Iowa Senate Republicans are closer to requiring some Medicaid patients in Iowa to work in order to receive health care benefits.

Legislation moving through the state Capitol would require able-bodied Iowans to work, get involved in community activities or be enrolled in school to be a part of Medicaid. Medicaid is the health care program for poor and disabled Iowans.

The Republican-controlled Senate voted 32-17, along party lines, Tuesday to advance the bill, which focuses on people who became eligible for Medicaid under the Affordable Care Act.

The bill now heads to the GOP-majority House, where its future is unclear.

The debate on the Senate floor highlighted partisan divisions over the role of some government programs that provide help to citizens.

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Sen. Jason Schultz, R-Schleswig and floor manager for the bill, said he's focusing on a people who receive Medicaid benefits who he believes should work.

“If there’s nothing holding you back except your own decision not to go forward, we’re going to bump you forward,” he said. “It’s not only good policy, it’s moral.”

The measure, if it becomes law, would require weekly work hours for Medicaid recipients but carves out people with physical and mental conditions.

The non-partisan Legislative Services Agency estimates there are about 166,000 people enrolled in the expanded Medicaid program known as the Iowa Health and Wellness Plan. The agency believes more than 70,000 from that group may require review under the bill, but the scope of the impact from there remains unclear.

If it becomes law, the measure would cost the state nearly $5 million in its first year of implementation and nearly $12 million in the second, according to one LSA analysis. The federal government would be on the hook for additional expenses.

The state would have to hire and train more state workers to oversee implementation.

Groups that are opposed to the legislation warn it will add red tape for people who are already working.

“You are creating a massive bureaucracy, new bureaucracy, of state employees to basically harass people that are in poverty, trying to make ends meet,” Sen. Joe Bolkcom, D-Iowa City, said.

An Iowan enrolled in Medicaid would have one of several options:

Work 20 hours or more per week, averaged over a six-month period

Comply with a work program for 20 hours or more per week, average on a monthly basis

Volunteer 20 hours or more per week, average on a monthly basis

Meet a combination of work and work program participation requirements

Participate in other eligible program activities.

Someone who doesn’t meet the requirements during an initial six-month period of eligibility would be terminated for the remainder of the benefit year.

There are multiple exemptions to the work requirements for someone who is medically certified as physically or mentally unable to fulfill them.

Those include: a woman who is pregnant; a parent or caretaker responsible for a child under six years old, a child with a disability, an elderly person or someone with a medical condition; someone in a drug or alcohol treatment and rehabilitation program; or involved in other exempt activities.

If the bill is enacted into law, the law would need approval from the federal government through the Centers for Medicare and Medicaid Services. The agency has approved similar plans from other states. Some of those states have been sued over their work requirements.

Senate Republicans have advanced other bills this session which they say are aimed at "welfare reform."

One proposal would require recipients of government food assistance to comply with child support. Another measure seeks to cut fraud within the program through better oversight of electronic cards that are used to receive benefits.

Both of those bills received broad support from Democrats on the chamber floor earlier this month.