Rating: +1

Bill Summary:
H0138 significantly revises Idaho’s Medicaid expansion framework by conditioning continued eligibility for the expanded population (adults under 65 with income up to 133% of the federal poverty level) on a series of conservative reform benchmarks. These include:

• Mandatory work requirements for able-bodied adults
• A cap on total enrollment (50,000 or fewer)
• A 36-month lifetime benefit limit
• Biannual eligibility redetermination
• Elimination of automatic re-enrollment
• Restriction of hospital presumptive eligibility to children and pregnant women
• Exclusion of Medicaid funding for gender reassignment treatments or services that violate Idaho abortion laws
• Allowing individuals above 100% FPL to opt for private coverage via the Idaho exchange with tax credits

The bill requires the state to terminate expansion if federal funding drops below 90% or if these conditions aren’t met by July 1, 2026. It also mandates ongoing legislative oversight and encourages care management for cost control.

Reason for Rating:
H0138 aligns strongly with the Idaho Republican Party Platform’s commitments to limited government, fiscal responsibility, and welfare reform. Rather than expanding entitlement programs without oversight, the bill installs clear guardrails to limit dependency, prevent fraud, and ensure that Medicaid serves only those who truly need it—temporarily and with accountability. By tying Idaho’s participation to federal cost-sharing and requiring robust work and eligibility checks, the bill restores state control over healthcare spending and aligns assistance with personal responsibility and taxpayer protection.

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