Starting in January, approximately 85,000 Idaho residents enrolled in the state’s Medicaid expansion program will face new work requirements to maintain their coverage. The mandate, approved by the Idaho Legislature and Governor Brad Little through House Bill 913, stems from the federal One Big Beautiful Bill Act passed by Congress in 2025 and signed by President Donald Trump. The Idaho Department of Health and Welfare recently held a virtual town hall to explain how the new rules will function and address public concerns about implementation across Kootenai County and the broader state.
How the Work Requirements Will Function
Under the new rules, Medicaid expansion enrollees must document either 80 hours of qualifying activity per month or earn at least $580 monthly to retain coverage. Qualifying activities include employment, school attendance, volunteer work, job training, and other state-approved pursuits. Idaho will use a three-month lookback period—the maximum allowed under federal law—to verify that individuals have met these thresholds, providing some flexibility for those experiencing temporary gaps in work.
Enrollment will require renewal every six months, creating an ongoing verification process. The state has already conducted preliminary reviews: among 83,000 people sampled in an early data check, approximately 68,400 met the work requirements, suggesting most current enrollees will retain eligibility.
Exemptions and Special Considerations
The state has carved out multiple exemptions to shield vulnerable populations. Those exempt from work requirements include pregnant individuals, caregivers for children under 13, people with disabilities, individuals in substance use disorder treatment, foster youth aged 19 to 25, Native Americans and Alaska Natives, veterans with 100% disability ratings, and people facing serious health conditions. The department plans to hold a future town hall to detail the medically frail exemption category.
Idaho is also evaluating an unemployment rate carveout—a provision that would temporarily waive work requirements in counties experiencing high joblessness. The Department of Labor is expected to make that determination in October. The state is also awaiting guidance on whether individual counties will receive their own exemption thresholds based on local labor conditions.
Enrollment Impact and Timeline
Idaho’s Medicaid expansion, approved by voters in 2018, has grown to serve approximately 85,000 residents. Under the income eligibility threshold of 138% of the federal poverty level—roughly $29,863 annually for a family of two—many working-age adults gained coverage previously unavailable to them.
National analyses project significant coverage losses as work requirements take effect. The Urban Institute and Robert Wood Johnson Foundation estimate that between 20,000 and 34,000 Idahoans could lose Medicaid coverage by 2028 if they fail to meet or document work requirements. State officials acknowledge the uncertainty many enrollees face. “There probably is some anxiety about what this will actually look like, and what this will do to individuals’ coverage,” Juliet Charron, director of the Idaho Department of Health and Welfare, told attendees at the recent town hall, as first reported by the Coeur d’Alene Press.
What Comes Next
Idahoans currently enrolled in Medicaid expansion should prepare documentation of work history and earnings to submit when the requirements take effect. Residents uncertain about their exemption status—particularly those with ongoing health conditions or caregiving responsibilities—should reach out to the Idaho Department of Health and Welfare for clarity before January.
The state will continue hosting informational sessions as the implementation date approaches. Coeur d’Alene and Post Falls residents, along with those throughout Kootenai County, can contact the department or visit its website for updated guidance on documentation requirements and exemption eligibility. The department’s decision on unemployment rate carveouts in October will determine whether certain North Idaho counties receive temporary relief if joblessness spikes.
For those seeking additional context on state Medicaid policy, Meta’s $127 million settlement toward child safety initiatives reflects one recent development in state health and welfare funding decisions.