Idaho seeks CMS approval for Medicaid work requirements

A sign next to a road reading "Welcome to Idaho"
Idaho became the latest state to apply for work requirements for Medicaid. (Oscity/Shutterstock)

Idaho has applied to the Trump administration to install work requirements for able-bodied Medicaid expansion beneficiaries a few months after the administration turned down the state’s attempt for partial expansion.

Idaho’s application submitted Friday to the Centers for Medicare & Medicaid Services (CMS) comes as court rulings have stymied work requirements in several other states. Idaho voters approved a ballot measure in fall 2018 to approve the Medicaid expansion, and the state legislature passed a law that added work requirements to the application.

The state’s waiver request is similar to other work requirement applications in that it mandates individuals in the Medicaid expansion who are between 19 and 59 years old to work 20 hours per week to keep on Medicaid’s rolls.

The state would allow exemptions that include if people are pregnant, mentally or physically ill or are receiving substance abuse treatment.

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Idaho wants the waiver to go into effect on Jan. 1, 2020.

However, the state has already failed to convince CMS to adopt a partial expansion of Medicaid. The agency ruled in August that Idaho’s waiver wasn’t complete because it didn’t fully include information on the impact of coverage and federal budget neutrality.

CMS also rejected a partial expansion request from Utah. That state was seeking to cover only a part of the Medicaid expansion population but receive full expansion funding.

Utah voters also passed a ballot measure in 2018 calling for full expansion under the Affordable Care Act.

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CMS has been encouraging states to apply for work requirements, but it hasn’t found much success in the courtroom. So far, the agency has approved work requirement waivers for nine states.

A federal judge has struck down the work requirement programs for Kentucky, New Hampshire and Arkansas. The judge has said that the states and CMS haven’t done a good job evaluating how the work requirements would affect coverage and questioned whether the requirements go against the purpose of the Medicaid program to provide coverage to low-income people.

Arkansas is one of the few states that has implemented a work requirement program, which has since been shuttered due to the court ruling. A few months after work requirements went into effect in 2018, the state saw 17,000 people lose Medicaid coverage.