BOISE, ID – The Idaho House — with support from every Republican House lawmaker — on Thursday widely passed a bill that proposes sweeping policy changes intended to cut Medicaid costs.

House Bill 345 calls for Idaho to seek work requirements for able-bodied Idahoans on Medicaid, and to give Idahoans eligible for Medicaid expansion access to tax credits to buy insurance on Idaho’s health care exchange.

“In many ways, I believe this is a broader bill that addresses the entire $5.2 billion Medicaid budget, and creates very good savings and sustainability for our state,” said Rep. Jordan Redman, R-Coeur d’Alene, who is cosponsoring the bill along with the chairs of the Idaho Legislature’s health committees.

The $5.2 billion figure Redman referenced appears to be the total, potential budget for Idaho Medicaid for fiscal year 2026 that Gov. Brad Little requested. But the program is mostly federally funded. Next fiscal year, Idaho would pay $1.8 billion for the program, under the governor’s budget request.

All nine House Democrats opposed the bill. The Idaho House debated it for less than 10 minutes Thursday.

The bill’s proposal for Medicaid work requirements — which requires federal approval to implement — has drawn the most opposition.

But the new bill had unanimous support from House Republicans, a significant shift from another bill by Redman that would’ve likely repealed Medicaid expansion that narrowly passed the Idaho House last month.

But beyond Medicaid expansion, the bill proposes broader policy changes for the entire Medicaid program — a health care assistance program for low-income earners, people with disabilities, pregnant women, and some older people.

The bill could save Idaho $15.9 million in fiscal year 2026 and even more in the future, the bill’s fiscal note estimates. But the timing depends on federal approval, the fiscal note says.

The bill now heads to the Idaho Senate, where it could be scheduled for a committee hearing with public testimony in the coming days before a possible vote by the full Senate.

To become law, Idaho bills must pass the House and Senate, and avoid the governor’s veto.

Medicaid work requirements are effectively just red tape, opponents say

Some advocates say Medicaid work requirements are costly and are effectively just administrative barriers to access the program — since almost half of Idahoans on Medicaid are already working. And many other Idahoans on Medicaid, advocates say, would be exempt from work requirements under exceptions the bill spells out, such as for parents of children age six and under, people with disabilities, college students, volunteers and caretakers.

Idaho House Minority Leader Ilana Rubel, D-Boise, said the bill proposes Medicaid work requirements that “essentially mirror” what Arkansas had.

In the first seven months of Arkansas’ Medicaid work requirement, one in four people subject to the rule lost coverage, the Center for Budget and Policy Priorities found. Rubel said 95% of them were working, “but the reporting requirements were so stringent that the paperwork tripped them up. And they ended up being kicked off.”

“This is not about requiring people to work. It’s about requiring people to navigate very extensive paperwork proving it,” she argued, adding that people removed from Medicaid would show up to hospitals uninsured.

A majority of people enrolled in Medicaid are already working, data published by health policy research group KFF show. Some research finds Medicaid work requirements waste time and resources.

About 48% of the roughly 102,000 able-bodied Idahoans on Medicaid are working, according to figures by the Idaho Department of Health and Welfare.

Under the Trump administration, CMS approved work requirements in 13 states — for the first time in Medicaid’s history, according to KFF. The Biden administration rescinded the approvals.

Georgia’s Medicaid work requirement has cost almost $87 million, new investigation finds

Other states’ experiences and a federal watchdog report suggests costs for Medicaid work requirements, alone, are high.

Georgia is the only state that has Medicaid work requirements. One of 10 states that hasn’t expanded Medicaid, Georgia prevailed in litigation against the Biden administration for revoking its work requirements approval.

But by the end of 2024, Georgia’s program “has cost federal and state taxpayers more than $86.9 million” and enrolled just 6,500 new Medicaid participants, far under the state’s goal, a recent investigation by ProPublica found.

In a 2019 report studying Medicaid work requirement implementation in six states, the U.S. Government Accountability Office estimated implementing work requirements costs ranged from $6.1 million to $271.6 million.

For the state of Arkansas, which had almost 26,000 more Medicaid expansion enrollees than Idaho currently has, implementing work requirements cost an estimated $26.1 million, the watchdog agency found.

The Idaho Medicaid cost-control bill’s fiscal note does not list estimates for the cost of Medicaid work requirements, or several other policy proposals in the bill. Typically, Idaho lawmakers pass separate budget bills for approved policy bills that require appropriations.

Bill would also propose ‘comprehensive’ private company management of Idaho Medicaid benefits

The new bill would also call for Idaho to plan to shift the management of Medicaid benefits to private companies, which is called managed care and is used by most states’ Medicaid programs. And the bill directs Idaho to end Idaho’s use of doctor-managed care, called value care, a unique model that has existed for a few years.

Rubel said Idaho’s disability community strongly opposes the bill, and “are very concerned that the forced managed care is going to undermine very important individualized services and make it difficult or impossible for them to receive those services.”

Many of the bill’s proposals require federal approval, and would likely take years to implement.

An Idaho ‘reform’ bill would likely repeal voter-approved Medicaid expansion. Here’s why.

In 2019, Idaho failed to receive federal approval — then by the Trump administration — for Medicaid work requirements and an exchange tax credit option, which are similar to the new bill’s provisions. Idaho’s 2019 work requirement waiver is still listed as pending by CMS.

If passed into law, the bill would take effect immediately through an emergency clause.

The bill also calls for Idaho to seek federal approval to no longer allow state health officials to automatically renew Medicaid for people based on publicly available information, or to use pre-populated forms. That process is commonly called “ex-parte renewals” in health policy jargon.

But the bill doesn’t include several provisions from an earlier Medicaid expansion repeal-or-reform bill by Redman that could’ve repealed Medicaid expansion, or removed more than half of the nearly 90,000 Idahoans enrolled in expansion.

Broad Medicaid expansion cuts power — if feds reduce pay

Republican lawmakers in Idaho have long worried about the federal government reducing its high match rate for Medicaid expansion.

The new Medicaid cost-control bill has a provision to address if the federal government reduces its financial matching rate for Medicaid expansion, which is 90% compared to Idaho’s typical federal Medicaid match rate of about 70%.

If the federal financial match rate for Medicaid expansion reduces outside of a state legislative session, the bill directs the Idaho Department of Health and Welfare director to “take any action necessary to offset the increase in state funding,” such as by cutting optional benefits or reducing provider payment rates.

“Such actions shall be taken until such time as the state legislature may convene and determine a proper course of action,” the bill says.

Last week, all but one U.S. House Republicans passed a congressional budget plan — supported by President Donald Trump — that critics say would massively cut Medicaid.

Trump has assured Republicans won’t “touch” Medicaid, Medicare or Social Security. U.S. House Speaker Mike Johnson pledged the focus will be on waste in Medicaid.

But the Congressional Budget Office, a nonpartisan office, found that the goal to deeply cut congressional spending can’t happen without cuts to benefits for Medicaid or Medicare, the Washington Post reported. Many health care policy experts also believe the tax cut goal would require deep Medicaid cuts, Roll Call reported.

Idaho Capital Sun is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christina Lords for questions: info@idahocapitalsun.com.