2027 changes to Medicaid expansion

• 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