Bill proposes work requirements for some Iowans receiving state Medicaid, food assistance

DES MOINES — Some Iowans receiving state-funded Medicaid coverage and food assistance would be required to work at least 80 hours a month to receive benefits under legislation critics say would put thousands of vulnerable Iowans at risk.

Statehouse Republicans on Thursday advanced legislation that would require the Iowa Department of Health and Human Services to seek a federal approval to include work requirements as a condition of maintaining eligibility in the Iowa Health and Wellness Plan, Iowa's Medicaid expansion program for low-income adults.

According to Iowa HHS, nearly 182,000 Iowans are enrolled in the Iowa Health and Wellness Plan, which covers adults ages 19-64 with a household income at or below 133 percent of the federal poverty level. That equates to about $20,000 for a household of one and $27,000 for a household of two.

Republican lawmakers who introduced the legislation say the goal of including work requirements is to reduce the dependence of low-income Iowans on public assistance programs through efforts that advance economic stability and mobility.

Currently, Medicaid eligibility in Iowa is based on income and whether a person has a disability.

Iowa Gov. Kim Reynolds proposed work requirements for Iowa Medicaid recipients who are able-bodied adults to receive benefits during her Condition of the State Address last month.

“If you can work, you should. It’s common sense and good policy,” Reynolds posted to X, formerly Twitter, on Thursday. “For the men and women who are receiving these government payments, getting back to work can be a lifeline to stability and self-sufficiency.”

According to the nonprofit health care advocacy and reporting organization KFF, 75 percent of adults on Iowa Medicaid are already working. And among those not working are disabled and sick Iowans, caregivers and full-time students.

Reynolds’ social media post asserts more than 100,000 “able-bodied adult Medicaid recipients are not working.”

Research: Work requirements do not increase employment

Religious and medical groups, community providers, disability rights and anti-hunger advocates, however, say past evidence in other states shows work requirements impose administrative barriers and red tape that lead to coverage losses among both people who are working as well as people who have caretaking responsibilities, disabilities or illnesses that keep them from paid work.

Moreover, research shows that work requirements do not increase employment, they argued.

“Research has shown that imposing work reporting requirements for programs like Medicaid and SNAP do not actually improve employment,” said Luke Elzinga, policy and advocacy manager at the Des Moines Area Religious Council Food Pantry network in Des Moines.

“They just boot people off benefit programs, leaving them in a far worse spot than they were before, and shifting the burden of care to local governments and nonprofit organizations,” Elzinga told lawmakers Thursday during a House subcommittee hearing on the bill.

During President Donald Trump’s first administration, 13 states were approved to implement work requirements, but several were blocked by the courts, and nine others requested approval but did not receive it by the time his term ended, according to KFF. The Biden administration withdrew all work state work requirement waivers that had approval.

Only Arkansas implemented such requirements, which resulted in more than 18,000 people losing coverage before a federal court deemed the requirements unlawful. KFF found the main reason individuals lost coverage was eligible recipients who were working or qualified for exemptions faced barriers meeting — or were unaware of — the work reporting requirements, and were dropped from the program.

Arkansas’ work requirement increased uninsured rates without increasing employment, studies by Harvard researchers found.

Other states that began implementation did not disenroll those who did not comply and instead paused implementation due to litigation and/or the COVID-19 pandemic.

Anne Discher, with Common Good Iowa, said before Iowa’s Medicaid expansion, about 12-13 percent of Iowans were uninsured. After expansion, that dropped to 7-8 percent.

“It's been incredibly effective at helping low income Iowans get the health care that helps them get to work and take care of their families,” Discher told lawmakers. “This bill would absolutely start reversing some of those gains.”

Tyler Raygor, with Americans for Prosperity, argued work requirements reduce poverty by connecting able-bodied individuals to work opportunities and increasing their self reliance.

What would the bills do?

House and Senate subcommittees on Thursday advanced similar bills — House Study Bill 248 and Senate File 363 — for further consideration in their respective chambers. Republican members moved the legislation forward, while Democrats declined to sign on.

The Senate subcommittee amended their bill to align with the House bill.

The legislation would:

Bill supporter says more people on Medicaid should be working

Andy Conlin, a lobbyist representing the Foundation for Government Accountability, said taxpayers should expect that Medicaid is achieving its goals of helping people in their time of need and “moving them into a place where they can be self sufficient.” The group is registered in favor of the bill.

“And, again, a lot of these folks are working, but more should,” Conlin said. “We need them in the workforce to be productive here in the state.”

Many Iowans covered under the Iowa Health and Wellness Plan “are the working poor” and young adults with chronic conditions who depend on Medicaid for treatments, said Chaney Yeast with Blank Children’s Hospital in Des Moines.

“They're working, typically, multiple part-time jobs,” Yeast said. “… So we're talking about the 20-year-old waitress at the local café that has diabetes and she relies on Medicaid for her insulin and her blood glucose pump. We're talking about the 19-year-old that stocks the grocery store shelves … who has Crohn's disease and relies on Medicaid to pay for their Remicade infusions every six weeks.

“We're talking about the 21-year-old student that maybe is trying to get her certified nursing assistant degree and she's going to school.”

Yeats and others noted the bill lacks exemptions for students pursuing degrees or job training, and for adults who are primary caregivers for elderly parents or a child with disabilities or a behavioral health condition.

Emily Ehlers with Disability Rights Iowa said Medicaid is a key tool that allows Iowans with disabilities to stay healthy and maintain their employment. The work requirements would penalize those Iowans during times when maintaining 80 hours would be difficult.

“But the nature of having a disability means that some days and weeks and months are better than others,” Ehlers said. “… And I'm especially concerned about the provision that would end Medicaid expansion should work requirements be disallowed at the federal level, which would only further threaten both the health care and therefore the employment of all Iowans who rely on the health and wellness plan.

“If we truly want to support work and Iowans with disabilities, this is not the way to do it.”

Rather, opponents said lawmakers should be focused on policies that make health care more affordable in the state and remove barriers to employment for low-income Iowans — whether that’s lack of access to reliable transportation, affordable child care or in-home care for a dependent parent.

“We have so many people who are working, and so many people who would like to work, but they have barriers,” said Rep. Beth Wessel-Kroeschell, a Democrat from Ames who declined to sign on to the bill. “What we should be working on is looking for ways to overcome those barriers.”

Rep. Carter Nordman, a Republican from Panora who introduced the bill in the House, said taxpayers also need to be prioritized in the conversation.

He said lawmakers will continue to discuss the proposal in committee ahead of a legislative deadline next week for bills to remain eligible for consideration for the remainder of the 2025 session.

Comments: (319) 398-8499; tom.barton@thegazette.com