Idaho’s Department of Health and Welfare will begin checking whether adults on Medicaid expansion show 80 hours a month of work, school or community service, or at least $580 a month in earnings, starting Jan. 1, 2027. The department’s Medicaid expansion page says reviews begin for participants whose coverage periods end on or after that date. Coverage can end for anyone who cannot show it.
The rule comes from the federal budget law signed July 4, 2025, Public Law 119-21. The Centers for Medicare & Medicaid Services (CMS) wrote it into an interim final rule that took effect July 31, 2026, and every expansion state must be running it by Jan. 1, 2027.
The group is adults aged 19 to 64 with household income up to 138% of the federal poverty level, which Medicaid.gov’s Idaho page puts at about $22,025 a year for one person and $29,863 for two. About 85,000 Idahoans were in expansion coverage this fall, Idaho Capital Sun reported, citing department figures. Anyone in that group should find out now which side of the line they are on.
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The 80-hour rule and the $580 option
The department’s July 23 announcement says enrollees must document 80 hours each month of employment, community service, or approved education or training. Earning at least $580 a month also meets the rule. The expansion page adds that hours can be mixed, including approved work programs, volunteering, job training and part-time school.
CMS ties the $580 figure to the federal minimum wage. Its fact sheet sets the income test at 80 times the hourly minimum, which comes to $580 a month in 2026.
New applicants face a look-back. The department says they must show three months of qualifying activity before approval. Current members must show compliance during their six-month certification period, and the department says re-evaluations will now come every six months instead of once a year.
Who is exempt in Idaho
Some people never have to prove hours. The department’s list of exclusions and exemptions includes:
- Women who are pregnant or were pregnant in the last 12 months
- The main caregiver of a child 13 or younger, or of a person with a disability
- People with a physical, mental or developmental disability, a serious or complex health condition, a disabling mental health condition, or blindness
- People with a substance use disorder or in drug or alcohol treatment
- Young adults aged 18 to 25 who aged out of foster care
- American Indians and Alaska Natives
- Veterans with a 100% disability rating
- People who are in jail or prison, or were released within the last 90 days
- People who get SNAP or TANF and already face those programs’ work rules
The expansion page also lists people under 19 and anyone enrolled in Medicare Part A or B. Medicaid.gov says people aged 65 and older are outside the rule. Anyone on that list should gather paperwork that proves it, because the department will ask.
How many are already in compliance
The state has told enrollees much of this is already met. In a July review of about 83,000 expansion enrollees, the state found 68,400 already met the requirements, according to the Idaho Capital Sun. That leaves roughly 14,600 who did not show up as compliant in that review.
Researchers at the Urban Institute and the Robert Wood Johnson Foundation project that 20,000 to 34,000 Idahoans could lose expansion coverage by 2028. That is a projection, not a state count. The department says it is sending letters to all affected households.
Notice window and what happens next
Idaho has not published a number of days to respond. The department says it will notify participants when action is needed, based on their renewal date. The federal rule is firmer. CMS requires states to send a notice of noncompliance and give 30 calendar days to show compliance, according to the Federal Register text and the CMS fact sheet.
People who lose coverage can reapply at any time, and Medicaid.gov’s Idaho page says they may be able to buy a plan through Your Health Idaho, though without premium assistance. Retroactive coverage is also shrinking. The expansion page says it will be two months for Medicaid and one month for expansion applicants.
The department asks members to keep their address, phone and email current through Idalink, the state’s online benefits portal, and to watch for letters. Questions can go to 1-877-456-1233. The full rules are on the department’s Medicaid expansion page.
Which month will the first letter land in?
The first reviews depend on each member’s coverage period, so timing differs from one household to the next. Someone whose period ends in January faces the check right away. Someone whose period ends later in 2027 gets more time, but the three-month look-back means the hours start counting earlier than the review.
The practical step is to keep a monthly log of hours or pay stubs now. Anyone who works irregular shifts should check whether $580 in earnings is the easier test than counting hours.
Need to prove 80 hours or an exemption before January?
A member who misses the state’s letter or cannot document an exemption can lose Medicaid expansion coverage, and a new applicant needs three months of qualifying activity before approval.
The SNAP & Medicaid Renewal Organizer covers the new Medicaid work requirement and who is exempt, and includes 51 state packs, a renewal document checklist and a renewal and reporting calendar, so each hour log, exemption paper and date has a place.
Get the Medicaid work-rule checklist and renewal calendar for Idaho expansion adults →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
Warren Cohen is a finance writer based in Phoenix, Arizona, covering personal finance topics including credit, banking, and beginner investing. He earned his degree in business administration from Arizona State University and began his career working in consumer finance, where he gained direct experience with lending and credit systems. He now writes for personal finance websites and fintech platforms, focusing on clear, practical content that helps readers make informed financial decisions.
