What You Need to Know About H.R. 1 and the Changes Coming to Iowa Medicaid
By My City My Health INC
Republished with permission from My City My Health INC.
Three years ago, a man experienced a devastating workplace accident involving anhydrous ammonia at a factory.
He described losing much of his lung function, suffering vision damage, and experiencing nerve complications that have changed nearly every aspect of his life.
During a community conversation in Des Moines on October 13, he shared that he now has approximately 31% lung capacity. Even something as simple as walking his dog can leave him struggling to catch his breath.
His doctors have told him he should not work.
For the past three years, he has been trying to obtain Social Security disability benefits. His initial application was denied, and he is now waiting for an appeal.
During that process, he said he had to exhaust approximately $5,000 in savings. A longtime friend has helped support him financially, including helping him keep his home.
Then he learned about upcoming Medicaid changes under H.R. 1.
He was concerned that maintaining his healthcare coverage might require him to work or volunteer 80 hours every month.
There was just one problem.
His doctors and disability attorneys had advised him against working because doing so could complicate his disability claim.
He was caught between two concerns: protecting the disability benefits he had spent years pursuing and maintaining the Medicaid coverage that pays for medications he needs to survive.
Some of those medications, he explained, are a matter of life or death.
He came to our community conversation hoping someone could help him understand what to do next.
And his question captured exactly why My City My Health wanted to bring this conversation into the community.
Because when we talk about legislation, federal spending, Medicaid eligibility, and administrative requirements, it can be easy to forget that there are real people on the other side of these decisions.
This was not a hypothetical situation.
This was someone’s life.
Why We Brought This Conversation to the Community
On October 13, My City My Health partnered with United Way of Central Iowa, the Polk County Health Department, and the Des Moines NAACP to host a community conversation at the Polk County Central Senior Center.
Our goal was simple.
Help community members understand the Medicaid changes associated with H.R. 1, how those changes may affect them, and where they can turn for help.
We weren’t trying to host a complicated policy seminar or provide an exhaustive explanation of federal legislation.
We wanted people to walk into a room, ask questions, hear from individuals who understand these systems, and leave knowing what they could do next.
The discussion featured:
Tyra Mays, a healthcare professional with more than 20 years of experience navigating Medicaid, Medicare, disability, and other assistance programs.
David Stone, Advocacy Officer at United Way of Central Iowa, who works on policy issues including public assistance, housing, childcare, and food security.
Michael Berger, Community Impact Officer at United Way of Central Iowa, whose work includes connecting community members with resources that support health, well-being, and essential needs.
Representatives of the Polk County Health Department and other community organizations contributed information and resources throughout the evening.
The conversation covered Medicaid work and community engagement requirements, exemptions, disability, immigration status, coverage renewals, and resources for people at risk of losing healthcare coverage.
It also highlighted how much uncertainty remains as the state prepares to implement these changes.
Below are the major takeaways from the discussion, along with clarification from current Iowa and federal guidance.
First, What Is H.R. 1?
H.R. 1 is the federal legislation commonly referred to as the “One Big Beautiful Bill.”
Among its many provisions are changes to Medicaid eligibility, reporting requirements, and federal funding.
For people enrolled in certain Medicaid programs, these changes may create new steps they must complete to obtain or maintain their health insurance.
One important distinction discussed during the forum is that Medicaid and Medicare are not the same program.
Medicaid provides healthcare coverage to eligible individuals and families, including many people with limited income, disabilities, and other qualifying circumstances.
Medicare primarily covers people age 65 and older, as well as certain younger people who qualify because of disabilities or specific medical conditions.
The new community engagement requirements discussed at our forum primarily concern certain adults enrolled in Iowa’s Medicaid expansion program, known as the Iowa Health and Wellness Plan.
Not everyone enrolled in Medicaid will have to meet these requirements.
Understanding which program you are enrolled in is one of the first steps toward knowing whether these changes may affect you.
1. New Medicaid Work and Community Engagement Requirements Are Coming
One of the most discussed provisions of H.R. 1 involves new community engagement requirements.
