BOISE (AP) — The Idaho Supreme Court heard arguments Tuesday in a lawsuit from a conservative group challenging the constitutionality of a voter-approved initiative to expand Medicaid.

The Idaho Freedom Foundation told justices that the initiative that passed in November with more than 60 percent of the vote is unconstitutional because it delegates authority to the federal government and the state Department of Health and Welfare.

The Idaho attorney general’s office in defending the statute told justices that the lawsuit does not delegate authority to the federal government and any work done by Health and Welfare is consistent with established law.

Voters authorized Medicaid expansion after years of inaction by the Idaho Legislature. The measure directs the state to expand Medicaid eligibility rules to include anyone earning less than 133 percent of the federal poverty level. That will provide access to preventative health care services for about 62,000 low-income Idaho residents. The federal government will pay for 90 percent of the estimated $400 million cost.

Gov. Brad Little has included the state’s share of the cost in his budget, which lawmakers are considering. Deadlines are approaching for both the budgeting process and federal requirements for the Medicaid expansion.

The five-member panel of judges must also consider whether the case is urgent enough for the state’s highest court to issue a ruling.

During arguments, justices reacted with skepticism to arguments by Assistant Chief Deputy Attorney General Brian Kane, who defended the voter initiative, that the case didn’t “rise to that level.”

“If we follow your argument and we dismiss on procedural grounds, then the Legislature is left with: Is this a good law or a bad law? What are we doing to do?” Chief Justice Roger Burdick told Kane. “So they’re paralyzed. And then the people’s will is also paralyzed.”

Justice John Stegner also appeared unconvinced by arguments that the case didn’t rise to the necessary level of urgency.

“Tens of thousands of people awaiting this decision will actually be impacted,” he said.

Bryan Smith, an attorney with the foundation, told justices that the federal government could reduce its share of Medicaid payments, meaning the state would have to pay more.

“The people didn’t vote for that,” Smith said. “That’s why we apply the same constitutional constraints to an initiative process that we do to legislation passed by the House and Senate and signed by the governor.”

But justices responded with pointed questions, asking why the state couldn’t opt out of Medicaid expansion if the federal government changes the rules. Justices also wondered whether the state needed to redo all kinds of interactions with the federal government if other federal benchmarks changed in a way that affected state programs.

The arguments for or against Medicaid expansion in Idaho have typically fallen along ideological lines, something not lost on the justices.

“I know there has been a lot of heated rhetoric about this case,” Justice Gregory Moeller told Smith. “What you deem a surrender of sovereignty, the attorney general’s office treats as mere cooperation. Philosophically, is it possible for us to work with the government in any way without in your view surrendering our sovereignty?”

The court didn’t indicate when it will rule.