(Des Moines) Legislation setting work requirements to receive Medicaid and SNAP benefits was approved by a Senate appropriations subcommittee Thursday.
The bill, Senate File 599, directs the Iowa Department of Health and Human Services to seek a waiver from the federal government to institute work requirements for the Iowa Health and Wellness Plan (IHAWP), the state’s Medicaid expansion program. The bill adds work requirements for other public assistance programs as well, including for food aid through the Supplemental Nutrition Assistance Program (SNAP).
The work requirements would apply to Iowans between age 19 and 65, with exceptions listed to the work requirements, including people with disabilities, parents of children under age 6, people with a high-risk pregnancy and those in substance abuse treatment programs for a period of up to six months.
While an earlier version of the bill set a requirement for Iowans to work or volunteer 20 hours a week to maintain IHAWP membership, language in the current legislation does not specify how many hours would be necessary to maintain benefits.
Several speakers said denying Iowans assistance who do not fit into these exceptions would lead to much higher overall costs for Iowa’s health care system, by not giving consideration to people like parents of children with disabilities, who are unable to work while caring for their child, or for people who are not disabled but still require access to their prescription medicine in order to avoid being hospitalized and to maintain a job.
Leslie Carpenter with Iowa Mental Health Advocacy gave a fiscal estimates for the cost of 100 people who would need to make a hospital emergency department visit if they cannot access their medication after being removed from Medicaid coverage. The U.S. Department of Health and Human Services estimated the average cost of an emergency department visit to be $1,506, she said, which means a there would be a cost of roughly $150,000 for 100 patients being hospitalized for a day and $1,316,000 if they were hospitalized for a week.
“I suspect that my estimates of having only 100 people who are severely sick being at risk for having their Medicaid insurance lost is actually quite low,” Carpenter said. “If those numbers are actually higher, you can imagine the fiscal impact on the taxpayers.”
Others called for Iowa legislators to look at other states, including Georgia, which have tried to implement Medicaid work requirements as proof that the policy does not work. Anne Discher with Common Good Iowa, a progressive nonprofit, also cautioned against Iowa lawmakers moving on work requirements when federal action is expected on the subject.
“It feels a little bit like we’re rushing forward on this bill at a point where we know at the federal level, Republicans are very interested in making massive changes to SNAP and to Medicaid, and the area where there seems to be agreement at the federal level is on something in the vicinity of reporting requirements,” Discher said. “We certainly oppose those at the federal level. However, the worst case scenario, the worst of both worlds would be for Iowa to rush ahead, the feds do something different, and then we have to come back and clean it up.”
Bill would suspend expanded Medicaid if work rules aren’t approved
The bill proposes suspending Iowa’s expanded Medicaid program if work requirements are not implemented, and would resume it if the work rules take effect. That could at least temporarily halt IHAWP, which provides health coverage to adults age 19 through 65 who have an income at or below 133% of the federal poverty level — roughly $20,030 for a single adult and $27,186 for a married couple. According to data compiled by the Legislative Services Agency, there were 179,918 Iowa adults on IHAWP in fiscal year 2025.
At the subcommittee meeting, multiple advocates criticized the bill for tying IHAWP coverage to receiving federal approval. MaryNelle Trefz with Iowa ACEs 360, an advocacy group focused on trauma recovery and support, said this provision will create financial hardships for Iowa’s economy by requiring federal approval for Iowa’s expanded Medicaid program to continue to exist.
“If those requirements aren’t approved now or in the future, Iowa would be forced to walk away from expansion entirely, jeopardizing coverage for thousands, increasing costs for hospitals and businesses, and worsening our workforce shortage,” Trefz said.
Sen. Mark Costello, R-Imogene, said there were “misunderstandings” about the IHAWP trigger provisions, saying he received letters from constituents who believed other Medicaid and benefit programs would be impacted if the federal government does not approve Iowa’s request to implement reporting requirements.
“That is, you know, a group that is already in a higher income or (a part of the) expanded population there, that we would hope some of them would be able to get insurance through the exchange or whatever,” Costello said.
Sen. Mike Bousselot, R-Ankeny, said he has been involved in state government since former Gov. Terry Branstad signed IHAWP into law in 2013. He said adding work requirements to the program “is common sense and is in line with why and how the bill passed at the very beginning.”
“The safety net is intended to be just that, a safety net that bounces people back up, not a poverty trap that has folks that are consistently sticking and staying and have no incentive to get off of those taxpayer-funded services,” Bousselot said. “The work and job training requirements that are found in this bill, and the goal to align those, are in line with the idea that job and work requirements have existed for folks that are disabled on Medicaid for decades, have existed for other social services that taxpayers provide.”
While Iowa lawmakers are pursuing legislative action to implement work requirements, Gov. Kim Reynolds also said during her Condition of the State address in January she plans to apply for a federal waiver to implement Medicaid work requirements.
