Why It Matters
Idaho House lawmakers are advancing legislation that would impose work requirements on nearly 79,000 Medicaid expansion enrollees in the state, fundamentally changing eligibility rules for a program that provides health coverage to low-income adults. House Bill 913 represents a significant shift in Idaho’s approach to public assistance, as the state seeks to implement work requirements without federal approval—a departure from previous unsuccessful attempts that required federal waivers. The policy could remove thousands of Idahoans from Medicaid coverage if they cannot meet employment or alternative activity documentation standards, affecting access to preventive care, emergency services, and ongoing treatment across the state.
What Happened
The Idaho House Health and Welfare Committee voted Friday to advance House Bill 913 to the full House floor for consideration. The bill, sponsored by Rep. John Vander Woude, R-Nampa, proposes implementing Medicaid work requirements modeled after provisions in President Donald Trump’s One Big Beautiful Bill Act, federal legislation passed in 2025.
Under the proposal, Idaho would require able-bodied adults enrolled in Medicaid expansion to demonstrate employment or participation in qualifying activities to maintain their benefits. The work requirements would officially take effect in January 2027, though the Department of Health and Welfare would conduct an early review later in 2026 to allow enrollees time to adjust their employment status before the rules become binding.
Vander Woude presented the bill as a measured approach that would achieve workforce participation goals while minimizing disruption to current beneficiaries. “This bill actually accomplishes what we’re trying to do without disrupting those who should be still on,” Vander Woude told lawmakers during the committee hearing.
The committee’s two Democratic members voted against advancing the bill. House Minority Leader Ilana Rubel, D-Boise, expressed concern that the legislation’s design would penalize enrollees unable to navigate administrative requirements. “I feel like this bill is really designed to maximize the number of people who trip up and don’t meet the paperwork requirements,” Rubel said.
By The Numbers
Idaho Medicaid expansion currently covers nearly 79,000 residents. Vander Woude estimated that between 15,000 and 20,000 people could lose Medicaid coverage under the work requirements, though he acknowledged uncertainty about the precise impact. Rubel suggested the figure could be higher, indicating that one-third to one-half of current enrollees might be removed from the program. Idaho first expanded Medicaid eligibility in 2019 under a voter-approved ballot measure, broadening access to adults earning up to 138 percent of the federal poverty level.
Zoom Out
Idaho’s push for Medicaid work requirements reflects a broader national movement among Republican-led states to condition welfare benefits on employment. The Trump administration has prioritized work requirements as a centerpiece of welfare policy, and multiple states have sought similar provisions in recent years.
However, Idaho’s previous attempts to implement work requirements faced obstacles. The state legislature has repeatedly called for able-bodied adults on Medicaid expansion to prove employment, but those efforts required federal approval through waivers—a process Idaho did not successfully complete. Work requirement waivers have produced mixed results in other states. Arkansas implemented work requirements in 2018 but suspended them in 2020 after approximately 18,000 people lost coverage. Kentucky’s work requirements were blocked in federal court in 2020, and similar policies in other states have faced legal challenges.
Vander Woude’s strategy of anchoring the Idaho bill to Trump’s One Big Beautiful Bill Act aims to sidestep the federal waiver process by framing the requirements as state implementation of federal law rather than a departure from existing Medicaid rules. This approach remains untested in Idaho’s regulatory environment.
What’s Next
House Bill 913 will now advance to the full Idaho House for debate and a floor vote. If approved by the House, the bill would move to the Senate for consideration during the remainder of the 2026 legislative session. The Department of Health and Welfare would begin planning the early review process scheduled for later in 2026 if the bill passes both chambers and receives the governor’s signature. Implementation of the actual work requirements would not begin until January 2027, providing enrollees the review period Vander Woude described. The state may face legal challenges once implementation begins, depending on how federal agencies interpret the relationship between state law and existing Medicaid regulations.