Updated Medicaid Requirements - IMPORTANT

Recent legislation was passed which has created some changes for Medicaid requirements.

A budget reconciliation bill (H.R.1), which was signed into law on July 4, 2025, introduced new work, or community engagement requirements for individuals who use Medicaid. In order for an individual to continue to receive Medicaid benefits, they must meet and continue to meet the requirements which were signed into law.

H.R. 1 states that Medicaid members who are aged 19-64 must have active engagement in employment, education, work program, or community service to maintain their Medicaid eligibility.

Here is the overview of the new requirements:

• This change will be fully implemented effective January 1, 2027.

• 80 hours per month of one or more of the following activities:

  • Employment

  • Participation in a work program, such as work training

  • Enrollment in an educational program (at least half time)

  • Community service activities

    or a combination of the above activities.

• Who does this apply to?

  • Individuals between the ages 19-64 who are enrolled in Medicaid under the Affordable Care Act

• Exemptions (who does this NOT apply to):

  • Foster care youth under the age of 2026

  • Caregivers who are responsible for a dependent child 13 years of age and under OR a disabled individual

  • Disabled veterans

  • Medically frail individuals

    • Blind

    • Disabled

    • Has a substance use disorder

    • A disabling mental disorder

    • Physical, intellectual, or developmental disability

    • Serious or complex medical condition

  • Individuals who are already meeting work requirements

  • Individuals who are participating in a qualifying substance use (SUD) treatment program (must meet SNAP related federal requirements, run by a nonprofit organization or public community mental health center).

  • Incarcerated or recently incarcerated individuals.

  • Pregnant and postpartum individuals (there is a 12 month postpartum extension).

  • Short-term hardship

    • Hospitalization

    • Individuals in a federally declared disaster area

    • Individuals living in counties with unemployment rates higher than 8%

    • Individuals or their dependents who are required to travel outside their home for medical care for an extended time.

• If you are impacted by this, what next steps do you need to do?

  • Make sure your address and contact information is up to date as State Medicaid agencies will be required to conduct member outreach between June 30th-August 31st, 2026 through regular mail and by another form of communication such as phone, text, website, and other electronic means.

  • Once this law is fully implemented, State Medicaid agencies will be conducting follow-up every 6 months for impacted individuals.

• Non-Compliance:

  • If a member does not meet the work requirements, the following may occur:

    • Notice of non-compliance: A notice will be sent out about requirements not being met according to the new standards.

    • After the notice is sent, members have 30 days to show compliance with the requirements before they are disenrolled from Medicaid.

For more information: https://www.chcs.org/resource/a-summary-of-national-medicaid-work-requirements/

For any questions related to these changes, you may contact Member Services at:
Email: [email protected] | Call: 1-800-338-8366 | Website: hhs.iowa.gov/IHAWP