Medicaid Expansion in Idaho: What’s at Stake?

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In 2018, Idaho voters made their voices clear: Medicaid expansion was the right step. The initiative passed with strong public support, ensuring thousands of working residents could access affordable healthcare.  

However, recent legislative proposals may affect the future of Medicaid expansion.

State lawmakers are considering significant changes through House Bill 138, which could impose work requirements and benefit caps. If the federal government doesn't approve these changes by July 2026, Medicaid expansion may be repealed, and 145,000 Idahoans who rely on Medicaid for health coverage could lose access. 

Let’s break down what this means for Idahoans and the broader community.

Who uses Medicaid expansion? 

Medicaid expansion supports working Idahoans. More than 80% of enrollees have jobs in essential industries like retail, food service, childcare, and healthcare. For some, Medicaid is the only affordable health insurance option, as employer-sponsored plans can be out of reach in low-wage jobs. 

As of January 2025, to qualify for Medicaid expansion: 

• An individual must earn equal to or under $1,677 per month (about $11 an hour) 

• A family of four must earn equal to or under $2,937 per month (about $35,245 a year) 

With Idaho’s minimum wage still at $7.25 per hour, many working families fall within these income brackets. 

The coverage gap: Who gets left behind?  

Without Medicaid expansion, some Idahoans could fall into a gap where they earn too much for Medicaid but too little to qualify for insurance subsidies through Your Health Idaho (the state’s health exchange). 

• Those who earn at least $15,060 per year ($31,200 for a family of four) qualify for subsidies to buy insurance. 

• Those who earn just below that amount won’t qualify for Medicaid or subsidies. That means they’d have to pay full price for a health plan, where the cheapest option is $326 per month. 

Why this affects everyone 

Even if someone has employer-sponsored insurance, repealing Medicaid expansion impacts healthcare costs across the board: 

• More unpaid hospital bills: Hospitals pass those losses to insured patients through higher costs. 

• Higher employer-sponsored premiums: As hospitals increase rates, businesses pay more for employee health plans, leading to lower wages or reduced benefits. 

• More ER visits for basic care: Without insurance, people often delay care until it’s an emergency. That drives up costs for everyone. 

What can Idahoans do?  

This issue affects all Idahoans. Here’s how to stay informed and get involved: 

Stay informed 

• Learn more from the Idaho Department of Health & Welfare 

• Explore insurance options at Your Health Idaho 

• Follow policy updates from the Idaho Center for Fiscal Policy 

Make your voice heard 

• Contact your state legislators to share your perspective: legislature.idaho.gov 

• Attend public hearings on Medicaid policy and healthcare costs. 

• Share this information with friends, family, and coworkers. 

Healthcare access is a community issue, and policies should foster a healthy workforce and stable insurance costs. Staying informed and involved ensures that healthcare access remains a priority.

Photo by lacheev