OBBBA (One Big Beautiful Bill Act) Medicaid Changes

Starting December 1, 2026, some Iowa Health and Wellness Plan (IHAWP) members will need to show that they are working, going to school, getting job training, or doing community service in order to keep Medicaid coverage.

If the requirement applies to you, you generally need to complete 80 hours each month through one or more of these activities:

• Work: Work at least 80 hours per month or earn at least $580 per month.
• School: Attend an eligible education program at least half-time.
• Job training: Participate in a qualifying job-training or work program for 80 hours per month.
• Community service: Complete 80 hours of qualifying volunteer/community service.
• Combination: Mix activities—for example, 40 hours of work + 40 hours of community service.

For more information, please visit the IHAWP Community Engagement Requirements website. 

Starting January 1, 2027, changes will be made to how retroactive Medicaid coverage is determined.

• Retroactive coverage will change from 3 months to 2 months for children, pregnant women, and people living in a facility.
• A 90-day reconsideration period will continue. If you return your review form within 90 days, your eligibility will be reconsidered without completing a new application.
• The review form will be treated as a new application. The date the review form is received will be used as the application date.
• Retroactive coverage will only be available to children, pregnant women, and people living in a facility.

6-Month Renewals

• Most IHAWP individuals will move from a 12‑month to a 6‑month renewal cycle. Alaska Native/American Indians will still be granted 12-month renewal period. 
  • Renewals: Goes into effect for renewals initiated January 1, 2027 and after, meaning Iowans with a March 2027 renewal and later.
  • Applications: Goes into effect for new applications received January 1, 2027 and after.

Person-Level Certifications 

• Certification periods will now be assigned at the individual level, based on each person’s eligibility effective date. You will no longer do renewals for an entire household at once; you will do them per person, based on their renewal date. 

Healthy Hometowns is Iowa’s submission to the Rural Health Transformation Program, a federal funding initiative managed by the Centers for Medicare and Medicaid Services (CMS). The bold and comprehensive proposal is aimed at building a high-quality, sustainable system of care that improves the health, well-being, and quality of life in rural communities across the state. If fully awarded, Iowa could receive $200 million per project year period (a total of $1 billion over the 5-year grant). In the first year, Iowa was award $209 million.

For more information, please visit the following website: Healthy Hometowns - Iowa's Rural Health Transformation Plan

Beginning October 1, 2026, Refugees and similar groups will lose Medicaid. New arrivals may instead receive up to twelve months of Refugee Medical Assistance, and emergency Medicaid will remain available for life‑threatening situations.

Children who are lawfully residing in the U.S. are still eligible for Presumptive Eligibility and ongoing Medicaid and Hawki. This includes refugee children or lawfully residing/U.S. Citizen children of a pregnant person who doesn’t qualify for Medicaid.

For more information, please visit the following website: https://hhs.iowa.gov/health-prevention/refugee-health 

Changes implemented October 1 impacting Presumptive Eligibility and ongoing Medicaid for pregnant women and Breast & Cervical Cancer Treatment (BCCT):

• Presumptive Eligibility Medicaid coverage now follows the same eligibility rules as ‘ongoing’ Medicaid.
• “Presumptive Eligibility Only” (PE only/short term) coverage for pregnant women and BCCT program who are not eligible for ongoing Medicaid is no longer available.
• Refugees who do not have Lawful Permanent Residency (green card) can no longer receive Presumptive Eligibility or ongoing Medicaid.
• Presumptive Eligibility and Ongoing Medicaid is still available for folks who meet eligibility criteria: U.S. Citizens, U.S. Nationals, Lawful Permanent Residents who have had qualifying immigration status for at least 5 years or meet criteria exceptions, certain Cuban/Haitian Entrants, Compacts of Free Association (COFA) migrants. A green card is required to verify lawful permanent resident status.
• Beginning January 1, the retroactive coverage period for pregnant women, children, and residents of a nursing facility will be two months.