Idaho’s strict Medicaid work requirements to start next year. Most meet the rules, official says.

Idaho state health officials plan to start implementing work requirements for people on Medicaid expansion starting next year.

Idaho Republican lawmakers and Gov. Brad Little in April adopted the work requirements from President Donald Trump’s One Big Beautiful Bill Act. The Idaho Department of Health and Welfare, the state’s largest agency that runs Medicaid and other public assistance programs, plans to implement the work requirements on Jan. 1, 2027, agency officials announced in a news release this week.

Under the federal law, work requirements, also called community engagement requirements, require people enrolled in Medicaid expansion to prove that they are working, doing community service or educational or training activities for at least 80 hours each month. 

About 85,000 Idahoans are enrolled in Medicaid expansion, the state says. Medicaid work requirements and other changes in the “Big Beautiful Bill” could kick 20,000 to 34,000 Idahoans off Medicaid expansion by 2028, according to an analysis by the Urban Institute and the Robert Wood Johnson Foundation. That’s lower than what some other researchers estimate.

In a statement last week, Idaho Medicaid Administrator Sasha O’Connell said in an initial review, the Department of Health and Welfare found that “the vast majority” of people on Medicaid expansion were already “meeting the new requirements.” The agency found that 68,400 Idahoans on Medicaid expansion met the new work requirements, out of the roughly 83,000 on the program at the time of the review, she said.

She said the agency found that many Idahoans on Medicaid expansion already met the work requirements for several reasons, such as meeting work requirements for other programs such as the Supplemental Nutrition Assistance program, or state officials could see they were working through sources such as the Department of Labor.

“The remaining population will have the opportunity to provide documentation showing that they met the requirements if it wasn’t in our systems,” O’Connell said.

How far back do you need to prove work history under Idaho Medicaid’s work requirements?

Idaho lawmakers decided to require Medicaid expansion enrollees to prove work history for three months before their application for Medicaid. That time period, called a lookback period, is the longest allowed under the federal law. Only three states — Idaho, Indiana and North Carolina — plan to use lookback periods that long, according to KFF, a nonpartisan health policy research organization.

“If you can show that you have been working, going to school, participating in a work program, volunteering, or earning at least $580 in the three consecutive months before applying for Medicaid, you will meet the new requirements,” a state website explaining the new work requirements says. 

People on Medicaid will also be required to re-apply to the program every six months, another change under the new federal law that increases the eligibility verification frequency from once a year. 

Medicaid expansion is a program, approved by Idaho voters through a 2018 ballot initiative, that offers health insurance coverage to a group of people commonly called the working poor. Idahoans can qualify for Medicaid expansion if their household earns up to 138% of the federal poverty level, or $29,863 for a family of two each year. 

What exemptions are there to Idaho’s Medicaid work requirements?

There are several exemptions to the work requirements, including for: 

• People who have been pregnant within the past year
• People who are primary caregivers of children age 13 or younger, or who are caregivers of a person with a disability
• People who are blind, or who have “a serious or complex health condition that requires regular medical care,” along with people who have “a substance use disorder, or are in a drug or alcohol treatment program,” or people who have “a disabling mental health condition,” or people who “have a serious or complex health condition that requires regular medical care.”
• People who are Native American or Alaska Natives, veterans with a 100% disability rating, people who are aged 18-25 and aged out of foster care, people incarcerated or released from incarceration in the last 90 days.
• People who receive food assistance through the Supplemental Nutrition Assistance program, or cash assistance through the Temporary Aid for Needy Families program, and “are already required to meet work requirements for those programs.”

Courtesy of Idaho Capital Sun