LEWISTON, Idaho — The Idaho Senate is poised to take up legislation that would impose work requirements on adults enrolled in the state’s Medicaid expansion program, a move that researchers warn could strip health coverage from tens of thousands of Idahoans, including many residents across Nez Perce County who rely on the program for basic medical care.
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 established under President Donald Trump’s “One Big Beautiful Bill Act.” The Idaho Senate represents the bill’s final legislative hurdle before it could reach Gov. Brad Little’s desk for his signature.
The stakes are significant. Idaho’s Medicaid expansion currently covers nearly 79,000 residents statewide. According to a newly published analysis by the Urban Institute and the Robert Wood Johnson Foundation, the proposed work requirements — combined with other changes contained in the federal legislation — could remove between 20,000 and 34,000 Idahoans from Medicaid expansion coverage by 2028. That represents a potential enrollment reduction of up to 44 percent.
What the Work Requirements Would Mean for Idaho
Under the proposed rules, able-bodied adults receiving Medicaid expansion benefits would be required to demonstrate that they are working, participating in job training, or engaged in community service activities in order to maintain their coverage. Supporters of the legislation argue the requirements are a reasonable safeguard to ensure that public assistance reaches those who genuinely cannot support themselves, rather than those who choose not to work.
Idaho lawmakers backing the bill have pointed to data from the Idaho Department of Health and Welfare showing that approximately 48 percent of able-bodied adults currently on Idaho Medicaid are employed. Proponents contend that encouraging or requiring work among those who are able promotes self-sufficiency and responsible use of taxpayer-funded resources — principles that resonate broadly with Idaho’s tradition of limited government and fiscal accountability.
Critics of the legislation, however, argue the requirements amount to costly bureaucratic hurdles that would push working Idahoans off the rolls not because they fail to work, but because they fail to navigate complex paperwork systems correctly. Advocacy groups have cited experiences in other states where work requirements were implemented, finding that administrative barriers — not lack of employment — were the primary driver of coverage losses. A federal watchdog report has similarly flagged high administrative costs associated with work requirement programs.
For rural communities like those throughout Nez Perce County, the concern carries added weight. Residents in areas served by St. Joseph Regional Medical Center and rural clinics across the Lewis-Clark Valley often have fewer health care options and less administrative support for managing government program paperwork than those in larger urban areas.
Idaho Voters Originally Approved Medicaid Expansion in 2018
The debate over work requirements touches directly on a landmark Idaho voter decision. In 2018, nearly 61 percent of Idaho voters approved Medicaid expansion through a ballot initiative specifically designed to close a coverage gap affecting what policy analysts commonly called the “working poor” — adults who earned too much to qualify for traditional Medicaid but too little to afford private insurance through the marketplace.
That voter-approved initiative targeted precisely the population that work requirements are now meant to screen. Many of those currently enrolled in Idaho Medicaid expansion are, in fact, already working — often in seasonal, part-time, or agricultural employment that does not come with employer-sponsored insurance. In Nez Perce County and across the Lewis-Clark Valley, agriculture, timber, and service-sector jobs fitting that description are common.
Past attempts by the Idaho Legislature to impose work requirements required federal approval through a waiver process, which created political and procedural barriers. The current legislation is structured to potentially bypass that federal approval requirement by tying Idaho’s rules directly to the federal “One Big Beautiful Bill” framework, which supporters say streamlines the process.
Protesters rallied at the Idaho State Capitol in January of this year, filling the rotunda across multiple levels to demonstrate opposition to Medicaid budget cuts and changes to health services — an early sign that the issue carries significant public attention heading into the Senate debate.
What Comes Next
The Idaho Senate will now consider House Bill 913, where it faces its final legislative vote before potentially moving to Gov. Brad Little for signature or veto. If signed into law, Idaho would be positioned to implement Medicaid expansion work requirements by the end of 2026 or into 2027, depending on the rollout timeline established within the bill. Residents of Nez Perce County who currently receive coverage through Idaho’s Medicaid expansion program should monitor developments closely, as changes to enrollment requirements could directly affect access to care at local facilities including St. Joseph Regional Medical Center. Further statewide coverage of Idaho health care policy can be found at idahonews.co and across the Idaho News Network.