CEO: Medicaid work requirements will hurt Iowa healthcare

Some of the 702,857 low-income Iowans who rely on Medicaid for their health insurance will need to meet new work requirements starting Dec. 1, and they also must have their eligibility for that subsidized insurance renewed every six months.

Of that number on Medicaid, 641,726 are adults who now face the work requirement. The remainder are children covered by the HAWK-i program.

The work requirement will not apply to anyone who is pregnant or who is taking care of children younger than age 14. Also excluded are people in a rehab program or in other specific categories.

All the other adults on Medicaid must prove to the state that they worked in the past month, were enrolled in an education program or volunteered 80 hours a month.

Additionally, people on Medicaid will have to recertify their eligibility every six months. Recertifications will begin on Jan. 1, and some enrollees already are getting recertification packets in the mail.

Iowa Gov. Kim Reynolds and other proponents say the work requirement will ensure those using Medicaid will be those who need it, while critics say it doesn’t account for the complex reasons why some people are unemployed.

Medicaid is the government’s healthcare program for people with low incomes or disabilities. To qualify for Medicaid, individuals can make up to 133% of the federal poverty level — which is $20,815 for an individual and $35,445 for a family of three.

An analysis by KFF, a healthcare policy organization, estimated the work requirements will save the federal government $326 billion over the next decade, but that it also will lead to 53 million fewer people on Medicaid.

KFF also reported that three-fourths of adult Iowans on Medicaid already work.

In another analysis, roughly 32,000 Iowans could lose their Medicaid coverage because of the work requirements, according to Iowa’s nonpartisan Legislative Services Agency .

The Gazette talked to Joe Lock, president and CEO of the Eastern Iowa Health Center in Cedar Rapids, about how the upcoming changes will affect people, the clinic and its patients. The clinic is a federally qualified health center, a safety net clinic primarily funded by Medicare and Medicaid payments. Lock’s comments have been edited for length and clarity.

Q: How do people apply for and keep their Medicaid coverage?

A: It’s relatively easy to get on Medicaid in Iowa as long as you have documentation of your income.

As of Jan. 1, people have to recertify twice a year, so every six months, in order to remain current.

Why that is difficult is because during the three-and-a-half or four years of the public health emergency nationally (during COVID-19), you didn’t have to requalify for Medicaid at all.

When someone is sent a letter from Iowa HHS that says, “Hey, it’s time for you to do your biannual certification,” it just says Iowa HHS, it doesn’t say Medicaid, it comes from Council Bluffs, Iowa, a packet of 14 pages, which includes a voter registration form, which is really odd in my opinion.

In other words, it looks like junk mail.

And if you can’t pay your bills to begin with, you’re not really eager to open the mail every day.

Q: How might that change once these new work requirements take effect?

A: The interesting thing is that the Medicaid work requirements will begin in effect Dec. 1 (this year), not Jan. 1, 2027.

They’d have to be verified by an employer or a nonprofit that, yes, these people really are here, they really are volunteering, that kind of thing — some kind of a (statement) that would have to be made by the organization that is enabling that person to volunteer.

Q: Are these new guidelines being clearly communicated to the people they’ll impact?

I think that there’s an attempt by Iowa Medicaid to communicate with everybody that is eligible for Medicaid in Iowa. The question is, are (those people) opening their mail?

Q: How do you anticipate this change will affect the healthcare system in Iowa?

A: In my opinion, this legislation is not going to benefit anyone because there’s been allegations of fraud, waste and abuse in the Medicaid system, but there’s been nothing that states that definitively.

In fact, the people that I’m worried about the most are critical-access hospitals and even major hospital systems, not unlike Mercy and UnityPoint here in town.

Because, let’s say that someone’s homeless and they have a headache, so they call 911. Well, it’s an $800 ambulance ride, it’s $1,200, on average, uncompensated care visit that the hospitals will have to incorporate or take care of, and then that person with the headache may be given by the emergency department doctor Tylenol for their headache, and then they may request an ambulance ride back to wherever their home is, even if their home is in a park.

And so I expect the amount of uncompensated care for hospital emergency departments to dramatically increase.

Q: How do you anticipate the work requirements will affect the Eastern Iowa Health Center?

A: A lot of our patients … make a little too much money to qualify for Medicaid, and so they go on our sliding fee discount program. And so the 200 who visit that would normally cost $160, they might pay $18 for that. But for that current 14% of our patients who are on the sliding scale, we never see that $18. They just don’t have the money.

So we’re going to end up just like the hospital emergency departments. We’re going to end up writing that money off.

‘We have been preparing for war in time of peace.’ — Joe Lock, Eastern Iowa Health Center

Q: How has Eastern Iowa Health Center been preparing for these changes?

A: We have been preparing for war in time of peace.

We opened a pharmacy, opened walk-in care, opened optometry, doubling the amount of pediatrics that we’ll see starting in January, doubling the amount of people with mental health issues that need a therapist or a psychiatrist, and getting all that done and doubling in those areas before the end of the calendar year in order to help offset that $3 million loss that we’re projecting.

We are paying an outside firm upwards of $10,000 a month to help us determine when those patients’ six-month recertification eligibility is going to happen. They’re going to be calling, emailing, phoning, texting with that patient.

In other words, we’re doing everything we can try to have them retain their benefits, for two reasons.

One is because it’s going to make a positive impact to overall population health to keep them where they can go see the doctor or the dentist or a therapist or whatever, and, very self-servingly, that we continue to get paid by Medicaid, which is by far our best payer.

In other words, it’s in the benefit of everybody that utilizes Medicaid for insurance, but it also benefits us and keeps us in business.

Q: What are the implications of this change for people who aren’t on Medicaid?

A: Once the Obamacare subsidies went away … so many people have chosen to go uninsured because they can’t afford an increase in premiums.

That’s why, again, we are worried about, just in our own operation, about that 14% of people that make too much money that are on our sliding fee scale — it’s going to go from 14% to 30%. This is a serious population health issue across the United States, not just here in Iowa.

People aren’t going to stop getting sick. It’s just that people are going to stop having coverage.

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