For certain adults ages 19 through 64 enrolled in the Iowa Health and Wellness Plan, Medicaid eligibility will depend in part on demonstrating qualifying work, educational, training, or community service activities.
The general requirement is 80 hours per month.
According to current Iowa HHS guidance, qualifying activities include:
Paid employment totaling at least 80 hours per month, or earnings of at least $580 per month.
Qualifying unpaid or in-kind work, including work performed in exchange for goods or services.
Volunteer work or community service through qualifying programs.
Participation in approved job training or employment programs.
Enrollment in qualifying educational programs, with at least half-time enrollment generally satisfying the education requirement.
A combination of eligible activities that totals 80 hours.
For example, someone who works 50 hours in a month may be able to combine those hours with 30 hours of qualifying volunteer work.
Someone enrolled at least half-time in an eligible college, vocational, or technical program may meet the requirement through education.
For seasonal workers, Iowa HHS also describes options for averaging income over six months.
The distinction between hours and income matters. During the forum, much of the discussion focused on completing 80 hours, but current state guidance also recognizes earning at least $580 per month through work as a way to satisfy that portion of the requirement.
These details matter for people whose work schedules fluctuate or who earn more than minimum wage.
When will these requirements begin?
The timeline is not the same for everyone.
Under Iowa HHS guidance available as of October 15, 2026:
December 1, 2026: Community engagement requirements begin for new Iowa Health and Wellness Plan applicants applying on or after that date.
February 2027 and beyond: Current Iowa Health and Wellness Plan members begin encountering these requirements at renewals scheduled on or after February 2027.
New applicants generally must demonstrate compliance for the month immediately before applying.
Current members generally must demonstrate compliance for at least two months during the period since their last eligibility determination or renewal, unless they qualify for an exclusion.
This is an important clarification from our community discussion, where speakers were still working through the state’s implementation timeline.
The requirements are described as monthly, but the specific months reviewed and when documentation must be submitted depend on the person’s application or renewal circumstances.
The best step is to confirm your renewal date with Iowa HHS and begin maintaining records of qualifying activities now.
2. You May Qualify for an Exemption, but You May Still Need Documentation
One of the most important parts of the discussion involved individuals who may not be required to meet the new community engagement requirements.
These exclusions are especially important for people living with disabilities, chronic health conditions, or caregiving responsibilities.
Under federal and Iowa guidance, categories of people who may qualify for exclusions include:
Individuals younger than 19 or older than 64.
People who are pregnant or have given birth within the previous 12 months.
Parents, guardians, or caregivers of children younger than 14.
People caring for someone with a disability.
Individuals who are medically frail or have special medical needs.
People with certain physical, intellectual, or developmental disabilities.
Individuals with functional limitations that interfere with daily living activities.
People with serious mental health conditions or substance use disorders.
Individuals participating in qualifying substance use treatment or recovery programs.
People who are blind.
Veterans with a total disability rating from the Department of Veterans Affairs.
Certain individuals recently released from incarceration.
Eligible current or former foster youth younger than 26.
American Indians and Alaska Natives covered by the applicable exclusions.
People who already satisfy certain SNAP or Family Investment Program work requirements.
Individuals enrolled in or qualifying for Medicare.
The exact rules and documentation requirements vary by category.
One point panelists emphasized was that people should not assume that having a qualifying condition automatically means no further action is required.
Iowa HHS may need documentation to confirm an exclusion, although the agency also says it will check information already available in its records.
For people with medical conditions, that may mean working with a healthcare provider to document their condition and functional limitations.
Why the medical exemption discussion mattered so much
This brings us back to the gentleman who shared his experience.
As he explained his situation, our panelists discussed the possibility of using a medically exempt attestation and documentation from his healthcare provider.
That gave him a potential path forward that did not require immediately choosing between his disability appeal and his Medicaid coverage.
The panel encouraged him to work with his doctor, document his medical limitations, and seek confirmation that he qualifies for the appropriate exclusion.
It was not a guarantee that his case would be approved.
It was a specific next step he could take to seek protection for his coverage.
There is an important distinction between a pending Social Security disability claim and Medicaid’s eligibility and medical-exclusion processes. They are separate determinations, with different rules.
