Idaho and North Dakota Implement Medicaid Expansion Work Requirements

The Idaho Department of Health and Welfare and North Dakota's Department of Health and Human Services will implement new Medicaid expansion work requirements starting January 1. These measures follow state laws and federal legislation, including the Working Families Tax Cuts Act and the One Big Beautiful Bill Act. Eligible adults aged 19-64 must demonstrate 80 hours per month of employment, volunteering, or schooling to maintain coverage. In Idaho, applicants must show earnings of $580 per month or 80 hours of qualifying activity for the three months preceding their application.

Approximately 85,000 Idaho enrollees are affected. While Idaho Medicaid Administrator Sasha O’Connell stated that 68,400 of the roughly 83,000 people reviewed already meet the requirements, analyses from the Robert Wood Johnson Foundation and the Urban Institute suggest the rules could remove 20,000 to 34,000 people from coverage by 2028. Idaho will not provide the one-year grace period for the medically frail exemption allowed under federal guidelines; instead, recipients must provide documentation, such as a doctor's note, if evidence of frailty is not already in the state's claims system.

Idaho Attorney General Raúl Labrador framed these requirements as protections against fraud, noting the Medicaid Fraud Control Unit recovered over $900,000 in the 2025 fiscal year. State agencies intend to notify impacted households through emails, letters, and virtual town halls.