On April 10, 2026, Idaho Gov. Brad Little (R) signed House Bill 913 establishing Medicaid work requirements in state law and requiring applicants to demonstrate three months of compliance with these requirements before enrolling. The bill incorporates federal Medicaid work requirements that the One Big Beautiful Bill Act (OBBBA) and goes further by requiring compliance before families or individuals can enroll in Medicaid.

The OBBBA, which President Trump (R) signed into law on July 4, 2025, created work requirements for able-bodied adults ages 19-64 without dependents in the Affordable Care Act’s (ACA) Medicaid expansion group. These individuals must work, volunteer, or participate in a work program for 80 hours per month to remain eligible for benefits. These federal work requirements take effect in 2027.

HB 913 codifies these requirements in Idaho law, but also establishes a requirement that individuals demonstrate compliance with work requirements for three consecutive months before they are eligible to enroll in Medicaid. This is not required by federal law. Other states, such as Nebraska, Kentucky, and Missouri have considered requiring or are planning to require Medicaid applicants to demonstrate compliance with work requirements in the month before they apply for benefits. As of the passage of ID H0913, Idaho was the only state planning to require three months of compliance before application.

ID H0913 passed the Senate along party lines, with all 28 Republicans voting in favor and all six Democrats voting against the bill. It passed the House mostly along party lines, with 59 Republicans voting in favor and one Republican joining eight Democrats to vote against the bill.

Supporters of the bill say that Medicaid was intended for low income individuals who are working and that the bill supports the program's goals. Representative John Vander Woude (R) stated, "When this program was started, it was for the working poor. This is still what the intention of that bill was passed for. And we’re just going to make sure that they are working."

Opponents of the bill said that it will lead to significant losses in medical coverage. Representative Ilana Rubel (D) stated, “This one is basically designed to maximize the number of people that will lose their health insurance… While it’s not full Medicaid expansion repeal, it’s going to have about a third to half the impact of full Medicaid repeal.”

Background

The One Big Beautiful Bill Act requires states to adopt community engagement requirements for able-bodied adults ages 19-64 without dependents in the ACA Medicaid expansion group by January 1, 2027. These community engagement requirements can be met by doing any of the following for 80 hours a month:

• working,
• doing community service,
• participating in a work program, or
• doing a combination of these activities.

An individual could also meet the requirements by enrolling at least part-time in an educational program or by making a monthly income of at least 80 times the federal hourly minimum wage. Failure to comply with the community engagement requirement would result in the denial of an application for Medicaid or disenrollment from the program.

Before the enactment of the OBBBA, there were no federally mandated work requirements for Medicaid. States could implement such policies by applying for a Section 1115 waiver. During the first Trump administration, 13 states received approval to implement work requirements using these waivers, but most efforts were blocked by legal challenges. The Biden administration later withdrew all 13 waivers. Georgia was the only state to successfully defend its waiver in court, and it implemented work requirements in 2023.

The OBBBA also expanded work requirements for the Supplemental Nutrition Assistance Program (SNAP). Click here to read Ballotpedia's coverage of these provisions.

Other states

Since the enactment of the OBBBA, states have taken actions to implement the work requirements early and or codify them in state law. Not all states plan to implement the requirements in the same way. Listed below are some other state actions related to the implementation of Medicaid work requirements:

• Nebraska will be the first state to implement the Medicaid work requirements required by the OBBBA on May 1. The state is using a state plan amendment to implement the new policy.
• Montana will also be implementing the work requirements early, beginning in July of this year.
• Arkansas has announced that the state will be implementing the work requirements on July 1, but that no one will face consequences, such as loss of benefits, for noncompliance until January 1, 2027.
• Kentucky HB2, which was vetoed on April 13, would have codified the work requirement with an implementation date no later than January 1, 2027 and would have required individuals to demonstrate compliance with work requirements for the month before they apply for benefits.
• Missouri HJR154, which passed the House on February 19, would codify Medicaid work requirements in the state constitution and similarly require individuals to demonstrate compliance with work requirements for the month before they apply for benefits.