All states Iowa
Iowa Medicaid and the new work rules
Iowa Health and Wellness Plan (IHAWP) is run by Iowa Department of Health and Human Services (HHS) — formed in 2023 when the state merged the former Department of Human Services (DHS) and Department of Public Health; older documents and some URLs still reference dhs.iowa.gov or DHS by name. Iowa expanded Medicaid on 2014-01-01, which is why the new federal work requirement reaches this state — and why what you do before December 1, 2026 matters.
From December 1, 2026, most adults have to show 80 hours a month
The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 179,000 people in Iowa. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.
Iowa HHS says it will first check records it already holds — including SNAP and FIP compliance and wage data — to work out automatically who already meets the requirement or qualifies for an exclusion. Only when its own records are not sufficient will HHS mail a letter asking a member to send proof, with instructions on what to submit.
If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.
You do not have to prove anything if any of these describe you
Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.
What you can earn and still qualify
Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.
Adults 19 to 64133% of the poverty line
- 1 person
- $1,769
- 2 people
- $2,399
- 3 people
- $3,028
- 4 people
- $3,658
- 5 people
- $4,288
- 6 people
- $4,917
- 7 people
- $5,547
- 8 people
- $6,176
Pregnant215% of the poverty line
- 1 person
- $2,860
- 2 people
- $3,878
- 3 people
- $4,895
- 4 people
- $5,913
- 5 people
- $6,931
- 6 people
- $7,948
- 7 people
- $8,966
- 8 people
- $9,984
Source: Iowa HHS, Comm. 119 (04/26), 'Income Eligibility Criteria for Common MAGI Programs,' effective April 1, 2026, read alongside the Medicaid Income Guidelines page at hhs.iowa.gov, which states that all its figures are effective as of April 1, 2026. A note on precision: Two income figures Iowa HHS publishes do not agree with each other, and both carry the same April 1, 2026 effective date. We publish the state figure.
Two other changes land on the same day
Renewals get more frequent, and back-dated coverage gets shorter.
P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.
Iowa has a law that would end expansion automatically
Coverage here is tied by statute to how much the federal government pays.
Iowa Code §249N.3(5), enacted by 2013 Iowa Acts, ch. 138; and Iowa Code §249N.4A(8), enacted by Senate File 615, 2025 Iowa Acts, ch. 1033. Iowa has two contingency provisions rather than one. Under §249N.3(5), if the federal matching rate for Iowa's expansion population is cut below 90% but not below 85%, Medicaid reimbursement rates for inpatient and outpatient hospital services are to be reduced by a like percentage in the following fiscal year — but only with prior statutory approval from the legislature; and if the matching rate is cut in a way inconsistent with federal law, or federal law on IHAWP eligibility or benefits changes, the department may put an alternative, more limited plan in place for the affected population, again only with prior statutory approval. Under §249N.4A(8), added in 2025, if Iowa receives federal approval to impose work requirements and federal law or regulations are later changed to remove work requirements as a condition of eligibility, the department shall discontinue the Iowa Health and Wellness Plan, subject to federal approval; and if federal law does not let it discontinue the plan, it may implement an alternative plan instead, with prior statutory approval.
Neither provision ends coverage the moment federal funding changes, but the 2025 one is closer to a termination trigger than the older one. The funding provision at §249N.3(5) is a rate-reduction and review clause: a drop in the match forces a hospital-payment cut and opens the door to a narrower replacement plan, but both steps need the legislature to act first, and IHAWP coverage continues until it does. The 2025 provision at §249N.4A(8) is a directive to end IHAWP outright, though it only bites in one specific situation — Iowa having been granted work-requirement authority and the federal government then taking that authority away — and it still needs federal approval to carry out. Either way, Iowa's law does not disenroll anyone by operation of law the way an automatic-termination statute does.
Both are in force and neither has been activated. The enhanced federal match rate for Iowa's expansion population has not dropped below 90%, and the §249N.4A(8) condition has not been met, because Iowa has not been granted and then stripped of work-requirement authority. Iowa's base federal matching rate for all other Medicaid spending is 62.7% for federal fiscal year 2026.
This is not a reason to delay applying. It is a reason to keep your contact details current, open everything the state sends, and not assume coverage renews itself.
Do this now
Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.
