Medicaid bill would require 'able-bodied' Iowa adults to work or study

In order to qualify for Medicaid health insurance, “able-bodied” Iowans would have to work at a job or attend school or job training under a bill introduced recently in the Legislature.

Under the bill, Iowa would join several other states in seeking federal permission to implement such work requirements on Medicaid, which is jointly financed and run by federal and state governments.

The Trump administration is encouraging the idea, saying Medicaid is supposed to be for Americans who are “most in need,” not for people who could provide for themselves. The idea is controversial, with critics contending most adults on Medicaid already work or are too disabled or sick to do so.

The Iowa bill, Senate File 2158, was introduced last week by Sen. Tom Greene. The Burlington Republican said his intent is to make the Medicaid program sustainable for people who can’t fend for themselves.

“With limited funds and yet a growing need, I want to make sure those Iowans who truly need assistance get that needed state aid,” Greene wrote in an email to the Register Wednesday. “The best result from a state welfare program is the number of citizens who remove themselves from assistance via education and employment.”

The bill would add several substantial requirements for enrollment in Iowa’s Medicaid program, which covers about 600,000 poor or disabled people. “If the individual is an able-bodied adult, the individual shall work, actively seek work, or attend school or job training for at least 20 hours per week,” the bill says. It does not define “able-bodied.”

The bill says Medicaid members with minor children in their households would have to ensure those children attend school. It also says that Medicaid applicants would have to undergo drug screening, and that applicants' Medicaid coverage wouldn’t start until 180 days after their applications are approved.

Critics say most adults on Medicaid already either work or attend school or have health problems that prevent them from doing so.

“No one disagrees that helping people who can work get good jobs is good for families and good for Iowa's economy. Imposing Medicaid work requirements is the wrong way to get there,” said Mary Nelle Trefz, an analyst for the Child and Family Policy Center. “Ultimately, what work requirements do well is to put up an obstacle to obtaining coverage by dramatically ramping up the red tape required to get it. Work requirements are effective at taking health coverage away from the people who need it most, in turn making it even harder for them to maintain their health and independence and be productive members of our workforce.”

The Child and Family Policy Center is one of several social-service agencies that have registered in opposition to the bill. Several others have registered as being “undecided.” No lobbyists have registered as being in favor of it.

Seema Verma, who is President Trump’s top Medicaid administrator, has touted the idea of adding work requirements for the program.

“True compassion is lifting Americans most in need out of difficult circumstances. The new flexibility requested by states will allow them to partner with us to help program beneficiaries live healthy, fulfilling lives as independently as possible,” Verma wrote in an opinion piece published in the Washington Post Sunday. “This administration stands for a policy that makes Medicaid a path out of poverty by empowering states to tailor programs that meet the unique needs of their citizens. We owe it to these Americans to try whatever may help them achieve the dignity and self-sufficiency they deserve.”

Before becoming a top administrator for President Donald Trump, Verma was a health-care consultant whose clients included Iowa’s state government. Verma helped design Iowa’s controversial shift to private management of the state’s $5 billion Medicaid program.

Before 2014, Iowa adults generally didn't qualify for Medicaid unless they were disabled, pregnant or had minor children at home. But that changed when Iowa opted to expand its Medicaid program under the Affordable Care Act. About 150,000 poor Iowa adults gained coverage because of the move.

Iowa reporters asked Gov. Kim Reynolds last month about the idea of work requirements for Medicaid. "That's something we can look at down the road,” she replied.

Reynolds' spokeswoman, Brenna Smith, said Wednesday the governor would not comment on the bill until she sees it in final form. But she added, "the governor believes Medicaid is an important safety net for many Iowans, and her hope is that those on the program who are able-bodied are able to find a career and re-enter the workforce." She said that's why Reynolds is promoting her "Future Ready Iowa" program to build job skills.

Iowa Senate Majority Leader Bill Dix said Wednesday that he's interested in the idea of adding work requirements to Medicaid, but he didn't commit to it. "The concept appears to have merit and I look forward to reviewing the policy as it works its way through legislative process," the Shell Rock Republican said in a statement released by his office.

As of Wednesday afternoon, Greene’s bill had not yet been scheduled for formal discussion by a subcommittee. To move ahead, it would have to be approved by a subcommittee and a full committee by next week's “funnel” deadline in the Legislature. However, if it fails to clear the funnel deadline, the idea could be revived as an amendment to another Medicaid bill.