Kelly Garcia, the newly appointed director of the Iowa Department of Human Services, talks about how she plans to examine the health of Iowa’s managed-care system.

The Des Moines Register

Republican lawmakers in the Senate are advancing legislation that would require Iowa Medicaid recipients to work in order to receive health care benefits, despite opposition from numerous social services agencies.

The bill, similar to efforts last year, also includes changes to food stamp eligibility requirements. The bill passed through a Senate subcommittee on Tuesday and is set for a committee vote Wednesday morning.

Senate Study Bill 3158 is more expansive than a Medicaid work requirements bill passed by Republicans in the Senate last session, which focused on people who became eligible for Medicaid under the Affordable Care Act. That bill failed to gain traction in the House

Sen. Jason Schultz, R-Schleswig, said he wanted to “take another run” at the issue this year and get both Iowans’ and the House’s attention. 

“I believe the people of Iowa want us to explore this idea,” he said.  

The Opportunity Solutions Project and Americans for Prosperity are the only groups registered in favor of the bill. Supporters on Tuesday that the bill will help close loopholes and get more able-bodied Iowans into the workforce, in which Iowa businesses face a worker shortage

Under the bill, to qualify for Medicaid, able-bodied recipients would have to work, volunteer or participate in a work program for an average of at least 20 hours per week, or participate and comply with the requirements of a workfare program. Medicaid is the health care program for poor and disabled Iowans.

Among those who would be except from the work requirement:

  • Recipients under 18 and over 64 years old.
  • Those medically certified as “physically or mentally unfit for employment.”
  • Pregnant women.
  • Parents or caretakers responsible for caring for a child under 1 year old or a child with a serious medical condition or disability.
  • Those receiving unemployment compensation and complying with applicable work requirements.
  • Those participating in a drug addiction or alcoholic treatment and rehabilitation program. 

Bill would also change some food stamp eligibility requirements

Alongside Medicaid work requirements, the bill would affect some of the eligibility requirements for the Supplemental Nutrition Assistance Program, also known as food stamps.

First, the bill would prevent the Iowa Department of Human Services from granting “categorical eligibility” for SNAP benefits. Categorical eligibility allows participants to be eligible for food stamps based on their qualification for other low-income assistance programs.

Currently, Iowa is among 39 states participating in “broad-based” categorical eligibility, through which the state allows all households with income of up to 160% of the federal poverty level to qualify for SNAP benefits. That’s above the 130% federal level. If the measure became law, it would prohibit DHS from applying gross income standards that are higher than those specified in federal law.

The Senate bill would additionally prevent DHS from seeking any work requirement waiver for SNAP assistance from the federal government, unless required by law. Those who receive food assistance would also need to be assigned to an employment and training program unless they are otherwise exempt under federal law. 

Scott Centorino, who spoke Tuesday on behalf of the Opportunity Solutions Project, a group that supports the bill, called broad-based categorical eligibility a loophole that allows “state-sanctioned fraud.” He said since there is no asset test for those recipients, someone theoretically could have $1 million in the bank but still qualify because they fall below the income threshold. The bill will begin to close that loophole, he said. 

Centorino also said Iowa currently doesn’t require any of the 100,000 able-bodied adults with kids, or the 20,000 able-bodied adults between 50 and 59 on food stamps to work. 

“It’s a missed opportunity because it does more than just strain your budget and rob your businesses of engaged workers,” he said. “It also robs those families that those individuals are in of one of the most important gifts a parent can give, and that’s having a role model in the home who’s working and providing for their family.” 

But Luke Elzinga, communications and advocacy manager for the Des Moines Area Religious Council, which oversees a network of 14 food pantry sites, said thousands of people would no longer qualify from food stamps under the bill, many of whom already don’t make enough to live on their income alone. 

“What it’s going to do is it’s going to push people off of food assistance,” he said. “And local governments and social service agencies — food pantry networks like the one I work for — are going to see those people turning to them because they are not making enough to make ends meet.”

Elzinga cited a study by the Robert Wood Johnson Foundation that showed doing away with categorical eligibility would cause more than 59,000 Iowans to lose SNAP benefits by reducing income eligibility from 160% of the federal poverty level to 130%. That would affect 16% of all SNAP recipients in Iowa, according to the report. 

Families can’t survive well at the 160% level, let alone the 130% level, Elzinga said. 

“You’ve heard it portrayed as a state-sanctioned fraud,” he said. “Nothing could be further from the truth.” 

He said the bill’s employment and training program provision would include 16- and 17-year-olds, pregnant women and caretakers. 

Democratic senator: ‘This is state-sanctioned abandonment’

Representatives of social service agencies who oppose Medicaid work requirements said they worry people who don’t have visible physical problems but suffer from issues like brain injuries could become vulnerable. Some also said the measure did not solve a problem. 

“The majority of adults on Medicaid are already working, and those who are not are in caretaking roles or disabled themselves,” said Mary Nelle Trefz, health policy associate with the Child and Family Policy Center.

“This is state-sanctioned abandonment,” Sen. Nate Boulton, D-Des Moines, said of the bill. “It’s state-sanctioned abandonment of vulnerable Iowans and people who are trying to take care of vulnerable Iowans.”

Schultz said Tuesday he plans to amend some of the portions of the bill based on feedback from the groups. The bill will be considered by the Labor and Business Relations Committee, which Schultz chairs, on Wednesday.

The bill faces an uncertain future in the Iowa House. Last year, the chairwoman of the House Human Resources Committee refused to take up a Medicaid work requirements bill after it passed the Senate on a 32-17 party-line vote

Schultz, who has pushed for “welfare reform” in a series of bills the past three years, has also introduced legislation this session that would computerize verification for programs like food stamps and Medicaid. Many of the same social service agencies have come out against the bill, which passed through the Senate Labor and Business Relations Committee last week despite Democratic opposition. 

Ian Richardson covers the Iowa Statehouse for the Register. Reach him at, at 515-284-8254, or on Twitter at @DMRIanR.

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Work requirement bill for Iowans on Medicaid, food stamps resurfaces in Iowa Senate – Des Moines Register