Idaho Senate Will Consider Establishing Medicaid Expansion Work Requirements by 2027
A bill that could remove tens of thousands of Idahoans from Medicaid expansion is advancing rapidly through the Idaho Legislature, with the Idaho Senate set to take up legislation that would impose work requirements on able-bodied adults enrolled in the state’s Medicaid expansion program.
Why It Matters
For nearly 79,000 Idahoans currently covered under Medicaid expansion, the outcome of this legislation could have direct and immediate consequences on their access to health care. Researchers warn that between 20,000 and 34,000 enrollees could lose coverage if the requirements take effect.
Supporters of the bill argue the change encourages self-sufficiency and ensures that public assistance reaches those who truly cannot support themselves. Critics, however, contend the requirements function as bureaucratic barriers that punish working Idahoans who simply fail to file the correct paperwork on time.
What Happened
House Bill 913, which directs Idaho to adopt Medicaid work requirements aligned with President Donald Trump’s One Big Beautiful Bill Act, passed the Idaho House on a near party-line vote last week. The bill is now headed to the Idaho Senate, its final legislative hurdle before reaching Gov. Brad Little’s desk for a potential signature.
The legislation would require able-bodied adults enrolled in Idaho’s Medicaid expansion program to demonstrate they are working, volunteering, or engaged in job training activities in order to maintain their benefits. If signed into law, the requirements could be in place before the end of 2026, with full implementation expected by 2027.
Lawmakers backing the bill say the policy is a reasonable expectation for a population that has the physical capacity to work. Opponents, including health care advocates, argue the requirements will primarily harm low-income workers who lack the resources or flexibility to navigate complex reporting systems.
By the Numbers
- 79,000: Approximate number of Idahoans currently enrolled in Medicaid expansion
- 20,000–34,000: Estimated number of Idahoans who could lose Medicaid expansion coverage by 2028, according to analysis by the Urban Institute and the Robert Wood Johnson Foundation
- 44%: Maximum share of Idaho Medicaid expansion enrollees researchers say could be removed under the new requirements
- 48%: Share of able-bodied adults on Idaho Medicaid who are already working, according to a December report by the Idaho Department of Health and Welfare
- 61%: Share of Idaho voters who approved Medicaid expansion through a 2018 ballot initiative
Zoom Out
Idaho’s consideration of Medicaid work requirements mirrors a broader national push by Republican-led states to attach conditions to Medicaid enrollment, particularly as Congress debates long-term federal spending on the program. The federal One Big Beautiful Bill Act provides a legislative framework that states like Idaho can now move to adopt, potentially bypassing the federal waiver process that previously slowed similar efforts.
In the past, Idaho lawmakers attempted to implement Medicaid work requirements but were stalled by the need for federal approval. The current bill takes a different approach, tying Idaho’s requirements directly to the federal legislation, which may streamline implementation.
Across the Mountain West and nationally, states that have implemented work requirements have faced legal challenges and administrative costs that critics say outweigh any savings achieved by reducing enrollment. A federal watchdog report has similarly flagged the high administrative overhead associated with enforcement of work requirement programs.
What’s Next
The Idaho Senate is expected to take up House Bill 913 in the coming days. If the Senate passes the bill, it will advance to Gov. Brad Little, who has not publicly stated his position on the legislation. Should Little sign it, Idaho would begin the process of establishing a work requirement framework, with full implementation targeted by 2027.
Health care advocates are expected to continue pressing lawmakers and the governor’s office to reject or amend the bill before it becomes law. The Urban Institute and Robert Wood Johnson Foundation analysis released this week is likely to factor into ongoing Senate debate over the legislation’s projected human and fiscal costs.
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