Iowa Senate Republicans on March 19 approved new work requirements for tens of thousands of Iowans on Medicaid or receiving food assistance. Senate File 538 would instruct the Iowa Department of Human Services to request a federal waiver for the Iowa Health and Wellness Plan, our state’s version of Medicaid expansion. Approximately 170,000 adults receive Medicaid through that plan, and an roughly 61,000 of them also receive Supplemental Assistance Nutrition Program (SNAP) benefits.
If the waiver were approved, Medicaid recipients would face new reporting obligations for “community engagement.” If not part of an exempted group, they could lose coverage due to paperwork errors, even if they were working the requisite number of hours per week. Nonpartisan analysis estimated this bill would cost the state budget nearly $5 million the first year after the waiver and nearly $12 million each subsequent year.
During floor debate (beginning at 11:53:20 of this video), Republicans characterized the bill as a way to hold Iowans accountable. Democrats offered two amendments that would have extended that accountability to large employers and the for-profit insurers known as managed-care organizations (MCOs), which oversee Iowa’s privatized Medicaid.