Anyone in a similar situation should speak with their healthcare provider, Iowa HHS, and their disability representative before making decisions about employment or volunteer activities that could affect their benefits.
For this gentleman, the value of the conversation was not that every question had been answered.
It was that he finally had a direction to pursue.
3. Losing Medicaid May Be About Paperwork, Not Just Eligibility
A recurring concern during the discussion was that people may lose health coverage because of administrative barriers.
David Stone discussed what happened when Arkansas previously implemented Medicaid work-reporting requirements.
He emphasized that losing coverage does not always mean someone was unwilling to work or failed to qualify for assistance.
Sometimes, the problem is demonstrating eligibility through a complicated reporting system.
A person might be working the required hours but fail to submit appropriate documentation.
Someone might qualify for an exclusion but not know that they need to provide proof.
Others might miss a letter, misunderstand a deadline, or struggle to use an online reporting system.
These situations become especially concerning when someone needs uninterrupted access to medications or treatment for an ongoing health condition.
As one panelist pointed out, people need prescriptions and medical appointments when they need them, not months later after an administrative issue has been resolved.
What should Medicaid members do now?
Our panelists offered several practical recommendations.
Make sure Iowa HHS has your current mailing address, phone number, and email address.
Open and read all mail from Iowa HHS. Do not assume every important notice will come from your managed care organization.
Check your email, including spam or junk folders, for official notices.
Find out exactly which Medicaid program you are enrolled in and when your next renewal is due.
Begin saving records of work, volunteer service, education, and job training if the requirements may apply to you.
Keep copies of pay stubs, letters from employers, volunteer logs, attendance records, and other relevant documents.
If you believe you qualify for a medical or other exclusion, gather relevant documentation and confirm with Iowa HHS what is required.
Respond to requests for information by the deadline and keep a record of anything you submit.
If you submit paperwork, confirm that it has been received and processed.
Ask for help before a deadline passes if you do not understand a notice.
Iowa HHS says it will check existing records first and contact members when additional documentation is needed.
The state has also published information about submitting requested documentation through available online, email, fax, and local office channels.
The message from the panel was consistent: preparation now may help prevent unnecessary gaps in coverage later.
4. Medicaid Renewals Will Become More Frequent
Another major change discussed was the frequency of Medicaid eligibility reviews.
Beginning January 1, 2027, Iowa Health and Wellness Plan eligibility reviews are scheduled to occur every six months rather than once annually.
This means people covered under that program will have to pay attention to renewal notices more frequently.
More frequent reviews can create additional opportunities for missed notices, missing documentation, or interruptions in coverage.
Imagine someone who moves to a new apartment and forgets to update their mailing address.
If a renewal notice goes to their previous residence and they fail to respond, they could encounter a coverage problem even if they otherwise qualify.
The same issue can affect someone who changes phone numbers, has inconsistent internet access, or struggles to understand mailed instructions.
What happens if your Medicaid is denied or discontinued?
The panel discussed situations in which an individual receives a request for information, a denial notice, or a renewal decision.
Tyra Mays emphasized the importance of identifying what type of notice someone has received and contacting the caseworker or team listed on it.
She also explained that people have opportunities to challenge certain determinations through appeal processes.
Different deadlines may apply depending on the action taken and the individual’s circumstances.
The most important recommendation is not to assume that every denial or renewal has the same response period.
Read the specific notice, identify its deadline, and seek assistance immediately.
If you disagree with a decision or believe your paperwork was processed incorrectly, ask about your appeal rights.
If you lose coverage, Iowa HHS says you can apply again. But applying again does not guarantee immediate approval or prevent a gap in care.
That is why responding early is so important.
5. Refugees and Other Humanitarian Immigrants Are Already Experiencing Changes
Not all Medicaid changes are still in the future.
Beginning October 1, 2026, federal eligibility changes affected some refugees and other humanitarian immigrants who had previously qualified for full Medicaid coverage.
During our forum, several attendees expressed concern about how these changes are affecting refugee families in Central Iowa.
