Program Integrity and Work Requirements

An excerpt from Growing Iowa's Economy - A Blueprint for Free-Market Solutions

In Iowa, Medicaid is not only one of the most significant drivers of the budget but also one of the fastest growing. Medicaid is a shared expense between states and the federal government, but recent policies on the national level, especially the Patient Protection and Affordable Care Act, have led to an expansion in recipients.

Iowa needs to audit its Medicaid program to ensure Iowans who truly need the services are protected and have access to funds, as well as confirm that taxpayer dollars are not needlessly spent on those who don’t actually qualify. Several states have conducted audits of their respective Medicaid programs, and the results confirm that abuse is occurring within their systems. Some audit findings from those states include:

  • Michigan identified more than 7,000 lottery winners who were still collecting welfare, some with jackpots as high as $4 million.
  • Illinois uncovered more than 14,000 dead enrollees on Medicaid.
  • Utah and Maine found that individuals were using their welfare benefits exclusively out-of-state.
  • Arkansas discovered more than 20,000 individuals with high-risk identities, including people using stolen identities or even fake Social Security numbers, who were enrolled in its program.
  • Louisiana’s legislative auditor made a random selection of 100 Medicaid recipients and determined that 82 of those individuals were not qualified to receive the level of benefits they were being given.


Two additional states have found savings eclipsing $100 million in their Medicaid systems. In March of 2019, Oregon announced that a Medicaid audit would save the state over $100 million annually by ending improper payments to people who didn’t qualify for the program. The North Carolina State Auditor reported that the Department of Health and Human Services improperly paid more than $100 million in Medicaid claims, which included overpayments to providers and benefits to ineligible recipients.

Other social support programs beyond Medicaid, including food stamps (SNAP), should receive greater scrutiny through verification requirements to ensure only the people who truly qualify for support are receiving government assistance.

Iowa should also consider work requirements. Those who are on Medicaid and who can work should be required to do so. Intelligently-crafted work requirements have led many people out of poverty and back into the workforce, breaking the cycle of government dependency.

Enhanced program integrity and work requirements for those who are able can combine to make a real difference in the financial futures of many, while also supplying Iowa with a larger labor force.