The Idaho Senate is now weighing a bill that would add strict work requirements to the state’s Medicaid expansion program. House Bill 913 passed the Idaho House on a near party-line 59–9 vote. It now awaits a Senate decision — the final legislative step before reaching Gov. Brad Little for his signature or veto.
What Is House Bill 913?
House Bill 913 proposes that Idaho adopt Medicaid work requirements tied to President Donald Trump’s federal legislation, known as the One Big Beautiful Bill Act. Rep. John Vander Woude, a Republican from Nampa, sponsored the bill. He argues that people who can work and receive Medicaid benefits should, in fact, be working.
Under this bill, Idaho must adopt the new eligibility rules by December 31, 2026. The federal law requires these work requirements to officially take effect by 2027. Crucially, Vander Woude believes Idaho would not need separate federal approval for this version of the policy — a key difference from past attempts that repeatedly stalled.
Idaho’s History With Medicaid Work Rules
Idaho has previously pushed for Medicaid work requirements. However, those efforts required federal approval — a slow process the state has not successfully completed. This new approach is designed to bypass that hurdle by aligning directly with the federal One Big Beautiful Bill Act.
How the Work Requirements Would Work
Under the bill, Medicaid expansion enrollees must prove they work, attend school, or volunteer for at least 30 hours per week — or at minimum 80 hours per month — for three consecutive months before they qualify for coverage. This three-month lookback period is the maximum allowed under the federal law.
Key Compliance Rules
- Applicants must demonstrate compliance for three months before enrolling
- The Idaho Department of Health and Welfare would remove “any person unable to demonstrate compliance”
- Exemptions apply for certain populations, such as people with disabilities or specific caregiving responsibilities
- If signed into law, the bill would take effect immediately
Vander Woude favored the three-month window over a shorter one-month period. “I want to make sure the requirements we’re putting in are more long-term,” he stated.
Who Could Lose Medicaid Coverage?
Idaho’s Medicaid expansion currently covers nearly 79,000 residents. The stakes are high. Estimates of how many people could lose coverage vary widely among lawmakers and researchers.
The Numbers at Stake
- Vander Woude estimates 15,000 to 20,000 people may be removed
- House Minority Leader Ilana Rubel (D-Boise) projects as many as 40,000 could lose coverage
- Researchers suggest the policy could remove up to 44% of Medicaid expansion enrollees — roughly 34,000 people — by 2028
- According to a December report by the Idaho Department of Health and Welfare, only 48% of able-bodied adults on Idaho Medicaid are currently employed
Moreover, advocates warn that even working enrollees could lose coverage due to paperwork failures, not ineligibility. Many low-income workers lack the administrative support needed to navigate complex reporting requirements.
Supporters vs. Critics: The Key Debate
Supporters argue the bill promotes personal responsibility and ensures that public assistance goes to those who cannot help themselves. They contend that able-bodied adults should contribute to the workforce while receiving taxpayer-funded benefits.
Critics, however, call the bill an administrative barrier — not a genuine effort to encourage employment. Senate Democratic Leader Melissa Wintrow (D-Boise) warned that Idaho’s Department of Health and Welfare is already stretched thin. She also cautioned that the bill could serve as a “back door” to drop people from Medicaid expansion — even those who are working.
The Voters’ Voice
In 2018, nearly 61% of Idaho voters approved Medicaid expansion through a ballot initiative. The measure was designed to close a health coverage gap for the so-called “working poor” — people who earned too little to qualify for subsidies but too much for traditional Medicaid.
Critics argue that HB 913 contradicts the will of Idaho voters. Furthermore, watchdog reports and experiences in other states show that the administrative costs of running Medicaid work requirement programs are substantial, often without meaningful gains in workforce participation.
A Staggered Rollout Plan
Rather than abrupt implementation, Vander Woude proposed a phased approach. Under his plan, the Department of Health and Welfare would conduct an early review later in 2026 — before the official January 2027 deadline. This step would give enrollees time to adjust their work status and remain on the program.
Why a Phased Approach Matters
A gradual rollout could reduce the number of people wrongly removed due to administrative errors. Additionally, it gives state agencies time to build reporting infrastructure. Nevertheless, critics remain skeptical that any timeline prevents large-scale coverage losses.
What Happens Next?
The bill now moves to the full Idaho Senate for a vote. If the Senate passes HB 913, it goes to Governor Brad Little for final action. Should he sign it, the law would take effect immediately — with Idaho required to implement Medicaid work requirements by the end of 2026.
The debate reflects a broader national conversation about Medicaid reform. Therefore, the outcome in Idaho could influence how other states approach Medicaid work requirements under the One Big Beautiful Bill Act.