One attendee shared that they sponsor a Ukrainian family and were concerned about what healthcare options would remain available after the adults in that family lost coverage.
The discussion highlighted how confusing these changes can become for families navigating both healthcare and immigration systems.
Under current Iowa HHS guidance, affected groups may include refugees, asylees, certain humanitarian parolees, and other qualifying humanitarian immigration categories who have not obtained lawful permanent residency.
There are exceptions and important differences between immigration categories.
Some people who have obtained a green card may remain eligible. Iowa also continues to provide certain Medicaid eligibility options for lawfully present children.
This means that different members of the same household may have different eligibility outcomes.
A child may qualify for coverage even when a parent does not.
That distinction is especially important for families trying to understand whether everyone in their household is losing benefits.
What about pregnant women?
One attendee asked what happens when a pregnant woman loses Medicaid eligibility because of her immigration status.
This raised concerns about access to prenatal appointments, ongoing monitoring, and treatment before delivery.
The panel discussed emergency Medicaid, financial assistance programs, federally qualified health centers, and other safety-net healthcare options.
Emergency Medicaid may help pay for certain qualifying emergency medical services, but it is not a replacement for full health insurance or routine prenatal care.
Eligibility for pregnancy-related and emergency services depends on the person’s individual circumstances and applicable program rules.
Community organizations encouraged individuals to work with healthcare providers and qualified navigators to determine what services may still be available.
For refugee and immigrant families, connecting with trusted organizations that understand both immigration and health coverage rules is especially important.
6. If You Lose Medicaid, You May Still Have Healthcare Options
One of the most important messages shared during the evening was that losing health insurance does not mean people should stop seeking medical care.
Healthcare and health insurance are connected, but they are not the same thing.
Our panel identified several resources people can explore if they are uninsured or at risk of losing coverage.
Federally Qualified Health Centers
Federally Qualified Health Centers, often called FQHCs, provide primary and other healthcare services to underserved communities.
They offer sliding-fee discounts based on income and family size for eligible patients.
In the Des Moines area, Primary Health Care, Inc. is one resource for individuals and families seeking medical, dental, behavioral health, and related services.
These centers can help people continue receiving important care when they do not have traditional health insurance.
Broadlawns Medical Center
Broadlawns offers financial counseling and assistance programs for eligible patients.
Its financial counselors can help individuals understand Medicaid applications, renewal requirements, and other potential sources of healthcare coverage or financial assistance.
People with limited income or no insurance can ask about available programs and whether they qualify.
Broadlawns Financial Counseling can be reached at 515-282-2246.
Free and charitable clinics
Community members may also be able to receive services through free or low-cost clinics.
Availability, services, appointment requirements, and eligibility vary by organization.
These clinics may provide an important option for individuals who cannot afford traditional healthcare services.
Membership-based healthcare
Exemplar Care was discussed as another option for people exploring alternatives to traditional insurance.
The organization offers membership-based healthcare services for a monthly fee.
It is important to understand that membership-based primary care is not the same as comprehensive health insurance. Individuals should confirm which services, prescriptions, specialty treatments, and hospital-related expenses are included or excluded.
Hospital and health system financial assistance
Hospitals and health systems may offer financial assistance or payment support to qualifying patients.
If you are concerned about paying for healthcare, ask to speak with a financial counselor or patient navigator.
For people who require ongoing prescriptions or specialty care, it is important to discuss potential coverage gaps with their medical team before treatment is interrupted.
The larger point is that people should not have to figure out these systems alone.
7. When You Don’t Know Where to Turn, Start With 211
During the conversation, Michael Berger and David Stone highlighted one of the most accessible community resources available: 211.
United Way’s 211 service connects people with information about resources and assistance programs.
That includes help related to:
Healthcare and health-related needs
Food assistance
Housing and rental assistance
Utility support
Transportation
Childcare
Employment and training
Other essential community services
People in Iowa can dial 211 or visit 211iowa.org.
They can also text their ZIP code to 898211 to connect with the service.
211 is available around the clock and offers access to language interpretation.
The resource itself does not guarantee that assistance will be available for every need. But it can help people identify organizations and programs they may not know exist.
