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By Jasmine Laws
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Iowa lawmakers have approved a bill mandating that certain Medicaid recipients work to retain benefits, a move expected to affect tens of thousands of constituents who use the health program.
The new legislation makes Iowa one of the latest states to pursue such requirements. Georgia remains the only state with work requirements already in place, but may others have similar legislation pending approval or at various stages of implementation.
Newsweek has contacted Iowa lawmakers and the state's Department of Health and Human Services for comment via email outside regular working hours.
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Why It Matters
Iowa's new Medicaid work requirement is expected to affect low-income adults who receive health care through the state's Medicaid expansion under the Affordable Care Act (ACA).
A number of states have recently pushed for Medicaid work requirements. On the federal level, House Republicans have proposed similar requirements as part of its budget.
Generally, critics of work requirements warn they will substantially weaken the Medicaid system, the largest public health insurance program in the country, by forcing millions off the service. Supporters argue that work requirements will foster employment, reduce fraudulent claims and improve personal responsibility.
What To Know
The bill seeks to include work requirements as a condition of eligibility for those on the Iowa Health and Wellness Plan, meaning they use Medicaid under the ACA expansion.
The legislation said, "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."
To be eligible for the program, Iowans 19 to 64 years old would have to work 80 hours a month, although some recipients would be exempt from the ruling.
Those who are "determined to be disabled by the United States social security administration" are exempt. Exemptions also include those identified as "medically frail," caregivers of a child under the age of 6 and people with "high risk" pregnancies.
As the bill has been deemed of "immediate importance," the new rules would come into effect upon its enactment.
According to the bill, if federal law or regulations affecting work requirements for the Iowa Health and Wellness Plan are "modified to exclude work requirements as a basis for maintaining eligibility," the department will discontinue the plan entirely, if it gets approval to do so.
A fiscal note on the bill said that as of April, 183,000 Iowans were enrolled on the state's Medicaid expansion program. Of those enrollees, the report expected 32,000 individuals to lose coverage beginning in 2026 because of the requirements.
The report also anticipated that the new requirements would decrease the state's total Medicaid expenditures by about $2.5 million in the financial year 2026 and by about $14.4 million in the financial year 2027.
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What People Are Saying
Iowa state Representative Beth Wessel-Kroeschell, a Democrat, told Newsweek: "Medicaid recipients want to work, and they do. We all agree that if they can, they should. According to KFF, 92 percent of Medicaid adults work full or part-time, or are not working due to caregiving responsibilities, illness, disability, or school attendance. The remaining 8 percent of Medicaid adults reported that they are retired or unable to find work."
She added: "We have a health care system that is in crisis, including a workforce shortage, a closure of labor and delivery units, one of the highest incidence of cancer in the nation, and increases in both infant and maternal death rates. All of those problems and more, and we have a bill before us to knock 182,000 Iowans who make less than $17,000 per year off of their health insurance. How does that help? It doesn't. The only argument for the bill during the subcommittee was that 'we need to listen to the taxpayers of Iowa.' The 182,000 Iowans who receive Medicaid through the expansion are also taxpayers."
She said: "Medicaid work requirements increase administrative costs, create bureaucratic barriers, disproportionately harm vulnerable populations, reduce healthcare access, and fail to meaningfully improve employment or economic mobility for Medicaid recipients."
The Iowa State Democrats account on X, formerly Twitter, wrote on Tuesday: "Many Iowans rely on state funding to help cover their healthcare needs. The scale of our maternal healthcare crisis is growing. The Medicaid waiver waitlist for Iowans with disabilities is growing. This Republican budget proposal fails to bring relief to those Iowans in need."
The Iowa Democrats X account wrote on Tuesday: "Countless Iowans rely on Medicaid to access healthcare coverage. Iowa Republicans in D.C. plan to ignore the concerns of their constituents and rip away their coverage to pay for a $4.5 trillion tax cut for the wealthy."
Democratic state Senator Sarah Trone Garriott said: "Taking away people's health care does not help them work. It often keeps people out of the workforce, because then they can't pay for their medications, they can't get the care they need. They end up getting sicker. They end up missing more work."
Republican state Senator Mike Klimesh said: "So at the end of demonstration year five, we will see a savings in the state of Iowa as a result of this program of $50 million. $50 million in savings that we can really reallocate or reappropriate to other areas, perhaps work with our programs. We may be able to develop with further communication between ourselves in the House."
What Happens Next
The Iowa Senate approved the bill in a 33-13 vote, the Des Moines Register reported. It went back to the House, which passed it in a 56-30 vote on Wednesday.
The legislation now heads to Governor Kim Reynolds, who is expected to sign it.
Update 05/16/25, 11:07 a.m. ET: This article has been updated with comment from Iowa state Representative Beth Wessel-Kroeschell.
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