Bill that could lead to repeal of Medicaid expansion passes Idaho House in close vote

BOISE — A bill that could eventually lead to the repeal of Medicaid expansion cleared the House in a narrow vote Wednesday.

Members debated House Bill 138 for an hour and a half before voting 38-32 to send it to the Senate.

Rep. Jordan Redman, R-Coeur d’Alene, sponsored the bill that requires the Department of Health and Welfare to apply for and receive 11 waivers — which are amendments to the way Idaho administers Medicaid — from the federal government by July 1, 2026.

Redman said the bill is meant to add “sustainability, financial security and still allows for coverage and keeping Medicaid expansion.”

If the waivers — which would include changes such as imposing work requirements, capping enrollment well below its current level, adding a three-year lifetime benefit limit, and others — are not approved and implemented by the July 2026 deadline, the bill would trigger a full repeal of the program by Oct. 1, 2026.

Voters in 2018 approved via a ballot initiative the expansion of Medicaid coverage to those who fell in the gap between eligibility for traditional Medicaid and qualifying for insurance through the state exchange.

As of Feb. 6, there are 83,324 Idahoans enrolled in the Medicaid expansion program, according to the health department.

During the lengthy debate, opponents of the bill argued that the timeline and waivers that were required under the bill were impossible to meet, thus tens of thousands of Idaho residents would be left uninsured with no system in place to replace that coverage.

“I have a better chance of flying a unicorn to the moon and back than we have of keeping Medicaid expansion if House Bill 138 becomes law,” House Minority Leader Ilana Rubel, D-Boise, said.

Others argued that this would put an additional strain on rural hospitals and clinics that would still have to pay for care for uninsured patients who couldn’t pay. Counties may also face the burden of helping pay indigent medical costs.

Those who supported the bill cited the increased costs of the program, and Medicaid as a whole. Idaho’s entire Medicaid program costs about $5.4 billion in mostly federal funds, and $995.4 million in state general funds, according to the legislative budget book. The expansion Medicaid plan costs a total of $1.36 billion in funds from all sources, including federal and state.

Supporters were confident the state would be able to obtain the required waivers from the Centers for Medicare & Medicaid Services because of the priorities laid out by President Donald Trump.

Others noted that some of the waivers required in the bill had already been applied for by Idaho and other states and were either never acted on or denied by CMS under the previous Trump administration.

Rep. Ben Fuhriman, R-Shelley, listed myriad logistical reasons that he thought it was “not possible” to receive all the waivers. He noted that federal laws around Medicaid require programs to expand coverage, and previous attempts to restrict it have been denied because they were in violation of that law.

“It doesn’t matter who the president is,” Fuhriman said. "It would require Congress to approve that waiver." 

He also argued even if the waivers would be approved, the process of applying and receiving a determination usually takes months, and that the “timeline on this bill is irrational.”

“This will repeal Medicaid expansion, because it is not possible,” he said.

Rep. Josh Tanner, R-Eagle, spoke in favor of the bill, especially adding the work requirements. Under the bill, adults between the ages of 19 and 64 would be required to work or volunteer at least 20 hours a week. There would be exemptions for those who were certified as physically or mentally unfit for employment, pregnant, a parent or caretaker of a child younger than 6 or a child with a serious medical condition or participating in a drug or alcohol rehabilitation program.

Tanner said he asked someone he knew who used Medicaid expansion why they didn’t get a better job, and the person responded that they didn’t want to lose Medicaid expansion coverage.

“Sometimes you have to rip the Band-Aid off,” Tanner said. “Sometimes you have to tell them you need to go work.”

Several people who opposed it also expressed concern with the cap, which the bill would set at either 50,000 people or the sum of adults enrolled in Medicaid or are disabled or over the age of 65, whichever is less. Redman said the current sum of disabled or adults over 65 is around 35,000.

Others also noted there was no direction as to how the cap would be achieved and how it would be decided who may enroll or keep their coverage and who would be dropped off.

Several proponents also supported the bill because of the growing federal debt, which they believe is worsening as Idaho accepts federal money for the program.

Idaho Falls Republican Rep. Wendy Horman, who co-chairs the budget-writing committee, said she supported the bill because Medicaid had a “runaway budget.”

“It is not sustainable and nothing we have tried so far has worked,” Horman said. “So I am willing to take the risk, because I think the risk of not acting leaves us in a very vulnerable position to provide essential services to our state, including those most vulnerable who do need medical attention and have no capacity to obtain it for themselves.”

The bill goes to the Senate, where it will be up for another public hearing.