Drug testing: Needless, costly, burdensome

To assure access to health care, drug testing just gets in the way

Multiple bills introduced in the 2019 Iowa legislative session would limit access to health care by posing bureaucratic hurdles to working families needing help.

Drug-testing Medicaid recipients is one of those ideas. Already shown to be costly and ineffective in other states, the idea is one more solution in search of a problem. Studies show that drug use among work support recipients is lower than the general population.[1] In most states, less than 1 percent of applicants have tested positive.[2]

Neighboring Missouri provides a lesson for Iowa on cost. Missouri spent $336,297 on drug testing of Temporary Assistance for Needy Families (TANF) in 2017.[3] After initial screening, the state tested 108 of 32,774 TANF applicants, finding 11 positive results. That’s an investment of over $30,000 per positive test. Another 305 applicants did not show up for a drug test or refused to take one.[4]

Iowa is familiar with these costs. Last session, a similar bill was proposed to implement drug testing for SNAP and Medicaid recipients. A Department of Human Services administrator estimated that costs to the state would have been at least $100 million.[5]

Medicaid plays a vital role in insuring more than 260,000 Iowa children.[6] Restricting access to medical care through drug testing poses a threat to child well being, by reducing resources available to the household as a whole.[7]

Over 225,000 Iowans living in working households struggle to make ends meet.[8] Medicaid and Affordable Care Act subsidies are important work supports that help families get by when wages aren’t enough to cover basic costs.

In Iowa, the large majority of Medicaid recipients who can work do work. Eighty-seven percent live in a working family and 72 percent work themselves.[9]

Instead of making it more difficult for low-income families to get the medical care they need, Iowa can invest in its workers by expanding the state Earned Income Tax Credit and Child Care Assistance programs. Other alternatives include raising wages to more accurately reflect workers’ productivity and higher living costs, or adequately funding mental health care.


[1] Center on Law and Social Policy, “Drug Testing SNAP Applicants is Ineffective and Perpetuates Stereotypes.” July 2017. https://www.clasp.org/sites/default/files/publications/2017/08/Drug-testing-SNAP-Applicants-is-Ineffective-Perpetuates-Stereotypes.pdf

[2] Center on Law and Social Policy, “Drug Testing and Public Assistance.” February 2019. https://www.clasp.org/publications/fact-sheet/drug-testing-and-public-assistance

[3] Ibid.

[4] Amanda Michelle Gomez and Josh Israel, “States waste hundreds of thousands on drug testing for welfare, but have little to show for it.” May 2018. Think Progress. https://thinkprogress.org/states-waste-hundreds-of-thousands-on-drug-testing-for-welfare-3d17c154cbe8/

[5] O. Kay Henderson, Iowa Senate bill to require drug tests, work for welfare.” February 2018. Radio Iowa. https://www.radioiowa.com/2018/02/15/iowa-senate-bill-to-require-drug-tests-work-for-welfare/

[6] American Community Survey, “Health Insurance Coverage Status and Type of Coverage by State and Age for All People: 2017. September 2018. U.S. Census Bureau. https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-hi.html

[7] Center on Law and Social Policy, “Drug Testing and Public Assistance.”

[8] Peter Fisher and Natalie Veldhouse, “The Cost of Living in Iowa 2018 Edition Part 2: Many Iowa Households Struggle to Meet Basic Needs.” July 2018. Iowa Policy Project. http://iowapolicyproject.org/2018Research/180702-COL-Part2.html

[9] Rachel Garfield, Robin Rudowitz, & Anthony Damico, “Understanding the Intersection of Medicaid and Work.” January 2018. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work/




Natalie Veldhouse is a research associate for the nonpartisan Iowa Policy Project. nveldhouse@iowapolicyproject.org

SNAP changes: Ignoring what works

EITC and child care more effective than drug tests and work requirements

Work requirements for public assistance seem to be all the rage — at both the national and state levels — when other policies would do more to encourage and support work.

