Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · Iowa

Medicaid work requirements in Iowa: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

Iowa expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 167,800 of them (9.1% of an expansion pool of 179,380) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 74,381 people in Iowa lose coverage by 2034: 69,347 of them still eligible but lost to paperwork and reporting failures, and 5,034 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Iowa scores 56 of 100 on this model's ex parte capability index, a mid band; its eligibility system is ABE.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureIowa
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)179,380
Adults subject, strict definition167,800
Adults subject, permissive definition164,444
Share of expansion pool subject9.1%
Projected coverage loss by 203474,381
Hardship exception statusNot adopting
Early implementer2026-12-01
Ex parte capability score (0 to 100)56 (mid)

Who is subject in Iowa

Of the 167,799 subject adults, 44% already work 80 or more hours a month and 46% are not working. 36% have a child under 14 at home. Among those not working, 55% report a disability and 15% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2415%
Age 25-3423%
Age 35-4422%
Age 45-5417%
Age 55-6423%
Not working46%
1 to 19 hours a month1%
20 to 79 hours a month8%
80 or more hours a month (meets the bar)44%
Not working: Disabled55%
Not working: Caregiver15%
Not working: Postpartum0%
Not working: Student2%
Not working: Other28%

Why eligible people lose coverage

Of the 74,381 projected to lose coverage in Iowa, 69,347 meet the requirement or qualify for an exemption but fail to document it. 29,376 of those are working people who cannot prove their hours through data the state can see, and 39,971 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Variable shifts / on-call work7,773
Multiple part-time jobs (aggregation failure)6,912
Self-employed (other)6,648
Full-time students not auto-verified2,213
Cash-paid construction & trades2,006
Volunteering / job training1,857
Seasonal: agriculture, hospitality, food service1,127
Gig / courier (DoorDash, Uber, Lyft, Instacart)841
Medically frail without auto-match15,823
Parent caregivers of children ≤13 without auto-match9,118
Caregivers of a disabled adult5,403
SUD treatment not flagged in claims data3,093
American Indian / Alaska Native (tribal exemption)2,418
Kinship caregivers (non-parent) of children ≤131,801
Recent incarceration (data-match gap)1,336
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)866
Pregnancy / postpartum data lag113

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (59% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Iowa's composite score is 56 (mid band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite56
Observed ex parte59
Core capability43
Data sources55
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four50,51530.1%
Working ≥ qualifying hours / income32,34019.3%
Working ≥ qualifying hours / income + Parent caregiver of child ≤1331,91019.0%
Medically frail25,52515.2%
Parent caregiver of child ≤1310,1736.1%
Full-time student5,2043.1%
Working ≥ qualifying hours / income + Full-time student4,6682.8%
Working ≥ qualifying hours / income + Medically frail2,8211.7%

Counties in Iowa

Subject adults concentrate: Polk County (22,916), Linn County (11,481), and Johnson County (8,910) account for 26% of the state's subject population.

