Work requirements for Iowa’s expanded Medicaid population approved by Republicans

DES MOINES — Many of the roughly 181,000 Iowans in the state’s version of Medicaid expansion would be subject to work requirements, and the entire program could be eliminated if the federal government ever disallows work requirements, under legislation approved this week by Republican state lawmakers.

Medicaid is the government’s health care program for people with low income or disabilities.

Iowa in 2013 expanded its Medicaid coverage to include individuals up to 133 percent of the federal poverty level, up from the previous threshold of 100 percent.

An individual at 133 percent of the federal poverty level makes $20,815 annually; a family of three at that level makes $35,445.

Under the proposed legislation, most physically able participants in the Iowa Health and Wellness Plan would be required to work at least 80 hours per month.

Out of the roughly 181,000 Iowans on the Health and Wellness Plan, a little more than 142,000 could be subject to the work requirements, according to analysis from the state’s nonpartisan Legislative Services Agency. Three-fourths of adult Iowans on Medicaid work, according to a report from the nonpartisan health care data and advocacy organization KFF.

Roughly 32,000 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 Iowa legislation 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, the Iowa Department of Health and Human Services would be instructed to discontinue the Iowa Health and Wellness Plan, pending federal approval. Should that request be denied, the state could develop an alternative program, according to the bill.

Children, senior citizens, pregnant people, some caretakers exempt

The bill exempts from any work requirement any physically able Iowans in the program who are younger than 19 or older than 64, is the caretaker of a dependent child under 6 years old, is undergoing a high risk pregnancy, or is in treatment for a substance abuse disorder.

The proposal was approved Tuesday by majority Republicans in the Iowa Senate and Wednesday by majority Republicans in the Iowa House.

Senate Republicans passed their bill, Senate File 615, Tuesday on a party-line, 33-15 vote with only Republicans supporting and all Democrats opposing. House Republicans passed the bill on Wednesday, 61-35, with only Republicans supporting and three Republicans joining all Democrats in opposition.

House Republicans also added a minor amendment that recommends studying a program for disabled workers. Because of that amendment, the bill must now go back to the Senate for approval there before going to Reynolds.

LSA’s analysis of the bill’s potential financial impact on the state is incomplete because, the state agency said, Iowa HHS has not responded to LSA’s multiple requests for information.

Iowa HHS also did not respond to The Gazette’s request for information and comment.

Gov. Reynolds’ plan for Medicaid work requirements

Reynolds, meantime, has directed the Iowa Department of Health and Human Services to request a federal waiver to allow the state to enact work requirements on the Iowans covered by expanded Medicaid. Reynolds pledged to apply for the waiver during her annual Condition of the State address to the Iowa Legislature in January.

Reynolds has issued the directive, and the waiver request has not yet been issued but will be soon, an administration spokesman said Wednesday. The waiver request will match the proposed legislation and include “common sense” exemptions such as age, disability, and caretaking for children, the spokesman said.

“Iowans who do not meet the new requirements will be given a time to come into compliance; those who choose not to will no longer be eligible for Medicaid coverage,” Reynolds spokesman Mason Mauro said.

Lawmakers debate the bill’s potential impact

Sen. Janet Petersen, a Democrat from Des Moines, proposed an amendment to remove the language that would discontinue the Iowa Health and Wellness Plan if the federal government disallows Medicaid work requirements. During a brief debate in the Senate on Tuesday, Petersen called the provision “gutting Medicaid expansion.”

In a more protracted debate Wednesday in the House, Rep. Carter Nordman, a Republican from Panora, argued the provision is needed to keep the work requirements in the program from changing every four years at the whims of which major political party controls the White House.

Democrats during House debate insisted that the vast majority of able-bodied Iowans on Medicaid are already working and that the bill will only punish those who already are working by forcing them to deal with more government regulations — or be removed from the program.

“This proposed solution is just adding red tape and bureaucracy,” Rep. Austin Baeth, a Democrat from Des Moines and a physician, said during debate. “That’s how people fall through the cracks. And when they fall through the cracks in this particular place, it can be a matter of life and death.”

Nordman said the Medicaid program needs to be “refocused” to its purpose of serving people with low incomes or disabilities.

“While Medicaid expansion has been a vital safety net, it is not meant to be a permanent solution,” Nordman said, arguing that work requirements will help Iowans in the program reduce their “dependence on government” and to “take control of their future.”

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

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