That matters when someone has already spent hours calling different offices without getting an answer.
Knowing where to start can make a difference.
8. Community Organizations Have a Role in Helping People Navigate These Changes
Toward the end of the forum, one attendee raised a question that I believe deserves more attention.
Many of the people in attendance represented organizations that serve individuals who may be affected by these changes.
The attendee wanted to know where organizations could get accurate information they could share with community members.
Could they print something?
Could they take information to their church?
Could they share it with friends, neighbors, or family members?
It was a great question.
And it highlighted a larger challenge.
Information about Medicaid implementation is changing, sometimes quickly. Printed materials can become outdated as new guidance is released.
Representatives from the Polk County Health Department explained that their approach is to maintain an updated online resource page that organizations can continue referring people to.
This provides one place to check as information develops.
Community partners can help by directing people to official information, explaining notices, and connecting residents with qualified professionals.
Authorized representatives can also help
Another important point discussed was the option to appoint an authorized representative.
For some people, navigating Medicaid paperwork independently can be difficult.
An authorized representative may be permitted to receive information, communicate with Iowa HHS, or help with certain eligibility-related tasks on someone’s behalf, depending on the authorization.
That can be useful for individuals who face language barriers, disabilities, limited technology access, or other challenges.
It can also be valuable for trusted caregivers and organizations assisting community members.
The panel encouraged people who need this type of assistance to ask Iowa HHS about the appropriate authorization process.
What organizations can do now
For churches, nonprofits, social service agencies, healthcare organizations, and community groups, there are several practical ways to help.
Share official Iowa HHS and Polk County Health Department resources.
Remind people to update their contact information.
Encourage community members to read and respond to Medicaid notices.
Help individuals locate appropriate navigators and financial counselors.
Connect people with medical providers when documentation may be necessary.
Help families locate food, housing, transportation, and other resources when health coverage is disrupted.
Share information in languages and formats community members can use.
Consider organizing future enrollment, renewal, or resource-navigation events.
These steps may sound simple, but they can help someone avoid a preventable coverage problem.
The challenge is making sure people receive this information before they are in crisis.
9. We Still Don’t Have Every Answer
One of the most consistent themes throughout the conversation was uncertainty.
Participants repeatedly asked how the reporting process would work, which forms would be required, what people would need to submit, and what would happen if an online system did not recognize their information.
Panelists acknowledged that they did not have every answer.
And that is an important part of this discussion.
Public policies are often discussed as though passing legislation is the final step.
It isn’t.
After a law passes, agencies still have to develop procedures, update technology, communicate requirements, train staff, and help people understand what they need to do.
Those steps determine how policies affect people in everyday life.
Since the forum, Iowa HHS has published information describing qualifying activities, documentation requirements, and its reporting process.
The state says it will review available records and contact members when additional proof is needed.
But questions about individual eligibility, exemptions, specific documentation, and coverage changes still require direct follow-up with Iowa HHS.
That is why we cannot treat one community conversation, one flyer, or one article as the final word.
Information needs to be updated, explained, and shared as implementation continues.
Where to Find Help and Stay Informed
If you or someone you know may be affected by these Medicaid changes, the following resources are places to start.
Resources
Iowa HHS Community Engagement Requirements
Details about qualifying work, education, volunteering, exclusions, and implementation dates.
Iowa HHS Medicaid Eligibility
Information about Medicaid eligibility, including changes affecting refugees and other noncitizen groups.
Iowa HHS Benefits Portal
Use the portal to review benefits-related information and access available self-service options.
Iowa HHS Eligibility and Case Questions
Phone: 1-877-347-5678
Monday through Friday, 8 a.m. to 4:30 p.m.
Iowa Medicaid Member Services
Phone: 1-800-338-8366
Community resources
Polk County Health Department Medicaid Information and Upcoming Changes
Local information and resources for Medicaid members, refugees, providers, and community partners.
United Way 211 Iowa
Dial 211 or visit 211iowa.org.
Refugee Alliance of Central Iowa
Healthcare resources for refugee and immigrant communities.
