Starting in January, Idahoans receiving Medicaid expansion coverage will need to document at least 80 hours per month of work, education, or volunteer activity to keep their benefits. The Idaho Department of Health and Welfare held a virtual town hall this week to walk enrollees through what the new rules will mean in practice.

The requirements stem from two layers of government action. Congress passed the federal “One Big Beautiful Bill Act” in 2025, which President Donald Trump signed into law and which mandated work requirements for Medicaid expansion recipients nationwide. Idaho’s Legislature and Gov. Brad Little then adopted House Bill 913 to bring the state into compliance.

Idaho voters originally approved Medicaid expansion through a 2018 ballot initiative. The program currently covers around 85,000 Idahoans whose household income falls at or below 138% of the federal poverty level, equivalent to about $29,863 per year for a two-person household.

What the Rules Require

Under the new rules, enrollees must show 80 hours monthly of qualifying activity. Work is the primary pathway, but school enrollment and volunteering also count. Earning at least $580 per month is treated as an automatic alternative that satisfies the requirement.

Idaho is requiring a three-month lookback period when reviewing work history, which is the longest period permitted under federal law. Enrollment recertification will also shift from annually to every six months.

The state mailed notices to all Medicaid expansion enrollees about the changes in July.

Who Is Exempt

People who are medically frail or have qualifying disabilities are exempt from the work requirement. The state is working with a contractor to automatically flag medical frailty by running enrollees’ existing claims data against defined criteria, which should reduce the burden on individuals who may struggle to document their status manually.

The Idaho Department of Labor is expected to decide by October whether the state can also exempt residents in counties with persistently high unemployment rates, which could shield some rural enrollees from the requirement regardless of their individual circumstances.

Early Data and Potential Coverage Losses

Preliminary state data offer a mixed picture. Idaho’s Medicaid administrator found that roughly 68,400 of 83,000 enrollees reviewed already met the work requirements based on available records. That suggests the majority of current recipients would not face immediate disruption if the rules were applied today.

However, longer-term projections are more concerning. An analysis from the Urban Institute and the Robert Wood Johnson Foundation estimates that between 20,000 and 34,000 Idahoans could lose Medicaid expansion coverage by 2028 as the requirements take full effect and administrative barriers compound over time.

The gap between the early compliance data and the longer-range loss estimates reflects the reality that some enrollees who technically qualify for an exemption or meet a work threshold may still lose coverage if they fail to navigate the six-month recertification process successfully, or if their employment situation changes.

Agency Director Juliet Charron acknowledged the uncertainty at this week’s town hall. “There probably is some anxiety about what this will actually look like, and what this will do to individuals’ coverage,” she told participants, as reported by the Idaho Capital Sun.

What Enrollees Should Do

With roughly four months before the January effective date, current Medicaid expansion recipients should review their eligibility status and gather documentation of their work, education, or volunteer hours. Those who believe they qualify for a medical frailty exemption should ensure their health care providers have submitted accurate and up-to-date claims records, since the state’s automatic verification process draws from that data.

The six-month recertification requirement means enrollees will need to interact with the state’s eligibility system more frequently than before, making it important to keep contact information current with the Department of Health and Welfare.

Idaho’s move to impose stricter work-based eligibility standards aligns with federal SNAP policy changes that have already taken hold in the state, reflecting a broader shift toward attaching work expectations to government benefit programs. Supporters argue the requirements promote self-sufficiency and responsible use of taxpayer dollars; critics contend administrative complexity will cause eligible people to lose coverage through paperwork failures rather than genuine ineligibility.

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