President Trump signed an executive order April 10 enhancing enforcement of federal public assistance work requirement laws, evaluation of program effectiveness, and consolidation or elimination of “ineffective” programs.[1] The Trump administration also is considering drug tests for SNAP (Food Stamp) recipients.[2]

Similar legislation in Iowa (Senate File 2370) intended to expand regulations on and further monitor recipients of public assistance in Iowa, but appears to have stalled as the 2018 session nears an end. This included implementing work requirements, drug testing, quarterly reviews of eligibility, and a one-year residency requirement.[3]

The Farm Bill draft[4] released April 12 would reduce or eliminate SNAP benefits for 1 million households, or 2 million recipients, according to the Center on Budget and Policy Priorities (CBPP). Work requirements would force able-bodied adults without dependents to prove every month that they work or participate in a training program 20 hours per week. Severe sanctions for noncompliance would cut off benefits for one year the first time — three years the second.[5]

Recent research found recipients under work requirements for Temporary Assistance to Needy Families (TANF) continued to live below the federal poverty level, and that small increases in employment diminished over time and did not result in stable employment in most cases.[6] In the long term, programs that provide training, skill building, and educational opportunities to recipients are shown to be more successful than only implementing work requirements.[7]

Evidence shows that people in SNAP households who can work do work. More than 80 percent work during the year before or after receiving benefits.[8]

Drug testing public assistance recipients has proven to be costly and frivolous. States that have implemented drug testing found that applicants have lower drug usage rates than the general population. The state of Missouri spent $336,297 in 2015 to test 293 of 31,336 TANF applicants and found only 38 positive results.[9]

Eleven percent of Iowans received public assistance in February of 2018.[10] Already, able-bodied adult without dependents have work requirements to receive SNAP in the state of Iowa.[11]

By contrast, the Earned Income Tax Credit and Child Care Assistance (CCA) are policies that are effective in encouraging work. In addition, Iowa could make changes in work support programs, such as CCA,[12] to reduce what are known as “cliff effects” — when families with a pay raise or a new job are faced with a net loss because a reduction in benefits exceeds the new income.

Policies that support working families, not drug testing and work requirements, would do more to encourage work, raise family incomes, and boost local economies.


[1] The White House, “Executive Order Reducing Poverty in America by Promoting Opportunity and Economic Mobility.” April 2018. https://www.whitehouse.gov/presidential-actions/executive-order-reducing-poverty-america-promoting-opportunity-economic-mobility/

[2] Associated Press, “Drug testing plan considered for some food stamp recipients.” April 2018. https://www.apnews.com/6f5adff5efeb4f9a9075f76bf9cf5572

[3] IA Legis, “Senate File 2370” February 2018. https://www.legis.iowa.gov/legislation/BillBook?ga=87&ba=SF2370

[4] House Agriculture Committee “H.R. 2: the Agriculture and Nutrition Act of 2018.” April 2018. 115th Congress. https://agriculture.house.gov/uploadedfiles/agriculture_and_nutrition_act_of_2018.pdf

[5] Center on Budget and Policy Priorities, “Chairman Conaway’s Farm Bill Would Increase Food Insecurity and Hardship.” April 2018. https://www.cbpp.org/research/food-assistance/chairman-conaways-farm-bill-would-increase-food-insecurity-and-hardship#_ftn1

[6] Urban Institute, “Work Requirements in Social Safety Net Programs.” December 2017. https://www.urban.org/sites/default/files/publication/95566/work-requirements-in-social-safety-net-programs.pdf

[7] Center on Budget and Policy Priorities, “Work Requirements Don’t Cut Poverty, Evidence Shows.” June 2016. https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows

[8] Center on Budget and Policy Priorities, “Making SNAP Work Requirements Harsher Will Not Improve Outcomes for Low-Income People.” March 2018. https://www.cbpp.org/research/food-assistance/making-snap-work-requirements-harsher-will-not-improve-outcomes-for-low

[9] Center on Law and Social Policy, “Drug Testing SNAP Applicants is Ineffective and Perpetuates Stereotypes.” July 2017. https://www.clasp.org/sites/default/files/publications/2017/08/Drug-testing-SNAP-Applicants-is-Ineffective-Perpetuates-Stereotypes.pdf

[10] Iowa Department of Human Services, “Food Assistance Report Series F-1.” March 2018. http://publications.iowa.gov/27299/1/FA-F1-2016%202018-03.pdf

[11] Iowa Department of Human Services, “ABAWD Letter.” September 2017. https://dhs.iowa.gov/sites/default/files/470-3967.pdf

[12] Peter S. Fisher and Lily French, Iowa Policy Project: Reducing Cliff Effects in Iowa Child Care Assistance, March 2014. https://www.iowapolicyproject.org/2014docs/140313-CCA-cliffs.pdf


2018-NV-6w_3497(1)Natalie Veldhouse is a research associate at the nonpartisan Iowa Policy Project.