Legislative changes affect thousands of Iowans on Medicaid expansion programs.
ALTOONA, Iowa — In June 2025, Governor Kim Reynolds signed groundbreaking legislation that fundamentally changed how Iowa's Medicaid programs operate.
The new law requires non-disabled adults enrolled in the Iowa Health and Wellness Plan (IHAWP) to work at least 80 hours monthly to maintain Medicaid eligibility.
This sweeping change affects approximately 146,000 Iowans out of the 181,000 total IHAWP enrollees and targets able-bodied adults ages 19-64 who rely on Medicaid for their healthcare needs.
Who Must Work 80 Hours?
The new state law establishes clear parameters for what counts toward the 80-hour monthly requirement.
Recipients can fulfill this obligation through:
- Traditional employment at any job.
- Community service work.
- Enrollment in educational programs.
- Participation in job skills training.
- Any combination of these activities totaling 80 hours per month.
Alternatively, if you earn monthly wages equal to the state minimum wage multiplied by 80 hours, you'll automatically meet the requirement regardless of actual hours worked.
This provision helps enrollees in higher-paying positions who work fewer hours but earn equivalent income.
Program dynamics: The IHWP currently serves adults with incomes up to 138% of the federal poverty level — about $21,597 annually for a single person in 2025. These individuals often work in industries with variable schedules, seasonal employment, or gig economy positions where documenting consistent hours can prove challenging.
Recipients must maintain detailed records of their work activities and submit documentation to Iowa HHS regularly—a burden falling squarely on the enrollees to prove compliance or risk losing their health coverage.
New Rules Protect Some Groups From Work Requirements
Not everyone enrolled in IHAWP faces these new work requirements. The legislation includes several exemption categories designed to protect vulnerable populations.
Caretakers of young children: Parents or guardians caring for children under age.
People with disabilities: Those verified as disabled by the Social Security Administration.
Pregnancy-related exemptions: Women experiencing high-risk pregnancies.
Substance abuse treatment: Participants in treatment programs (limited to 6 months).
Students: Full-time students enrolled in educational institutions.
Unemployment recipients: Those receiving unemployment benefits.
Medically frail individuals: People with serious or complex medical conditions.
What Happens When Medicaid Recipients Can't Meet Work Requirements?
The consequences of non-compliance follow a specific timeline designed to give recipients opportunities to meet requirements before losing coverage.
Initial non-compliance identification: Iowa HHS identifies individuals not meeting work requirements.
30-day notice period: Recipients receive written notice of non-compliance.
Opportunity to respond: During the 30 days, recipients can demonstrate compliance or prove exemption eligibility.
Coverage termination: Health coverage ends if requirements remain unmet after 30 days.
Reapplication required: To regain coverage, individuals must reapply and prove compliance.
This process means you could lose coverage in as little as 30 days after receiving a non-compliance notice. The new law doesn't provide a three-month grace period or multiple chances to comply before termination.
How Coverage Termination Impacts Healthcare Access?
Losing Medicaid coverage often creates immediate healthcare challenges:
Prescription medications: Chronic disease medications become unaffordable without insurance.
Doctor appointments: Routine check-ups and specialist visits must be canceled or paid out-of-pocket.
Emergency care: Without coverage, emergency room visits result in substantial medical debt.
Preventive care: Cancer screenings, vaccines, and wellness visits become financially inaccessible.
Mental health services: Therapy and psychiatric care requiring consistent treatment may be disrupted.
For the estimated 32,000 Iowans who may lose coverage, these disruptions could lead to worsening health conditions, increased emergency room usage, and mounting medical debt.
When Iowa's Medicaid Work Policy Takes Effect
The law’s implementation timeline depends entirely on federal approval
Current status: Iowa HHS is preparing a federal waiver application.
Target implementation date: January 1, 2026.
Public comment period: Thirty days for public input on the proposal.
Public hearings: Two scheduled hearings for community feedback.
Federal review period: Typically takes several months.
Iowa HHS must consider all public feedback before submitting the final waiver request to federal authorities.
Advocates Propose Action Steps for Current IHAWP Enrollees
The nonpartisan Legislative Services Agency suggests that current Iowa Medicaid recipients should take immediate steps to prepare for the upcoming changes.
Document Everything Now: Start immediately! You should establish a comprehensive record-keeping system for all work-related activities and program participation. This means saving every pay stub from any employer, no matter how small the job, and requesting written verification for any volunteer work you complete. This proactive approach ensures you have a complete paper trail when reporting periods begin and helps prevent any gaps in documentation that could complicate your case later.
Understand Your Exemption Status: Take time to thoroughly research and document any circumstances that might qualify you for exemptions from work requirements. If you have any disabilities or health conditions, gather comprehensive medical documentation from your healthcare providers that clearly outlines how these conditions affect your ability to work. Also, document any caregiving responsibilities for children under six years old or other dependents, as these often qualify for exemptions.
Know the Reporting Deadlines: Establish a reliable system for tracking and meeting all reporting deadlines by setting up calendar reminders before monthly reporting periods. Understanding the specific submission process and required forms ahead of time prevents last-minute scrambling and potential missed deadlines. Finally, always make copies of everything you submit and maintain detailed records of when and how you submitted each report.
Contact Local Iowa Medicaid Advocates: Contact Medicaid advocacy professionals who can provide personalized guidance based on your circumstances and help you navigate the complex requirements. These advocates can clarify confusing aspects of the work requirements, help you understand which exemptions you might qualify for, and guide you through the application processes for relevant programs or exemptions. Contact advocates early to understand the appeal procedures and your rights within the system.
Don't wait until you encounter problems to take these action steps. Starting early gives you time to address work requirement issues before they affect your Medicaid benefits and keep you in compliance.
Looking Ahead to Iowa's Healthcare Landscape
Implementing medicaid work requirements represents a fundamental shift in how Iowa approaches healthcare for low-income adults.
Several factors will determine the policy's ultimate impact as the state moves toward the January 1, 2026 target date. The coming months require careful preparation for the 146,000 Iowans subject to these new requirements.
Understanding exemptions, gathering documentation, and establishing systems for tracking work hours will soon become vital tasks for Medicaid enrollees.
As Iowa becomes one of the first states to implement comprehensive Medicaid work requirements, success or failure in Iowa could influence how other states approach their own implementations as the federal deadline of January 2027 approaches.