Why It Matters
Idaho lawmakers are moving quickly to impose Medicaid expansion work requirements on tens of thousands of residents, a policy shift that researchers say could strip healthcare coverage from up to 44% of those currently enrolled in the program. The legislation directly affects nearly 79,000 Idahoans who rely on Medicaid expansion for health coverage, many of whom belong to the working poor population the program was originally designed to serve.
If enacted, the policy would represent one of the most significant changes to Idaho’s Medicaid landscape since voters approved expansion in 2018, and would make Idaho one of the first states to align its Medicaid rules with the federal framework established under President Donald Trump’s One Big Beautiful Bill Act.
What Happened
The Idaho Senate is now reviewing House Bill 913, legislation that would require able-bodied adults enrolled in Idaho’s Medicaid expansion program to demonstrate they are working in order to maintain their benefits. The bill passed the Idaho House on a near party-line vote last week and is now awaiting Senate action, which represents its final legislative stop before reaching Gov. Brad Little’s desk.
The bill is designed to align Idaho’s Medicaid expansion rules with federal work requirement provisions included in the One Big Beautiful Bill Act, Trump’s signature domestic policy legislation. Supporters of the measure argue the requirements ensure that Medicaid resources are directed toward those who are genuinely unable to work, rather than those who could participate in the workforce.
Opponents, including healthcare advocates, counter that the requirements function primarily as administrative barriers. They argue that many working Idahoans could lose coverage not because they fail to meet the work threshold, but because they fail to navigate the paperwork process required to prove compliance.
By the Numbers
- 79,000: The approximate number of Idahoans currently covered under Medicaid expansion.
- 44%: The estimated share of Medicaid expansion enrollees — up to 34,000 people — who could lose coverage under the new requirements, according to a joint analysis by the Urban Institute and the Robert Wood Johnson Foundation.
- 20,000 to 34,000: The projected range of Idahoans who could be removed from Medicaid expansion by 2028 due to the work requirements and related changes in the federal legislation.
- 48%: The percentage of able-bodied adults currently enrolled in Idaho Medicaid who are already working, according to a December report from the Idaho Department of Health and Welfare.
- 61%: The share of Idaho voters who approved Medicaid expansion through a 2018 ballot initiative, reflecting broad public support for the program at the time of its passage.
Zoom Out
Idaho’s legislative push mirrors a broader national trend as Republican-controlled state legislatures look to implement or expand Medicaid work requirements in coordination with the Trump administration’s federal policy agenda. The One Big Beautiful Bill Act has provided a federal framework that several states are now moving to adopt at the state level.
Historically, Medicaid work requirements have required federal waivers for implementation, and previous efforts by the Idaho Legislature to impose such conditions on expansion enrollees stalled due to the approval process. House Bill 913 is structured in a way that may bypass the traditional federal waiver requirement, potentially allowing Idaho to implement the rules more quickly than past proposals allowed.
Federal watchdog reports and studies examining outcomes in other states have consistently found that Medicaid work requirements carry significant administrative costs and frequently result in coverage losses among people who are already employed but unable to meet documentation requirements. Arkansas, which implemented work requirements in 2018, saw more than 18,000 people lose Medicaid coverage within months before a federal court intervened.
What’s Next
The Idaho Senate will now deliberate on House Bill 913, with the bill’s outcome hinging on whether enough senators support aligning Idaho’s Medicaid expansion rules with the federal framework. If the Senate passes the bill, it will advance to Gov. Brad Little, a Republican, for final consideration and a potential signature into law.
Should the bill become law, state agencies would likely begin developing implementation timelines and compliance reporting systems ahead of a projected 2027 effective date. Advocacy groups and healthcare organizations are expected to mount continued opposition and may pursue legal challenges if the legislation is signed. Idaho residents enrolled in Medicaid expansion should watch for communications from the Idaho Department of Health and Welfare as the process moves forward.