, 2025, the state Department of Health and Human Services was seeking a federal waiver to implement work requirements for Iowa Health and Wellness Plan (IHAWP) recipients. (Photo by Robin Opsahl/Iowa Capital Dispatch)
Gov. Kim Reynolds announced Tuesday the state has submitted a waiver to the federal government to implement work requirements for Iowans on the state's expanded Medicaid program.
The governor directed the Iowa Department of Health and Human Services to seek a waiver to the U.S. Centers for Medicare & Medicaid Services for work requirements, according to a Tuesday news release — an effort she announced she would take action on at the beginning of the 2025 legislative session.
The news release Tuesday stated the waiver reflects the legislation being considered by Iowa lawmakers, Senate File 615. The bill has been approved by both chambers, but the Senate must approve an amendment from the House before it goes to the governor.
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The Iowa Health and Wellness Plan, or IHAWP, the state's expanded Medicaid program, provides health coverage to able-bodied Iowans from ages 19 to 64 with household incomes at or below 133% of the federal poverty level. There are exceptions to the proposed work requirements, including for people who are considered medically frail or medically exempt under Medicaid , adults caring for a child under age 6 and people in substance abuse treatment programs for up to six months.
The bill proposes that non-exempt IHAWP recipients work at least 80 hours each month to be eligible for health coverage. According to the Iowa HHS proposal, the governor's waiver proposal sets a 100-hour per month requirement for individuals to remain eligible for coverage. If the federal waiver is rejected under the legislation, the state would be required to end the expanded Medicaid program for all recipients, regardless of whether they are working.
Reynolds said in a statement that she has prioritized ensuring Iowa's government programs 'reflect a culture of work.'
'If you are an able-bodied adult who can work, you should work,' Reynolds said. 'We need to return Medicaid back to its core purpose — to provide coverage to the people who truly need it.'
The state estimated that nearly 100,000 individuals currently on IHAWP report having no income, according to the governor's news release.
The Legislative Services Agency estimated 142,000 of the 181,000 Iowans currently on IHAWP would be subject to work requirements under the Medicaid work requirements bill, and that 32,000 Iowans would likely lose the health coverage if the legislation is implemented. Democratic lawmakers have argued work requirements will result in higher costs to the state, by pushing health care costs from low-income individuals currently on IHAWP to other areas of the state's health care system.
There will be two public hearings for the waiver — the first at Urbandale Public Library on April 23 at 10:30 a.m., and the second at Marshalltown Public Library on April 29 at 2 p.m., with both meetings available for remote access via Zoom.
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