Iowa Gov. Kim Reynolds directed the state health department to seek federal approval for Medicaid work requirements, she announced Tuesday.
“It has always been a priority of mine to make sure our government programs reflect a culture of work,” Reynolds, a Republican, said in a statement. “It is common sense and good policy. If you are an able-bodied adult who can work, you should work. We need to return Medicaid back to its core purpose — to provide coverage to the people who truly need it.”
Iowans who get their health insurance through the state’s Medicaid expansion, known as the Iowa Health and Wellness Plan, would be required to prove they are working at least 100 hours per month if they don’t meet certain exemption criteria.
That's more than the 80 hours of work per month minimum that would be required under a bill that was approved by House and Senate Republicans in March, and is now back in the Senate for consideration.
A 30-day public comment period on the proposal is now open, and the Iowa Department of Health and Human Services has scheduled two public hearings on the waiver request. If approved, the work requirements would take effect in January.
The Iowa Health and Wellness Plan provides health insurance for more than 180,000 Iowans, ages 19-64, with incomes at or below 133% of the federal poverty level — that's about $20,000 per year for a one-person household.
Reynolds has said about 100,000 "able-bodied adults" on Medicaid are not working, but she defined that as earning less than $551 per month.
Rep. Beth Wessel-Kroeschell, D-Ames, said in a statement that Reynolds' "unilateral policy change" will put the health coverage of these Iowans at risk.
"Medicaid recipients want to work, and they do," she said. "We all agree that if they can, they should. According to the Kaiser Foundation, 92% of Medicaid adults work full or part-time or are caring for a family member, are ill, disabled, or attending school. This decision will do nothing but put the healthcare of thousands of Iowans in jeopardy—stripping away coverage from those who need it most: working families."
A projection from Iowa HHS shows the department expects the number of Iowans getting this health insurance to drop to about 144,000 in the first year of implementation, and 124,000 in the second year. HHS estimates that would save the state about $16 million in the first year and $39 million the second year.
According to the Iowa HHS website, IWHP members would have to meet one of the following requirements to keep their health insurance:
- Work at least 100 hours per month, or earn wages monthly at least equal to the state minimum wage multiplied by 100 hours
- Be enrolled in an educational or job skills program
- Be enrolled in and complaint with Iowa’s Temporary Aid to Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) work requirements
- Be exempted from SNAP work requirements
The following people would be exempt from the work requirements:
- People who are under the age of 19 or are 65 or older
- People who have a high-risk pregnancy
- People determined to be disabled by the U.S. Social Security Administration
- People identified as medically exempt under the Medicaid program
- Caretakers of kids under the age of 6
- People receiving unemployment benefits
- People participating in substance use disorder treatment for six months or less
- People who provide proof of good cause as defined by Iowa HHS
