Idaho Governor Brad Little has signed House Bill 345, a law aimed at reforming the state’s Medicaid program by adding work requirements and shifting its management to private companies. The bill, which took effect immediately through an emergency clause, is designed to control rising costs while giving some Medicaid recipients the option to buy private insurance with tax credits.
The bill passed along party lines, with all Republican lawmakers in favor and all Democrats opposed. It introduces work requirements for able-bodied adults on Medicaid and mandates twice-yearly eligibility checks, up from the current annual review. Additionally, it directs Idaho to move toward managed care, a system where private companies oversee Medicaid benefits—an approach already used by most states.
Supporters argue these changes will reduce costs and promote self-sufficiency, estimating savings of $15.9 million in fiscal year 2026, with further reductions expected over time. Critics warn that work requirements could lead to coverage loss for eligible Idahoans, citing other states’ experiences where administrative hurdles caused thousands to lose benefits.
Several provisions, including work requirements and tax credits, require federal approval, which could take years. Idaho previously attempted to implement similar policies in 2019 under the Trump administration but was denied.
While the long-term impact remains uncertain, the bill marks one of the most significant changes to Idaho’s Medicaid program in recent years, reshaping how health coverage is managed for the state’s 262,000 Medicaid recipients.
