Starting January 1, 2027, Iowans on Medicaid will need to work or volunteer 80 hours per month to maintain coverage, according to state officials.
Medicaid recipients like Alyssa Miller of Muscatine say the new requirements could feel burdensome. “It’s just constantly trying to prove that you’re this or you’re that, and it just becomes a lot,” Miller said.
The Eastern Iowa Health Center (EIHC), where 70% of patients rely on Medicaid, anticipates significant impacts. CEO Joe Locke estimates that about 2,000 patients could be affected. If patients fail to meet requirements or aren’t exempt, EIHC will still provide care but may have to absorb the cost, potentially totaling $3 million in 2027.
Locke explained that the clinic also expects an influx of new patients from other facilities, as EIHC treats individuals regardless of ability to pay. To prepare, EIHC has expanded services, including a pharmacy, walk-in care, and upcoming optometry services starting April 7.
Some Medicaid recipients will be exempt from the work requirements, including:
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Individuals under 19 or 65 and older
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Pregnant women, particularly high-risk pregnancies
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Caretakers of children under 6
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Those determined disabled by the SSA
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Medically exempt individuals
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People receiving unemployment benefits
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Participants in substance use disorder (SUD) treatment (up to six months)
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Individuals providing proof of good cause as defined by HHS
Locke added that exemptions may also apply to those with severe mental illnesses or other qualifying conditions.
The clinic is now preparing for the policy change, describing the effort as “preparing for war in time of peace,” given the federal-level shift coming in just over a year.
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