Iowa Bureau of Refugee Services
Phone: 515-344-3675
Broadlawns Financial Counseling
Phone: 515-282-2246
Volunteer Iowa
Find opportunities for community service and volunteer activities.
People who have questions about whether a particular activity qualifies should confirm with Iowa HHS rather than assuming that all volunteer opportunities or unpaid activities will be accepted.
Why This Conversation Was Worth Having
We didn’t have a packed room on October 13.
And I’m okay with that.
From the beginning, I said that even if one person showed up, this conversation would be worth having.
Because the goal wasn’t attendance.
The goal was to connect people with information and resources that could make a difference in their lives.
And I keep coming back to the gentleman who shared his story.
He came into the room concerned about potentially losing the coverage that helps pay for his medications.
He was trying to navigate a disability appeal while facing uncertainty about another government program.
He had questions that even some of the professionals he had already contacted could not fully answer.
By the end of the conversation, he had a potential next step to discuss with his healthcare provider.
That doesn’t mean all of his problems are solved.
But it does mean he has more information than he walked in with.
And that matters.
I also think about the individuals working with refugee families, the community members who wanted resources to share with their neighbors, and the organizations trying to prepare for what is coming.
These are people who care about what happens to others.
They’re looking for ways to help.
That’s what community is supposed to look like.
We often talk about Medicaid in terms of eligibility, budgets, savings, and program spending.
Those discussions are important.
But they cannot be separated from the people who depend on these programs.
When someone loses access to a medication, misses a medical appointment, or has to choose between protecting a disability claim and maintaining healthcare coverage, those decisions have consequences beyond a spreadsheet.
They affect people’s lives.
My City My Health exists to create spaces where these conversations can happen, where community members can be heard, and where information can lead to action.
Our work doesn’t end because the forum is over.
We intend to continue sharing information as guidance develops and working with community partners to connect people with resources.
One Final Thought: Your Vote Matters
Before we ended our conversation, I reminded everyone in the room about one thing we can do right now.
Vote.
The Des Moines NAACP joined us with voter information and resources because decisions made by elected officials influence healthcare access, public assistance, and the systems our communities depend on.
And these decisions don’t simply exist on paper.
They show up in our neighborhoods, our hospitals, our families, and the lives of people like the gentleman who shared his story.
You don’t have to be a policy expert to participate.
Learn about the issues. Pay attention to what candidates are proposing. Ask questions about the policies that affect your community.
And make your voice heard at the ballot box.
Because the conversations we have today and the choices we make as voters help shape the systems we will live with tomorrow.
Our communities deserve to understand those decisions before their consequences arrive.
Important Disclaimer: Medicaid Information Is Changing
This article summarizes information shared during the My City My Health community conversation on October 13, 2026, along with publicly available Iowa and federal guidance reviewed on October 15, 2026.
H.R. 1 implementation is ongoing. Program rules, reporting processes, eligibility requirements, exemption documentation, administrative procedures, and timelines may change as state and federal agencies release additional guidance.
Some statements made during the community forum reflected the information available to participants at that time. Where more specific official guidance was available when this article was prepared, it has been incorporated into the article.
This article is intended for community education. It is not individualized legal, medical, immigration, or benefits eligibility advice.
If you receive Medicaid, believe you may qualify for an exclusion, are applying for disability benefits, or are concerned about losing coverage, contact Iowa Health and Human Services or a qualified professional who can review your individual circumstances.
For the most current information, regularly visit:
Please do not rely solely on social media posts or older printed materials when making decisions about your coverage.
If you receive a notice from Iowa HHS, review it promptly and follow the instructions and deadlines provided.
My City My Health will continue sharing information and resources as they become available.
If this article helped you understand what is changing, consider sharing it with someone who may need the information. That person might not know these changes are coming.
And helping one more person prepare is exactly why we started this conversation.
About My City My Health
My City My Health is a Des Moines community health nonprofit that creates spaces where community voice meets health awareness and action through conferences, community conversations, podcasts, and newsletters.
Follow their Substack for more plain-language health information, and tune in to their podcasts, My City Talks and The Community Resource, to keep the conversation going.
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