New federal rules that are to go into effect in 2027 will require some Americans enrolled in an expansion of the Medicaid program to prove they’re working at least 80 hours per month, however the law President Trump signed in July lets states implement the changes earlier.
Governor Kim Reynolds said the change will take effect in Iowa on January 1, 2026. “We’ll have to align with what the federal government’s regulations are,” Reynolds told Radio Iowa.
The State of Iowa sought a waiver that would have required able-bodied adults under the age of 65 who are covered by the Iowa Health and Wellness Plan to work 100 hours per month. These are Iowans with slightly higher incomes enrolled in Medicaid under a program expansion approved in 2013. Reynolds expects federal officials to release final work requirement guidelines soon. “There’s not very many discrepancies between what we had submitted and what they’re doing,” Reynolds said.
The work requirements for adults enrolled in expanded Medicaid in Iowa will not apply to Iowans with disabilities, serious illnesses or injuries or to parents caring for children under age six. Given those exemptions, Reynolds recently said state officials estimate about 100,000 Iowans who aren’t working today will have to show they’re working 80 hours a month or they’ll no longer be eligible for Medicaid coverage.
“It’s about building a healthier lifestyle. It’s about being able to take care of yourself,” Reynolds said during an appearance on “Iowa Press” on Iowa PBS. “We want to work with these individuals to help them either get a job, work on their resume or get a skill that would allow them to get a job that would, hopefully, allow them to take care of themselves.”
Democrats and others critics have said some eligible Iowans are likely to lose Medicaid coverage if there’s a glitch in submitting monthly reports and rural hospitals that get a large portion of their revenue from Medicaid will take a financial hit.
