Idaho committee advances bill to reshape Medicaid expansion after hours of testimony

Lawmakers advanced a proposal that would impose work, time and enrollment limits on Idaho’s Medicaid expansion population while seeking federal waivers to reshape the program.

Representative Jordan Redmond, R‑District 3 of Kootenai County, presented House Bill 138 to the House Health and Welfare Committee and said the measure “is a common sense bill to restore integrity, fiscal responsibility, and self‑sufficiency back into our Medicaid program.” Redmond told the committee he wants to keep expansion but add “safeguards” including caps on enrollment, a 36‑month limit for able‑bodied adults, and work or community‑engagement requirements.

The bill would require the state to obtain multiple federal approvals (including Section 1115 and Section 1332 demonstration waivers discussed in testimony) to implement waivers and other changes. Redmond said the waivers are intended to let Idaho move expansion enrollees to private silver plans with advanced premium tax credits in some cases, cap or limit able‑bodied enrollment, and impose a 36‑month time limit for that population. He told the committee the measure is not a repeal: “This bill does not repeal Medicaid expansion. It keeps it and makes it work better.”

Why it matters: Committee members and dozens of public witnesses framed the bill as a trade‑off between fiscal control and access to care. Supporters argued the expansion’s cost trajectory is unsustainable and cited improper payment rates they said must be reduced. Opponents — including rural physicians, hospital leaders, behavioral‑health providers and patient advocates — warned that the bill would reduce coverage for tens of thousands of Idahoans, threaten rural hospitals and treatment capacity, and shift costs to counties, emergency care and criminal‑justice…