House sends expanded Medicaid work requirements bill back to Senate
The Iowa House sent the bill imposing work requirements on recipients of Iowa's expanded Medicaid program back to the Senate Wednesday.
Senate File 615 was approved by the House 61-35 with some changes. The bill, which passed in the Senate Tuesday, would require people receiving health insurance through Iowa's expanded Medicaid program known as IHAWP, or the Iowa Health and Wellness Plan, to work at least 80 hours each month to be eligible for coverage.
IHAWP coverage is available to able-bodied Iowans from ages 19 to 64 who have household incomes at or below 133% of the federal poverty level — roughly $20,030 in annual income for a single individual and $27,186 for a household of two.
Rep. Carter Nordman, R-Adel, the bill's floor manager, said Medicaid is intended to serve individuals with disabilities and with very low incomes. However, he said currently 'more able-bodied adults are accessing Medicaid benefits without the requirement of work' through the IHAWP program.
'While Medicaid expansion has been a vital safety net, it is not meant to be a permanent solution,' Nordman said. 'We want to help individuals transition off the reliance of government and into a position where they can thrive independently. Requiring work is a key part of that transition.'
According to analysis by the Legislative Services Agency, roughly 142,000 of the 181,000 Iowans currently enrolled in IHAWP would be subject to work requirements under the bill when accounting for medical exemptions and other caveats provided in the legislation, like exemptions for people with children under age 6 and in substance abuse treatment programs for up to six months.
Of the people who would be required to work 80 hours a month — and report this information to the state to continue receiving care — LSA estimated that 32,000 Iowans would lose IHAWP coverage if the bill is implemented. This figure was calculated using data from Arkansas, a state that previously implemented Medicaid work or community engagement requirements.
Rep. Austin Baeth, D-Des Moines, said the bill will deprive low-income people of health care and coverage using a false argument that there are a large number of people receiving Medicaid coverage who are choosing not to work. He cited a study from the Kaiser Family Foundation that found 92% of adults under age 65 who did not receive benefits through other programs like Social Security or Medicare were working full or part time, or were not working because of caregiving responsibilities, school or due to an illness or disability.
Baeth said the bill sends a 'cynical message that people in poverty are lazy' and will take away health care coverage from working Iowans who do not have the time or resources to meet the reporting requirements that would be implemented under the bill.
'Hardworking people are too busy working their jobs, trying to make rent, trying to put food on the table, not watching the news (to know) that they have to go to a particular website by a particular amount of time to press some particular button,' Baeth said. 'That's how people fall through the cracks. And when they fall through the cracks, in this particular case, it can be the matter of life or death.'
A major point of contention for Democrats on the bill was language that directed the Iowa Department of Health and Human Services to discontinue IHAWP if the federal government does not approve work requirements for the program. The House amended the bill to clarify that this 'trigger' language to seek federal approval for ending IHAWP would only apply if the implementation of work requirements has been federally approved and later revoked.
If the federal government does not allow the state to end the Medicaid expansion program, the bill would direct Iowa HHS to pursue implementation of an 'alternative plan' acceptable under federal Medicaid administration guidelines.
Nordman said the language on discontinuing IHAWP without work requirements was to avoid making Medicaid policy changes in Iowa contingent on who is in the White House.
'The reason why this is in there is we are not going to play this back-and-forth game with the federal government that would disallow us to do it every four years, and then we do it another four years, and then four years later we're not allowed to do it,' Nordman said. '… Just to make it clear, if this is approved by the Trump administration, as I believe it will be, the only reason why Medicaid expansion in the state would go away is because of a Democrat president.'
Rep. Timi Brown-Powers, D-Waterloo, questioned how these changes would be implemented by HHS, pointing to the fact that the department has a 'pause' on hiring for new positions.
LSA, a nonpartisan agency, noted that the Iowa Department of Health and Human Services had not responded to multiple requests for information on the fiscal impact of implementing work requirements, but estimated that the bill would result in $3.1 million in decreased Medicaid expenditures for fiscal year 2026 and $17.5 million in FY 2027.
Iowa HHS has not responded to requests for comment on why information was not shared with LSA or lawmakers who said they had made requests.
Brown-Powers said the department has also not shared figures on Medicaid waste, fraud or abuse occurring through IHAWP that would be addressed through work requirements. She said unless HHS data shows there is a substantial number of people misusing the expanded Medicaid system, the costs of implementing the bill will outweigh money saved.
'And guess what? We don't have a lot of money,' Brown-Powers said. 'We're already dipping into the funds to pay the bills. So how are we going to pay for this? Where are the (full-time employees) going to come (from) to monitor this? How are we going to assure Iowans that they're not going to lose their insurance?'
Nordman said that in Iowa 'it is estimated that more than 100,000 able-bodied people on Medicaid expansion are not working … to their capacity or what they should be.'
The bill also directs Iowa HHS to seek federal approval to implement work requirements for public assistance programs like Supplemental Nutrition Assistance Program (SNAP). SNAP recipients who are able-bodied adults with no dependents already are required to work, volunteer or participate in work programs for at least 80 hours a month to receive benefits.
The House passed another bill Wednesday related to SNAP benefits that proposes a new $1 million appropriation to the food stamps program to the Double Up Food Bucks program, allowing recipients to double SNAP dollars for fresh produce purchases. However, the bill makes the additional funding contingent on the federal government approving restrictions on what foods are available for purchase through SNAP to only include healthful foods 'based on necessary nutrition for good health.'
The House sent the legislation back to the Senate with some changes, including the language clarifying IHAWP federal approval contingencies as well as a new section requiring Iowa HHS to conduct a review on the Medicaid for employed people with disabilities program. The department would be directed to look at issues like eligibility criteria, asset limits and cost-sharing requirements in other states' programs over the 2025 interim and deliver a report to lawmakers by December with recommendations on how to expand employment opportunities for people with disabilities on this Medicaid program.
The bill also includes a provision to raise the amount of available resources that a married couple receiving coverage through the Medicaid for employed people with disabilities program can have from $13,000 to $21,000. Individuals with disabilities on this program would still have the $13,000 asset limit if they are single.
The amended bill must be approved by the Senate before it would go to Gov. Kim Reynolds for final approval. A spokesperson for the governor said Tuesday that the governor has directed HHS to submit a federal waiver for Medicaid work requirements independent of the legislation 'which will be done soon.'
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