Medicaid Community Engagement (Work Requirements) Town Hall: What You Need to Know
Changes to Medicaid—including new reporting requirements for Idaho’s Medicaid expansion population—will affect expansion enrollees beginning in 2027. We invite you to join us for a community town hall to learn more about these upcoming changes and discuss how they may impact the people we serve and the work we do.
This informative session will outline what Medicaid work requirements are, who may be affected, and what these changes mean for Idaho communities.
Monday, August 31, 10:00 AM - 11:00 AM MT
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Understanding Medicaid Expansion
Medicaid Expansion is Idaho’s health‑coverage program for adults ages 19 through 64 years old who meet income and eligibility criteria and would not qualify for traditional Medicaid.
Idaho voters approved Medicaid Expansion in the 2018 general election, extending coverage to adults earning up to 138% of the federal poverty level. The program was implemented in January 2020 and now provides health insurance to tens of thousands of Idahoans.
Medicaid Expansion Eligibility
You may qualify for Medicaid Expansion if:
- You are aged 19 through 64 years old
- You meet income limits up to 138% of the federal poverty level
- You are a U.S. citizen or have a certain qualified non‑citizen status
- You are an Idaho resident
- You are not disabled
- You are not pregnant
- You are not eligible for Medicare or another Medicaid program
Changes to Medicaid Expansion in 2027
Note: The information contained on this page is based on guidance from the Centers for Medicare and Medicaid Services (CMS) and other federal entities. The information on this page is subject to change based on updated guidance from CMS, changes to law or regulation, or other circumstances.
- H.R. 1 (the “One Big Beautiful Bill Act”) was approved by the U.S. Congress and President Trump in 2025, directing states to implement new requirements for Medicaid expansion participants
- New and existing applicants must demonstrate three months of qualifying activity (work, volunteering, or education) or must meet an exclusion or qualify for an exemption
- Re-evaluations will occur every six‑months
- Retroactive coverage will change to two months for Medicaid and one month for Medicaid Expansion applicants
- Note that Renewal dates can differ for people in the same household, and compliance is based on each person, not the household
Work Requirements Overview
If a Medicaid Expansion participant is not exempt from work requirements, they must demonstrate they are meeting the rules by completing at least one qualifying activity each month or a combination of the activities listed below.
At least 80 hours monthly of qualifying activities, which may include:
- Working
- Participating in an approved work program
- Doing volunteer or community service with an approved agency or organization
- Participating in an approved job training program
- Enrollment in an education program less than half time
- A combination of the above activities
Income earnings:
- Household income of at least $580 / month
Enrollment in an education program:
- Enrollment in an educational program, such as high school, a GED program, technical training, or college
- For individuals enrolled in Medicaid through Medicaid Expansion, the Idaho Department of Health and Welfare (DHW) reviews whether work‑activity requirements have been met to maintain eligibility. Renewal dates can differ for people in the same household, and compliance is based on each person, not the household
- DHW will begin reviewing work requirements for participants whose coverage periods end on or after January 1, 2027.
Some Medicaid expansion participants are not required to meet work requirements. Exclusions are circumstances that mean a person does not have to meet Medicaid expansion work‑requirement rules .If someone qualifies for an exclusion when they apply or renew, they can keep their coverage without showing qualifying‑activity compliance.
- You are currently pregnant
- You are receiving postpartum Medicaid coverage
- You are a caregiver of a child age 13 or younger
- You are a caregiver of a person with a disability
- You have a physical, mental, or developmental disability that makes it hard to do daily activities
- You have a serious or complex health condition that requires regular medical care and limits or prevents your ability to work.
- You have a substance use disorder, or are in a drug or alcohol treatment program
- You have a disabling mental health condition
- You are blind
- You are 19-25 and aged out of foster care
- You are an American Indian or Alaska Native
- You are eligible to receive Indian Health Services
- You are a veteran with a total, or 100%, disability rating
- You are currently incarcerated
- You get SNAP (food benefits) or TANF (cash assistance), and are already required to meet work requirements for those programs
Some Medicaid expansion participants may have circumstances that satisfy work‑requirements
Exemptions are circumstances that count as meeting the work‑requirement rules
If someone qualifies for an exemption, their circumstances allow them to remain eligible without showing qualifying‑activity compliance
- You are under the age of 19
- You are entitled to or enrolled in Medicare Part A or enrolled in Medicare Part B
- You were released from incarceration within the last 3 months
- You receive Medicaid under another eligibility group
- You were hospitalized or in a nursing home (or a similar facility) or got outpatient care for a serious issue
- You or a dependent traveled outside of their community for an extended period of time, to receive medical care for a serious medical condition during a qualifying month.
- The State of Idaho reserves the right to request an exemption for those residing in a county with a federal emergency or disaster declaration
- The State of Idaho reserves the right to request an exemption for those residing in a county with high local unemployment
Keeping Medicaid Coverage
- Participants must stay enrolled and either meet an excluding circumstance, qualify for an exemption, or demonstrate at least three months of qualifying‑activity compliance during their current six‑month certification period
- DHW will notify participants when action is needed based on their renewal date
- Staying informed, reporting changes, and completing required steps on time helps keep coverage uninterrupted
- If a participant cannot demonstrate compliance with work requirements or qualify for an exemption, they may lose Medicaid eligibility and may not be able to claim the Advance Premium Tax Credit (APTC)
- Individuals who do not qualify for a tax credit can still purchase coverage through Your Health Idaho, the state’s official health insurance exchange.
- Make sure you have an account created on the Idalink customer portal and your communication preferences are up to date.
- Update your contact information: Make sure your contact information (like address, phone number, and email address) is up to date in Idalink idalink.idaho.gov
- Report changes that may affect your coverage in Idalink using the "Report Changes" function
- Watch your mail, email, and text alerts
- Take action right away if you get an official communication about your health coverage. Make sure to complete, sign, and return any paperwork by the deadline, along with any requested documents
- Track your activities. Keep track of any work, volunteer, job training, or school hours you complete each month. Start now so you’ll be ready to show you meet the new requirement when it’s time to renew your coverage.
- Gather documents: gather important medical or legal documents in case you need to show that you qualify for an exclusion or exemption.
- Sign up for the IDHW newsletter
- Continue to check the Idaho Department of Health and Welfare webpage for updates and information
If you are a current Medicaid recipient, you must report changes that impact your eligibility, including changes in income, home address, work status, and household size (like marriage, divorce, pregnancy, or adoption).
Contact DHW to report a change or provide requested information:
Online: idalink.idaho.gov
Phone: 877-456-1233
Email: MyBenefits@dhw.idaho.gov
Mail: P.O. Box 83720, Boise, ID 83720-0026
In person: Office Locations
Coming Soon
- Partner Toolkit
- Work Requirements Screening Tool