The Iowa Health and Wellness Plan (IHAWP) is Iowa's Medicaid expansion program for adults ages 19 to 64, and in 2026 it covers people with household income up to about 138% of the federal poverty level, roughly $1,835 a month for a single adult or $3,795 a month for a family of four. Coverage is free for most members, though a small monthly contribution can apply in year two if you skip the required wellness exam. Starting December 1, 2026, most working-age members will also need to report at least 80 hours a month of work, job training, school, or volunteering to keep their coverage. Here is what actually qualifies you, what the plan covers, and how to apply.
What Is the Iowa Health and Wellness Plan?
IHAWP is Iowa's version of ACA Medicaid expansion. It replaced the state's earlier "IowaCare" program in 2014 and gives full Medicaid-style coverage to low-income adults who don't fit into other Medicaid categories, meaning they aren't pregnant, aren't 65 or older, and don't have a qualifying disability. Before expansion, most childless adults in Iowa had no path to Medicaid at all regardless of how little they earned. IHAWP closed that gap.
The plan is administered by Iowa HHS (Health and Human Services) and delivered through Iowa's Medicaid managed care organizations. Members get a card, choose a primary care provider, and access nearly the same benefit package as traditional Iowa Medicaid, with dental handled through a separate Dental Wellness Plan.
Iowa Health and Wellness Plan Income Limits 2026
IHAWP uses Modified Adjusted Gross Income (MAGI) rules. The stated eligibility threshold is 133% of the federal poverty level, but a standard 5% income disregard is applied during the actual determination, which raises the effective, working income limit to about 138% FPL for almost everyone who applies.
| Household Size | 133% FPL (Monthly) | Effective ~138% FPL (Monthly) | Effective ~138% FPL (Annual) |
|---|
| 1 | $1,769 | $1,835 | $22,025 |
| 2 | $2,398 | $2,489 | $29,863 |
| 3 | $3,028 | $3,142 | $37,702 |
| 4 | $3,658 | $3,795 | $45,540 |
| 5 | $4,287 | $4,448 | $53,378 |
| 6 | $4,917 | $5,101 | $61,217 |
| 7 | $5,546 | $5,755 | $69,055 |
| 8 | $6,176 | $6,408 | $76,894 |
Figures are based on the 2026 federal poverty guidelines and are approximate. For households above 8, add roughly $655 to the monthly 138% figure for each additional person. Iowa HHS updates these dollar thresholds each year, generally around April 1, so always confirm the current number on your application rather than relying on last year's chart.
Because IHAWP uses MAGI, most pre-tax deductions (retirement contributions, certain student loan interest, alimony paid under older agreements) reduce your countable income before it's compared to these limits. Child support received and most Supplemental Security Income (SSI) payments are not counted at all.
Who Qualifies for IHAWP
To qualify for the Iowa Health and Wellness Plan, you generally need to meet all of the following:
- Be age 19 through 64
- Be an Iowa resident
- Be a U.S. citizen or have an eligible immigration status
- Have household income at or below the limits above
- Not already be eligible for Medicare or another Medicaid category (such as pregnancy Medicaid, a disability-based category, or coverage as a child)
If you're pregnant, under 19, over 64, or have a qualifying disability, you'll likely be evaluated under a different Iowa Medicaid category with its own (often higher) income limit rather than IHAWP. Iowa HHS screens every application against all Medicaid categories automatically, so you don't need to guess which one applies to you before applying.
New 2026 Work Requirements (Community Engagement)
Iowa received federal approval to add a community engagement requirement to IHAWP, and it is being phased in during 2026. According to Iowa HHS, the requirement applies to new applicants starting December 1, 2026, and to existing members at their renewal beginning in February 2027 or later. Members should watch their mail and their online HHS account closely as these dates approach, since requirements have shifted before and Iowa has signaled interest in moving faster than the federal minimum timeline.
Once the requirement applies to you, you'll need to complete at least 80 hours a month of one or a combination of:
- Paid employment (or self-employment)
- Job training or job search activities
- Enrollment in school at least half-time
- Community service or volunteering
You automatically satisfy the requirement if you earn at least $580 a month in wages, regardless of your actual hours worked.
Who is exempt: members under 19 or over 64, pregnant or postpartum individuals (up to 12 months), people who are medically frail or have a disability, caregivers of a child under 14 or a dependent with a disability, American Indian and Alaska Native members, people in SNAP or FIP work programs, veterans with a total disability rating, people in active substance use treatment, and people who are currently or recently incarcerated.
If you think you qualify for an exemption, report it as soon as you're notified of the requirement rather than waiting, since Iowa HHS has said it will share exact reporting procedures closer to the effective dates.
