Idaho Senate to Consider Medicaid Expansion Work Requirements That Could Remove Thousands From Coverage
MOSCOW, Idaho — The Idaho Senate is poised to take up legislation that would establish work requirements for adults enrolled in Idaho’s Medicaid expansion program, a move that researchers warn could remove tens of thousands of Idahoans from health coverage by 2028.
House Bill 913, which passed the Idaho House on a near party-line vote last week, would direct Idaho to adopt Medicaid work requirements aligned with those included in President Donald Trump’s One Big Beautiful Bill Act. The bill now heads to the Idaho Senate — its final legislative stop before a potential trip to Gov. Brad Little’s desk for his signature.
The legislation carries significant implications for Latah County residents and communities across northern Idaho, where working-age adults in agricultural, service, and seasonal industries often fall into the income bracket covered by Medicaid expansion.
What the Bill Would Require
Under the proposed legislation, able-bodied adults enrolled in Idaho’s Medicaid expansion program would be required to demonstrate they are working, participating in job training, or engaged in community service in order to maintain their health coverage. The state would need to have those requirements in place by the end of the year if the bill is signed into law.
Supporters of the measure in the Idaho Legislature argue the policy is a straightforward matter of fiscal responsibility and fairness — ensuring that Idahoans who are capable of working are doing so while receiving taxpayer-funded health benefits. Proponents contend the state has an obligation to prioritize limited Medicaid resources for those who truly cannot provide for themselves.
Idaho Department of Health and Welfare data from December shows that approximately 48% of able-bodied adults currently on Idaho Medicaid expansion are already employed. Supporters of the bill say that figure demonstrates a need for clearer accountability within the program.
However, opponents of the legislation, including health care advocates and some policy researchers, argue the requirements function primarily as administrative hurdles rather than genuine incentives to work. They warn that many Idahoans who are already employed could lose coverage simply by failing to submit the correct paperwork documenting their work status — a scenario they describe as bureaucratic disenrollment rather than meaningful reform.
Researchers Warn of Significant Coverage Losses
A new analysis published by the Urban Institute and the Robert Wood Johnson Foundation projects that Medicaid work requirements and other changes embedded in the One Big Beautiful Bill could remove between 20,000 and 34,000 Idahoans from Medicaid expansion by 2028. A separate estimate cited in the bill’s discussion suggests the policy could ultimately cut Idaho’s Medicaid expansion enrollment by as much as 44%.
Idaho’s Medicaid expansion program currently covers nearly 79,000 residents. The program was approved in 2018 through a voter-approved ballot initiative that passed with nearly 61% support statewide. The initiative was designed to close a coverage gap affecting what health policy circles commonly refer to as the “working poor” — adults whose incomes fall above Medicaid’s traditional threshold but below the level required to qualify for federal marketplace subsidies.
Reports from other states that have implemented Medicaid work requirements, along with findings from federal watchdog agencies, suggest that administrative costs associated with running such programs are substantial, often without producing meaningful increases in employment among the affected population.
One notable aspect of House Bill 913 is that it may not require federal approval to take effect, unlike previous legislative attempts in Idaho to impose similar requirements on Medicaid expansion enrollees. Earlier efforts by the Idaho Legislature to condition Medicaid expansion benefits on work participation required federal waivers, which added time and regulatory uncertainty to the process.
The Idaho Senate’s consideration of the bill comes as state capitols across the country grapple with the downstream effects of federal budget and policy changes tied to the One Big Beautiful Bill Act. For rural counties like Latah County, where Gritman Medical Center serves as the primary hospital and health care access is already a subject of community concern, shifts in Medicaid enrollment could have ripple effects on local health care economics and provider stability.
What Comes Next
House Bill 913 now awaits a hearing and vote in the Idaho Senate. If the Senate passes the bill, it will advance to Gov. Brad Little, who will decide whether to sign it into law. Should the governor sign the legislation, Idaho would need to implement the new Medicaid work requirements by year’s end. Latah County News will continue to follow this story as it moves through the Idaho Legislature. For additional statewide coverage of Idaho health care policy, visit Idaho News and the Idaho News Network.