Iowa Medicaid work requirement

Iowa Health and Wellness Plan (IHAWP) expansion adults ages 19–64 who are not otherwise exempt. New applicants face the requirement starting December 1, 2026; existing members are first reviewed at renewals on or after February 2027.

• Work 80+ hours/month (paid or unpaid, including self-employment or work for goods/services)
• Community service / volunteering at a public or non-profit organization — 80+ hours/month
• Participation in an approved job training or workforce program — 80+ hours/month
• Enrollment in an educational program at least half-time (high school, GED, community college, vocational, or four-year college)
• Any combination of the above totaling 80+ hours/month
• Income ≥ $580/month (federal minimum wage × 80 hours) — regardless of hours tracked; seasonal workers may average $580/month over the prior 6 months

• Pregnant or less than 12 months postpartum (regardless of pregnancy outcome)
• Primary caregiver of a child 13 years old or younger
• Primary caregiver of a disabled individual
• Medically frail or living with a disability that significantly limits ability to work
• American Indian / Alaska Native (AI/AN)
• Former foster youth who aged out of foster care
• Veteran with total disability rating (VA)
• Household receiving TANF where work rules already apply
• Household receiving SNAP where SNAP work rules already apply
• Enrolled in or recently completed a substance use disorder (SUD) treatment program
• Currently incarcerated or released from incarceration within the prior 3 months

Caring for a child 13 or younger, or for a person with a disability, is usually an exemption. Caregiving hours are not counted toward the 80 hours.

Your state will first check its own records and data sources. If it cannot verify compliance or an exemption, it will send you a notice requesting documentation at application or renewal. Keep records of pay stubs, volunteer hour logs, school enrollment letters, training confirmations, and medical or legal documents supporting an exemption. Respond to any notices by the deadline stated. If the state can't confirm you met the rule, it must send you a notice first. You then have 30 days from when you get the notice to show that you met the rule, or that you have an exemption or don't have to meet it. If you already have Medicaid, it keeps going while the state decides.

• If applying for Iowa Medicaid on or after December 1, 2026, you must demonstrate compliance in the prior month
• Existing members: watch for renewal notices beginning February 2027
• Visit hhs.iowa.gov/medicaid/plans-programs/iowa-health-wellness-plan/ihawp-community-engagement-requirements for official guidance
• Keep your contact information current with Iowa HHS (1-800-338-8366)
• Report life changes (pregnancy, disability, household changes) to Iowa HHS promptly

• IHAWP Community Engagement Requirements
• Iowa HHS Medicaid

Sources: Iowa HHS (hhs.iowa.gov). CMS IFC CMS-2454-IFC.

Last checked September 2026.