Work requirements for Iowa Medicaid recipients signed into law

DES MOINES — Some able-bodied Iowans who are covered by Medicaid would be subject to work requirements under legislation signed into law Friday by Gov. Kim Reynolds.

Reynolds directed the Iowa Department of Health and Human Services to request a federal waiver that would allow the state to implement work requirements for some Medicaid patients. Such a waiver is required because the Medicaid program for low-income and disabled individuals is jointly funded by the state and federal government, and operated by the states under federal guidelines.

The waiver has not yet been submitted by the state, Reynolds said Friday.

If the federal government approves the state’s waiver request, the new state law will require Iowans covered by Medicaid to work at least 80 hours per month unless they qualify for an exemption. The new state law exempts from work requirements any physically able Iowans in the program who are younger than 19 or older than 64, the caretaker of a dependent child under 6 years old, undergoing a high risk pregnancy, or in treatment for a substance abuse disorder.

Roughly 146,000 Iowans in the Iowa Health and Wellness Plan — the state’s version of Medicaid expansion — would be subject to the work requirements, according to analysis from the state’s nonpartisan Legislative Services Agency.

Roughly 32,000 eligible Iowans would lose coverage because of the proposed work requirements, according to LSA’s projections, which are based on a similar program in Arkansas. In that state, roughly 25 percent of non-exempt Medicaid recipients failed to meet the state’s work or reporting requirements.

The federal government also is considering adding work requirements to the Medicaid program. Reynolds said Friday that the state is moving forward with its proposal for Medicaid work requirements, and that she does not know when the federal government will act. She said there are subtle differences between Iowa’s new law and the federal proposal.

“We’ll see what happens at the federal level. We’re going to go ahead and submit ours, because I truly believe it is the right thing to do,” Reynolds told reporters Friday after a public signing ceremony for a different bill. “We want to make sure that (Medicaid) stays solvent for those that truly need it, and it’s in danger of that not happening.”

Reynolds described the proposed state requirements as “sound” and “well thought out,” and said the state will help Iowans look for work if needed.

“We’re working to either get them some education, get them some job training, or to match them up with a job,” she 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 the system. That’s what it was designed for.”

The bill, Senate File 615, passed the Iowa Legislature largely on party-line votes with only Republican support.

The new state law also says if the federal government approves work requirements for Medicaid recipients but later changes its policy and declares work requirements impermissible as a condition for eligibility, Iowa HHS would be instructed to discontinue the Iowa Health and Wellness Plan altogether, pending federal approval. Should that request be denied, the state could develop an alternative program, according to the bill.

Comments: (515) 355-1300, erin.murphy@thegazette.com

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