All 99 counties in Iowa with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
Polk County22,9167.5%10,15810.0%304,303
Linn County11,4818.5%5,0899.0%135,489
Johnson County8,9108.8%3,95017.0%101,080
Scott County8,5938.5%3,80912.0%101,459
Story County7,44711.4%3,30120.0%65,572
Black Hawk County7,1419.3%3,16516.0%76,833
Woodbury County5,3818.9%2,38514.0%60,371
Dubuque County5,2339.3%2,32010.0%56,104
Pottawattamie County4,7799.0%2,11811.0%53,156
Dallas County4,7737.4%2,1166.0%64,386
Warren County2,7098.7%1,2016.0%31,238
Clinton County2,3649.2%1,04812.0%25,804
Cerro Gordo County2,2669.7%1,0059.0%23,275
Muscatine County2,2389.3%99212.0%24,174
Webster County2,0339.7%90112.0%20,914
Sioux County2,03010.3%9006.0%19,714
Marshall County1,9969.0%88511.0%22,112
Des Moines County1,9949.3%88415.0%21,338
Jasper County1,8968.8%8409.0%21,656
Marion County1,8459.8%8188.0%18,806
Wapello County1,7688.9%78417.0%19,966
Lee County1,6979.3%75213.0%18,302
Boone County1,4839.6%6577.0%15,502
Bremer County1,3809.8%6127.0%14,061
Plymouth County1,3689.8%6066.0%13,964
Benton County1,3609.4%6038.0%14,466
Winneshiek County1,26111.4%5599.0%11,054
Mahaska County1,22810.0%54412.0%12,269
Washington County1,1939.7%5297.0%12,260
Buena Vista County1,16310.1%5167.0%11,562
Buchanan County1,0879.6%4829.0%11,363
Henry County1,0769.3%47711.0%11,514
Poweshiek County1,07410.3%47611.0%10,469
Carroll County1,0689.7%4738.0%11,010
Jones County1,0678.9%47311.0%12,006
Fayette County1,06610.2%47312.0%10,475
Jackson County1,0549.9%46710.0%10,610
Dickinson County1,02610.9%4556.0%9,397
Delaware County99610.5%4417.0%9,504
Clayton County97610.9%43313.0%8,909
Cedar County9459.1%4198.0%10,414
Tama County92710.1%41115.0%9,144
Jefferson County91410.5%40514.0%8,664
Crawford County91410.1%40517.0%9,026
Madison County9009.5%3996.0%9,474
Hardin County8949.6%3968.0%9,298
Clay County88910.1%39411.0%8,817
Floyd County86510.6%38311.0%8,143
Iowa County8619.4%3829.0%9,149
Kossuth County83411.1%37010.0%7,496
Hamilton County80710.0%3588.0%8,052
Allamakee County78510.8%34812.0%7,258
Harrison County7799.5%3458.0%8,160
Butler County76310.0%33812.0%7,636
Page County7619.0%33713.0%8,453
Mills County7419.0%3287.0%8,206
O'Brien County7379.8%32712.0%7,556
Wright County69910.8%31014.0%6,509
Chickasaw County68511.0%3046.0%6,254
Cass County6739.8%29815.0%6,875
Lyon County66310.6%2944.0%6,268
Appanoose County66210.1%29417.0%6,540
Union County66010.0%29312.0%6,622
Grundy County6389.4%2836.0%6,754
Shelby County63210.2%2809.0%6,192
Cherokee County61710.3%27413.0%6,016
Hancock County61710.7%27410.0%5,784
Emmet County59311.8%26313.0%5,014
Guthrie County59310.3%26310.0%5,726
Keokuk County58510.9%25912.0%5,374
Winnebago County58310.0%2598.0%5,854
Mitchell County57010.1%2537.0%5,673
Louisa County5639.3%25010.0%6,067
Montgomery County55010.1%24414.0%5,460
Sac County54610.6%2429.0%5,158
Franklin County54010.3%23914.0%5,266
Clarke County53110.4%23517.0%5,117
Calhoun County5179.8%2299.0%5,260
Howard County50310.1%2239.0%4,986
Greene County49110.7%21712.0%4,589
Humboldt County4839.4%21413.0%5,136
Decatur County48011.5%21314.0%4,190
Palo Alto County48010.2%21311.0%4,735
Davis County47710.3%2129.0%4,658
Lucas County46910.0%20817.0%4,683
Monona County45210.1%20112.0%4,460
Van Buren County42211.3%18711.0%3,736
Worth County41810.1%1857.0%4,120
Adair County40710.2%18110.0%4,001
Pocahontas County39310.8%1749.0%3,642
Ida County37710.4%16712.0%3,608
Wayne County37511.3%16613.0%3,304
Monroe County3738.9%16511.0%4,176
Fremont County35910.3%1598.0%3,494
Osceola County35110.8%15513.0%3,242
Taylor County3079.8%1369.0%3,131
Audubon County2889.8%12812.0%2,932
Ringgold County25310.4%1128.0%2,440
Adams County19310.1%859.0%1,908

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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