Legislature passes bill for Medicaid expansion work requirements

Republicans in the Idaho Legislature widely approved the implementation of federal Medicaid work requirements for adults enrolled in the Medicaid expansion by the end of the year.

House Bill 913 calls for Idaho to adopt Medicaid work requirements that were part of President Donald Trump’s cornerstone law, the One Big Beautiful Bill Act. The policy could remove up to 44% of Idahoans, or 34,000 people, from Medicaid expansion, researchers say. 

After passing the Idaho Senate on a 28-6 party-line vote Tuesday, the bill heads to Gov. Brad Little for final consideration. 

Lawmakers pushing for the change say they want to ensure that people receiving Medicaid who can work are working. But advocates say Medicaid work requirements are effectively costly administrative barriers to accessing the program. The rules, they say, could kick working Idahoans off the program because many would fail to submit the right paperwork. 

Medicaid work requirements and other changes in the “Big Beautiful Bill” could kick 20,000 to 34,000 Idahoans off Medicaid expansion by 2028, according to an analysis published last week by the Urban Institute and the Robert Wood Johnson Foundation.

Idaho Medicaid expansion covers nearly 79,000 Idahoans. About 48% of non-disabled adults on Idaho Medicaid are working, according to a December report by the Idaho Department of Health and Welfare.

In 2018, nearly 61% of Idaho voters approved Medicaid expansion through a ballot initiative intended to close a health care assistance gap affecting a population commonly called the working poor. 

Other states’ experiences and a federal watchdog report suggest that costs associated with Medicaid work requirements are high.

In the Legislature, the bill had the support of all 87 Republican lawmakers present, with one exception. Grayson Stone, a long-term substitute for Rep. Don Hall, R-Twin Falls, was the only Republican to vote against the bill. The 14 Democrats present for the vote opposed the bill. 

Once the bill arrives on the governor’s desk, he has five days, excluding Sundays, to decide on it. He has three options: Sign it, allow it to become law without his signature or veto it. 

These work requirements might not need federal approval

In the past, the Legislature had made similar calls to require non-disabled adults enrolled in the Medicaid expansion to prove they are working to receive benefits through the public assistance program. But those rules need approval from the federal government, a process that is often lengthy and one Idaho hasn’t succeeded in.

Nampa Republican Rep. John Vander Woude, who’s sponsoring the bill, hopes the state wouldn’t need federal approval for this iteration of work requirements. 

In 2019, Idaho failed to receive federal approval under the first Trump administration for Medicaid work requirements. In 2025, the Idaho Legislature and the governor approved another bill that called for Idaho to seek federal approval for Medicaid work requirements. 

Medicaid enrollees would need to prove they are working twice a year to maintain coverage, because the federal law requires enrollment renewals every six months. Idaho’s bill would require state health officials to verify work history for Medicaid enrollees over a period of three months, the longest “look-back” time allowed under the federal law. 

That period is long enough to ensure people don’t just get a job weeks before they apply to Medicaid, Sen. Julie VanOrden, a Republican from Pingree, said Tuesday. 

“I feel like what we’re doing is pretty conservative,” she said. 

But Boise Democratic Sen. Melissa Wintrow said that using the longest “look-back” period allowed would add red tape to kick more people off Medicaid expansion.

“This bill is an attempt to do a backdoor repeal of Medicaid expansion,” Wintrow said. 

Vander Woude called for a staggered implementation of the work rules. The Department of Health and Welfare could do an early review later this year, before the work requirements officially take effect in January. Vander Woude says that would give people time to fix their work status so they can remain in the program.

In a statement Tuesday, the American Cancer Society Cancer Action Network asked the governor to veto the bill.

“Forcing these people into a suffocating paperwork quagmire will serve no function other than to keep them and their children from getting the care they need, be it cancer treatment, a mammogram or a regular checkup,” the group’s Idaho Government Relations Director, Randy Johnson, said. 

What would the Medicaid work requirements look like?

The bill calls for Idaho to adopt by Dec. 31, 2026, Medicaid work requirements included in the One Big Beautiful Bill Act. The federal law requires the work requirements to take effect by 2027.

The federal law’s work requirements mandate that people enrolled in Medicaid expansion work or perform community service for at least 80 hours per month, according to the health policy research group KFF. Several exemptions would apply, such as for people who are: 

• medically frail;

• enrolled in school at least half-time;

• caretakers or parents of dependent children younger than 13 years old or people with disabilities;

• pregnant or receiving postpartum coverage;

• veterans with disabilities; 

• and those under age 26 who are or were in foster care.

The Idaho bill requires people to comply with the work requirements for three months before applying for Medicaid. The Idaho Department of Health and Welfare would remove “any person who is unable to demonstrate compliance” from Medicaid.