Updated Thursday, February 20: The Labor and Business Relations Committee advanced a Medicaid work requirements bill (SSB 3158) Thursday, making it eligible for debate in the Iowa Senate.
Most Iowans on Medicaid are employed at least part-time and the proposal lists exemptions for many others including people caring for a disabled relative. Sen. Jason Schultz, R-Schleswig, said he supports the plan even if it impacts a relatively small number of people.
“I think it’s worth it,” Schultz said. “I think we have people that are on the system somewhat mocking the system and those who are working.”
Opponents of the program said qualified Medicaid recipients could unintentionally lose health coverage by missing paperwork deadlines.
“Even if you do catch a couple of those people the question arises, what about the children of those individuals who are going to get removed?” said Sen. Bill Dotzler, D-Waterloo. “Who’s going to take care of them?”
A provision enforcing stricter income limits for people applying for SNAP food assistance was removed from the proposal. Another section added to the bill would allow families to gradually phase-out of the state child care assistance program as their incomes increase.
Original story on Tuesday, Febuary 18: A proposal passed by an Iowa Senate subcommittee would require some low-income Iowans to work in order to stay enrolled in Medicaid. The same bill (SSB 3158) also would eliminate a form of automatic eligibility for food assistance through the federal SNAP program and prevent the state from seeking a temporary waiver from existing SNAP work rules in times of economic turmoil.
The Medicaid work requirements would apply to people ages 18 to 64 who are not disabled. They would have to work or volunteer for at least 20 hours per week, on average, over the course of each month. The bill makes some exemptions including for pregnant women, parents of young children and people in substance abuse treatment.
Supporters of the bill said at a subcommittee meeting Tuesday that stronger work requirements prevent dependency on public assistance.
“It moves people out of dependency, back to work, and it helps Iowans do more than just see higher incomes. It helps Iowans reengage in their communities, build connections and skills,” said Scott Centorino of the Opportunity Solutions Project, which advocates for stronger work requirements in public assistance programs across the country.
If the proposal were to pass, Iowa would join a group of states—including Arizona, Ohio and South Carolina—that has received federal waivers allowing them to impose Medicaid work requirements. Although work rules have been implemented in Indiana and Michigan, most states have not yet followed through. Arkansas, Kentucky and New Hampshire each had their plans blocked in court.
According to figures gathered by the Kaiser Family Foundation, 78 percent of working-age Medicaid recipients in Iowa are already employed. Opponents said that shows the bill is unnecessary. They said instead of helping people advance in a career, work rules would punish those who have not had training or don’t have easy access to transportation or child care.
“They encourage people to take or remain in very low-wage positions instead of investing the time that’s needed to train for a position that would allow you to reduce your dependence on public benefits,” said Melissa Johnson, the state policy director for the National Skills Coalition, a nonprofit that promotes job training.
Work requirements already exist in SNAP for people who are not disabled and don’t have children or other dependents. States can apply for a waiver from the U.S. Department of Agriculture to suspend those rules in times of high unemployment or in certain cities or counties with persistent high jobless rates. The Senate bill would prohibit the Iowa Department of Human Services from applying for a USDA waiver in the future. It requires DHS to assign people subject to SNAP work rules to a job training program.
The bill also cancels a policy that effectively raises the income threshold for Iowans to receive food assistance. Iowa families earning up to 160 percent of the federal poverty level can automatically qualify for SNAP if they also participate in the Temporary Assistance for Needy Families program (TANF).
Under the bill, Iowa would stop using that form of categorical eligibility and enforce the original income limit of 130 percent of poverty. Luke Elzinga of the Des Moines Area Religious Council said that would cause working families to lose food access.
“A family of four with two parents both working $8.50 an hour for an income of $35,360 annually can currently receive SNAP benefits,” Elzinga said. “No longer if we eliminate categorical eligibility.”
According to the Robert Wood Johnson Foundation, a proposed federal rule eliminating categorical eligibility would have resulted in 16 percent of Iowa SNAP households losing access to the program.
Bill supporters said it would restore the original intent of the income limits and ensures the neediest families receive assistance.
“There are limited resources in this state,” said Drew Klein of Americans for Prosperity. “We should preserve the integrity of these welfare programs for the truly needy.”
Similar proposals passed in the Senate last year but never came up for consideration in the Iowa House. Sen. Jason Schultz, R-Schleswig, said he hopes the new version of the legislation will advance farther.
“I want to move this out. I want to get it through committee and lay it out there so the people of Iowa hear this exists,” Schultz said following the subcommittee hearing. “I believe the people of Iowa want us to explore this idea.”
The bill passed in subcommittee. It must be approved by the full Labor and Business Relations Committee by the end of the week in order to be available for debate on the Senate floor this session.