Iowans would have to work or volunteer at least 20 hours per week to remain eligible for Medicaid health care coverage under legislation that passed the Senate Health and Human Services Committee on Wednesday.

Senate File 363 would require Medicaid recipients to work, participate in a work program or volunteer at least 20 hours per week. Certain people would be exempt from the requirement, including people under age 19 or over age 64, people medically certified with a disability that makes them unable to work, people who are pregnant or parenting a child under age 1 or a child with a serious illness or disability. People in substance abuse treatment would also be exempt.

The committee amended the bill to align the exemptions with work requirements for SNAP and other programs for low-income Iowans. Sen. Mike Zimmer, D-DeWitt, sought to expand the list of exemptions to include caregivers for a disabled adult or elderly family member or someone experiencing homelessness. But the bill’s floor manager, Sen. Mike Klimesh, R-Spillville, said the amendment would have to be offered on the Senate floor.

The bill would require the state to request a waiver, if necessary, from the federal Centers for Medicare and Medicaid Services to implement the requirements. The amendment also would provide an upgrade in computer systems for the Iowa Department of Health and Human Services to help administer Medicaid and other programs. Klimesh said he did not yet have a cost estimate for the computer work.

Democrats voted against the bill. Sen. Sarah Trone Garriott, D-West Des Moines, said the experience in other states shows Medicaid work requirements cause eligible recipients to lose their health care benefits because additional reporting requirements are complicated, there are delays for qualified people to get accepted because the additional workload for administrators and an increase in uncompensated care that hurts hospitals and clinics.

“And the biggest thing that every state that has implemented similar policies has seen is an increase in the cost to taxpayers,” she said. “I mean, that is a given. It is a guarantee that it is going to cost our state a lot of money to hurt people, a lot of money to hurt our health care system, a lot of money that is going to not do us any good.”

Klimesh said out of Iowa’s expanded Medicaid population of about 180,000 people, roughly 60% of able-bodied adults “aren’t working at all.”

“So they’re not even attempting to find work,” he said, even though recipients could maintain their benefits while gaining experience that could eventually qualify them for a job with health benefits.

The bill moves to the Senate floor for further debate. It does not have a companion bill in the Iowa House, but it is a priority of the governor.

During her Condition of the State address in January, Gov. Kim Reynolds said she planned to apply for a federal waiver to implement Medicaid work requirements, though she did not share details like how many hours would be required to continue receiving benefits.

House Speaker Pat Grassley told reporters Monday that House Republicans have not had a discussion with Reynolds on “the right path” for pursuing Medicaid work requirements, but that lawmakers are pursuing legislative action because the subject was brought up as a priority leading into the 2025 session.

“Whether it’s the governor doing it, whether it’s through our bill, I think we just want to make sure that it’s something that does get done,” Grassley said. “And we know if we could pass a bill to do it, we’ll at least get that formal request submitted through legislation as well.”

— Robin Opsahl contributed to this report.