About the phone numbers: Iowa Medicaid Member Services (1-800-338-8366, Monday–Friday 8 a.m.–5 p.m.) handles eligibility checks, MCO/dental plan changes, premiums, and card replacement. A separate Income Maintenance Customer Service Center (1-877-347-5678, Monday–Friday 8 a.m.–4:30 p.m.) is the line for reporting a change of address, income, or household — and it is also the number Iowa HHS prints on its community engagement notice for questions about the new work rules. The HHS Contact Center (1-855-889-7985) is for applying by phone and Affordable Care Act questions. A general HHS Central Office line (1-800-972-2017) exists only for problems with a local office, not for coverage questions.
Deaf, hard of hearing or speech-impaired: 1-800-735-2942 (Relay Iowa TTY).
Iowa Medicaid provides free interpreter and translation services in these and other languages at no cost to members. Call Iowa Medicaid Member Services at 1-800-338-8366 (locally in Des Moines, 515-256-4606) and ask for an interpreter in your language, or ask your IA Health Link managed care plan directly — Iowa Total Care, Molina Healthcare of Iowa, and Wellpoint Iowa each operate their own member language lines. People who are deaf, hard of hearing, deaf-blind, or have difficulty speaking can reach Relay Iowa TTY at 1-800-735-2942. Written materials are also available in large print, audio, Braille, and other accessible formats on request.
Most people who lose coverage lose it over paperwork, not eligibility
Nationally, most people who lose Medicaid lose it over paperwork rather than because they stopped qualifying. From December 1, 2026 that matters more, not less.
NOTICE OF ELIGIBILITY DETERMINATION
Case number: ███████
Date of this notice: 1January 12, 2027
Our records do not show that you met the community engagement requirement for the reporting period.
2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.
3Coverage for other members of your household is not affected by this notice.
What the federal data says about coverage here
Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.
Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.
Check your doctor is in the plan before you choose it.
Where you live in this state changes what coverage is worth. Iowa relies heavily on small, rural, critical-access hospitals, and obstetric (labor and delivery) services at those hospitals have been closing steadily. Research affiliated with Iowa State University and the Iowa Department of Public Health, as reported by NPR and KFF Health News, found that 41 Iowa hospitals stopped offering labor and delivery services between 2000 and the mid-2020s; the American Hospital Association's count is a close 42. A University of Iowa College of Public Health study published in the Journal of Rural Health found Iowa lost more than a quarter of its rural labor-and-delivery units in the single decade from 2009 to 2019. The American Medical Association's 2025 maternity-care-access analysis found that 57% of Iowa counties have no hospital offering obstetric services at all, and that 14% of Iowa women of reproductive age live more than 30 minutes from the nearest hospital that delivers babies. For a pregnant Medicaid enrollee, coverage does not guarantee a labor-and-delivery unit within reach. Iowa State University and Iowa Department of Public Health-affiliated rural obstetric access research as reported by NPR and KFF Health News; University of Iowa College of Public Health, Journal of Rural Health (rural labor-and-delivery unit closures, 2009–2019); American Hospital Association hospital closure tracking; American Medical Association, 2025 maternity care deserts analysis.
Questions people ask about this
Do the new Medicaid work rules apply to me in Iowa?
How many hours a month do I have to work?
Who is exempt from the work requirement in Iowa?
When do the Iowa work rules start?
What is the income limit for Iowa Medicaid?
How do I apply for Iowa Health and Wellness Plan (IHAWP)?
How often do I have to renew Iowa Medicaid?
Guides for neighboring states
The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.
Iowa is starting its new Medicaid work rule a month ahead of the rest of the country.
From December 1, 2026, anyone applying for the Iowa Health and Wellness Plan must show 80 hours a month of work, school, job training, or community service — or at least $580 in monthly earnings — unless an exclusion applies, such as being pregnant, caring for a child under 14, or being medically frail. If you are already on IHAWP, the check reaches you at your renewal if it is scheduled for February 2027 or later, and from January 2027 those renewals come every six months instead of once a year. The single most useful thing to do today is make sure Iowa HHS has your current address, phone number, and email — through the Self-Service Portal at hhsservices.iowa.gov, or by calling the Income Maintenance Customer Service Center at 1-877-347-5678 — so a renewal notice or a request to prove your hours does not go to an old address.
Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.
Go to Apply on the Iowa HHS Self-Service Portal →