Starting next year, Idahoans on Medicaid expansion will need to prove they’re working to keep accessing the health insurance public assistance program.
That’s only if they don’t meet one of several carveouts, like going to school, or being a caregiver for young kids or people with disabilities.
State officials think most of the roughly 85,000 people on Medicaid expansion are already meeting the new rules. But if Idahoans want to tap one broad exception, meant for people with disabilities, they might need a doctor’s note, according to a top official at the Idaho Department of Health and Welfare, which runs Medicaid.
“The department will review any medical documentation submitted, but the most straightforward documentation will be a note from their health care provider,” Idaho Medicaid Administrator Sasha O’Connell said in a statement. “This would only be needed if we don’t already have evidence of medical frailty in our claims system for existing members.”
Some advocates in Idaho say that will add another hurdle to a process that they say is already filled with administrative burden.
“If somebody is diagnosed with cancer, it’s already a full-time job in itself,” American Cancer Society Cancer Action Network’s Idaho Government Relations Director Randy Johnson said in an interview. “You’re trying to navigate your treatment, you’re trying to get your life tasks, and then just simply trying to get out of bed or brushing your teeth. And so the ability to have your insurance being taken away by another set of bureaucracy that’s put in front of people — it’s terrifying.”
As states rush to change Medicaid enrollment systems to comply with new work requirements in President Donald Trump’s One Big Beautiful Bill Act, the Trump administration narrowed its interpretation of one exception for the new rules: For people who are “medically frail.”
In June, about six months before most states needed to roll out the work requirements, the Centers for Medicare and Medicaid Services published guidance clarifying that to qualify for the “medically frail” designation, a person must have a significant health condition and be significantly impaired in their ability to work, Stateline reported. Then 25 states — all led by Democrats — sued, arguing that the narrowed definition may cut out many sick and disabled people from the program.
In Idaho, a Republican-led state, state health officials have been developing their own policy for the exemption that leans on a mix of medical claims and requiring medical documentation from patients.
The feds let states ease patients into providing medical proof. Idaho isn’t taking it.
The Idaho Department of Health and Welfare isn’t going to give patients a one-year grace-period that the feds allowed — in which patients can simply claim the exemption without providing proof, O’Connell said.
“We plan to accept attestations the first time someone is subject to the new Medicaid rules for Medicaid, and will require medical documentation if we do not see in our claims system that the person had a corresponding doctor’s visit, hospital stay, or other interaction supporting that they have a condition that makes it difficult for them to meet the new rules,” she said.
But after then, state health officials will rely on a mix of medical claims data and notes from healthcare providers.
Health and Welfare couldn’t immediately provide estimates for how many people on Medicaid expansion could be subject to the exemption. But O’Connell suggested the number would likely be small, since the “vast majority of people with disabilities who rely on Medicaid” qualify for traditional Medicaid, not Medicaid expansion, which is the only population affected by the work requirements.
On an initial review, she said Health and Welfare found that “the vast majority” of people on Medicaid expansion were already “meeting the new requirements.” The agency found that 68,400 Idahoans on Medicaid expansion met the new work requirements, out of the roughly 83,000 on the program at the time of the review, she said.
“The remaining population will have the opportunity to provide documentation showing that they met the requirements if it wasn’t in our systems,” O’Connell said.
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