Idaho’s new Medicaid work requirements will take effect in January, requiring approximately 85,000 current enrollees to document at least 80 hours monthly of work, school attendance, or volunteering to maintain their health coverage. The state held its first public town hall Monday to walk residents through the mechanics of the new system.
The work requirement mandate stems from House Bill 913, which the Idaho Legislature approved and Governor Brad Little signed into law. The state is implementing federal authority granted under the One Big Beautiful Bill Act, which Congress passed in 2025 and President Donald Trump signed.
How the Requirements Work
Medicaid expansion in Idaho covers individuals earning up to 138 percent of the federal poverty level—approximately $29,863 annually for a family of two. Beginning in January, those enrollees must prove they meet one of several conditions to keep their coverage.
The primary requirement is 80 hours monthly of employment, school attendance, or volunteer work. An alternative pathway allows enrollees earning at least $580 per month to satisfy the requirement without documenting specific hours.
The state will examine a three-month lookback period when evaluating work history—the longest window federal law permits. Idahoans receiving Medicaid expansion coverage will need to recertify their status every six months, an increase from the previous annual recertification schedule.
Not all enrollees will face the same burden. Exemptions exist for individuals who are medically frail or have disabilities. Additionally, the state will determine in October whether to exempt people based on local unemployment rates, a determination the Department of Labor will make.
Initial Compliance and State Authority
When the state conducted an early review in July, approximately 68,400 of the 83,000 Medicaid expansion enrollees met the work requirements. That suggests a substantial portion of the population already satisfies the standard through employment or school enrollment.
However, the state currently lacks authority to remove people from Medicaid for failing to meet work requirements. Idaho officials notified all Medicaid expansion enrollees about the new rules in July and are directing them to create Idalink accounts—the state’s benefit portal—to update their preferences and receive recertification reminders.
Juliet Charron, director of the Idaho Department of Health and Welfare, acknowledged the transition period. “There probably is some anxiety about what this will actually look like, and what this will do to individuals’ coverage,” she told the Idaho Capital Sun, as first reported by the outlet.
Projected Impact
National research organizations including the Urban Institute and the Robert Wood Johnson Foundation have estimated that between 20,000 and 34,000 Idahoans could lose Medicaid coverage by 2028 if they fail to meet work requirements or navigate the recertification process successfully.
The work requirement system represents a significant shift in how Idaho manages Medicaid expansion, which voters approved in 2018 through a ballot initiative. The expansion has provided coverage to tens of thousands of low-income Idahoans, but the new federal law and state law now tie that coverage to employment or school participation.
Residents who have questions about how the requirements apply to their specific situation can contact the Idaho Department of Health and Welfare or access information through official state channels.
What Comes Next
The state will determine unemployment-rate exemptions in October, giving the Department of Labor several months to set that threshold. January’s implementation will mark the first time Idaho enrollees must actively document work or school activity to maintain Medicaid expansion coverage. State officials expect the recertification process to begin in the final months of 2026, with the six-month cycle starting in early 2027.