BOISE, ID – After little debate, the Idaho House widely passed a bill that calls for the state to implement Medicaid work requirements for adults enrolled in Medicaid expansion by the end of the year.

The Idaho Legislature has called for able-bodied adults on Medicaid expansion to prove they are working to receive benefits through the public assistance program before. But those rules need approval from the federal government, which is often a lengthy process that Idaho hasn’t succeeded with.

But House Bill 913 proposes adopting Medicaid work requirements that were part of President Donald Trump’s cornerstone law, the One Big Beautiful Bill Act. Rep. John Vander Woude, a Nampa Republican who’s behind the Idaho bill, hopes the state wouldn’t need federal approval for this iteration of work requirements.

In 2018, nearly 61% of Idaho voters approved the policy through a ballot initiative meant to close a health care assistance gap that affected a population commonly called the working poor.

In debating the bill on the House floor, Vander Woude leaned into the program’s intent.

“When this program was started, it was for the working poor. This is still what the intention of that bill was passed for. And we’re just going to make sure that they are working,” Vander Woude said.

Idaho Medicaid expansion covers nearly 79,000 Idahoans.

The Idaho House passed the bill on a near party-line 59-9 vote. Grayson Stone, a long-term substitute for Rep. Don Hall, R-Twin Falls, was the only Republican to vote against the bill. All eight Democrats present opposed the bill.

To become law, Idaho bills must pass the House and Senate, and avoid the governor’s veto.

Why some critics see Medicaid work requirements as red tape

House Minority Leader Ilana Rubel, D-Boise, said the bill would likely kick 40,000 people off Medicaid expansion. She said it goes further than other conservative states in requiring state officials to verify work history for three months instead of just one month.

“This one is basically designed to maximize the number of people that will lose their health insurance,” Rubel said. “… While it’s not full Medicaid expansion repeal, it’s going to have about a third to half the impact of full Medicaid repeal.”

She argued the state’s economy would feel the fallout from the bill, estimating 3,000-4,000 job losses.

Some advocates say Medicaid work requirements are effectively costly administrative barriers to access the program — since almost half of Idahoans on Medicaid are already working. Other states’ experiences and a federal watchdog report suggest costs for Medicaid work requirements are high.

In a statement, American Cancer Society Cancer Action Network Idaho Government Relations Director Randy Johnson said the bill is an attack on Medicaid expansion.

“Voters have told lawmakers repeatedly to stop these attacks on ballot-initiated Medicaid expansion as well as the brazen disregard for their wishes. Idahoans have been clear that they want Medicaid expansion to remain in place without changes,” he said. “Yet House Bill 913 is the same, old play with a different name.”

About 48% of able-bodied adults on Idaho Medicaid are working, according to a December report by the Idaho Department of Health and Welfare.

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 required the work requirements to take effect by 2027.

The federal law’s work requirements will require that people enrolled in Medicaid expansion work or do community service at least 80 hours per month, according to 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 would require that people comply with the work requirements for three months before they apply to Medicaid. The Idaho Department of Health and Welfare would remove “any person … who is unable to demonstrate compliance” from Medicaid.

If passed into law, the bill would take effect immediately.

This story first appeared on Idaho Capital Sun.