DES MOINES, Iowa (AP) — As Iowa’s modified Medicaid expansion hits the one-year anniversary mark, some enrollees will be asked to pay small monthly premiums because they haven’t completed a physical exam and health questionnaire. For Gov. Terry Branstad, those health requirements were key provisions for expanding Medicaid in Iowa using funding from President Barack Obama’s health care overhaul. Iowa received federal approval to make modifications to the traditional Medicaid terms, including setting health requirements and charging contributions.

Branstad spokesman Jimmy Centers says the governor “continues to believe that a critical component of improving the health and wellness of Iowa is having citizens take ownership of their health.” Lydia Mitts, a policy analyst with health care advocacy group Families USA, says such incentives might not work and could hurt people who need health coverage.