What's Covered Under IHAWP
IHAWP benefits closely mirror traditional Iowa Medicaid. Covered services typically include:
- Primary care and specialist visits
- Preventive care and annual wellness exams
- Prescription drugs
- Hospital and emergency care
- Maternity and women's health services
- Mental health and substance use disorder treatment
- Lab work and imaging
Dental coverage is delivered separately through the Dental Wellness Plan, which most IHAWP members are automatically enrolled in.
Healthy Behaviors Program and Costs
IHAWP is designed to be free of premiums for members who complete the plan's Healthy Behaviors requirements: a wellness exam and a health risk assessment within the first year of enrollment. Iowa has removed most of the old premium structure, but Iowa HHS notes that starting in a member's second year of enrollment, a small monthly contribution can apply if these wellness steps were not completed, with the amount scaled to household income. Completing your wellness visit and health risk assessment early is the simplest way to avoid this.
How to Apply for Iowa Health and Wellness Plan
You can apply for IHAWP through any of these channels:
- Online: Apply through the HHS Services Portal, Iowa's official benefits application system.
- By phone: Call Iowa Medicaid Member Services at 1-800-338-8366 for help applying or checking your case status.
- In person: Visit a local Iowa HHS office to apply with help from a caseworker.
- Through HealthCare.gov: If you apply for ACA marketplace coverage and your income falls at or below the Medicaid expansion threshold, your application is automatically routed to Iowa Medicaid.
You'll need to provide proof of identity, Iowa residency, household income (recent pay stubs, tax returns, or an employer letter), and Social Security numbers for household members applying for coverage. Iowa HHS typically processes MAGI-based applications like IHAWP within 45 days, and often faster.
For general guidance on Iowa's broader benefits landscape, including SNAP, LIHEAP, and other assistance programs, visit our Iowa state benefits page.
IHAWP vs. Other Iowa Medicaid Programs
| Program | Who It's For | 2026 Income Limit |
|---|
| Iowa Health and Wellness Plan (IHAWP) | Adults 19-64 without another qualifying category | ~138% FPL |
| Traditional Iowa Medicaid | Children, pregnant individuals, people with disabilities, seniors | Varies by category, often 167% to 300% FPL |
| Hawki (Iowa CHIP) | Uninsured children in families with income too high for Medicaid | Up to 302% FPL |
| Medicare Savings Programs | Medicare beneficiaries with limited income and assets | Up to 200% FPL (varies by program) |
If your income is above the IHAWP limit, you may still qualify for subsidized ACA marketplace coverage, which uses a separate income scale that extends well beyond 138% FPL.
Frequently Asked Questions
What is the income limit for the Iowa Health and Wellness Plan in 2026?
The effective income limit is approximately 138% of the federal poverty level, about $1,835 a month for a single adult and $3,795 a month for a family of four, after the standard 5% income disregard is applied.
Is the Iowa Health and Wellness Plan free?
Coverage has no premium for most members. A small monthly contribution can apply starting in your second year of enrollment if you don't complete the required wellness exam and health risk assessment, with the amount based on income.
Do I have to work to keep IHAWP coverage in 2026?
Most members ages 19-64 will need to report at least 80 hours a month of work, job training, school, or volunteering, or earn at least $580 in monthly wages. Iowa HHS says this applies to new applicants starting December 1, 2026, and to existing members at renewal beginning in February 2027 or later. Several groups, including people with disabilities, caregivers of young children, and pregnant individuals, are exempt.
Who is exempt from Iowa's Medicaid work requirements?
Exemptions include people under 19 or over 64, pregnant or postpartum individuals, people who are medically frail or disabled, caregivers of a child under 14 or a dependent with a disability, American Indian and Alaska Native members, people in SNAP or FIP work programs, totally disabled veterans, people in substance use treatment, and people who are currently or recently incarcerated.
Can I apply for IHAWP if I already have a job?
Yes. IHAWP is based on income, not employment status. Many working Iowans with lower wages qualify, and once the community engagement requirement takes effect, having a job that meets the 80-hour or $580 income threshold will already satisfy that requirement.
What happens if my income goes above the IHAWP limit?
If your income rises above 138% FPL, you may lose IHAWP eligibility but could qualify for subsidized health insurance through the ACA marketplace instead. Iowa HHS should notify you of any change in eligibility and provide information on marketplace options.
How long does it take to get approved for IHAWP?
Iowa HHS generally processes MAGI-based Medicaid applications, including IHAWP, within 45 days, though many applications are approved faster, especially when submitted online with complete documentation.
