This year, it seemed like a repeal of Idaho Medicaid expansion — a longtime goal of some Republican state legislators — might have a shot.
After four patients died, Idaho governor approves restoring cut Medicaid mental health programs
At the start of the 2026 session, it was clear that the Legislature was bracing for a tough budget year, after years of tax cuts and plans for even more. Before the session started, House Speaker Mike Moyle, R-Star, signaled he was open to repealing expansion.
But a repeal bill didn’t even advance out of committee. To Republican Sen. Julie VanOrden, it seemed miraculous.
“The fact that we didn’t have a Medicaid expansion repeal bill, and get it passed and get it through was, to me, short of a miracle. Because the topic kept coming up over and over again,” VanOrden, of Pingree, told the Idaho Capital Sun. “… I think they really wanted to do it, but I will tell you in an election year, they don’t want to have that going into a campaign for their primary elections.”
But what lawmakers actually did seemed like a “backdoor” way to repeal expansion, argues Boise Democratic Sen. Melissa Wintrow.
In the 2026 legislative session, which was defined by budget cuts, Republican legislators tacked on strict work requirements for the roughly 80,000 low-income Idahoans on Medicaid expansion — which researchers estimate will kick tens of thousands of Idahoans off the public assistance program. And lawmakers cut pay rates for providers who care for people with disabilities and extended cuts to Medicaid’s already low pay rates for doctors.
But Medicaid’s budget could’ve fared worse this year, said Idaho Voices for Children Policy Director Hillarie Matlock. Lawmakers on the budget committee spared Medicaid from the deeper cuts they applied across state government. And in the final weeks of the Legislature, lawmakers and the governor restored funding to a cut Medicaid mental health program — after four patients died.
“We are grateful that lawmakers blocked Medicaid expansion repeal, and restored some critical mental health programs, but they also left $239 million unspent while cutting $45 million from Medicaid,” Matlock told the Sun. “That wasn’t unavoidable. It was a choice by the Legislature. And in the end, Idaho families and providers are going to feel the impacts of that.”
Disability pay cuts could push providers to close, one provider says
The Legislature’s cuts to disability provider pay rates, approved by the governor, will take effect July 1, at the start of the 2027 fiscal year.
House Bill 863 calls for cutting provider reimbursement rates for residential habilitation services by $21.8 million next fiscal year. It would rescind parts of pay raises that the Legislature approved in 2022. Some lawmakers say those raises were meant to expand services and use a new budget tool, which didn’t end up happening because of a court order in the KW v. Armstrong lawsuit.
The cuts, combined with the Medicaid pay rate cuts made last year, amount to a 10% reimbursement rate reduction for residential habilitation providers. But after the cuts, lawmakers behind the bill say providers will still be left with reimbursement rates that are 33% over where they were four years ago.
The services, also called supported living, are a range of help with routine daily living for people with disabilities, meant to help them live independently. Without residential habilitation, the alternative for some patients is living in an institution like a nursing home, said Jodi New, who owns Teton Supported Living.
During the legislative session, she told lawmakers the cuts would force some providers to close.
The 2022 raises helped her raise her staff’s pay rates from $12 to $18 an hour, and give them health insurance, she told the Sun. But the new cuts will mean she has to let go of her program director, a position that she said lifted some of the burdens of running the business off her.
The 4% Medicaid provider pay rate cuts last year caused her to close her work office — and shift to working out of her home, she said.
“Any additional cuts from there, we would probably have to close our doors,” New said.
She said she’s working hard to not cut her staff’s pay or health insurance.
“If we can’t pay our staff a reasonable wage, we’re not going to get good staff. And these participants’ lives are in their hands. And that is something that they are not understanding, is that this directly comes out of the direct support staff budgets or what we pay them. And the quality of care goes down, and that’s not fair to the participants,” New said.
Part of why lawmakers landed on the residential rehabilitation cuts is it was one of few services on the governor’s list of cut options that wouldn’t entirely eliminate a service, VanOrden said. She said she hopes providers won’t close.
“I would hope that it’s just like any other business. When you don’t get the income that comes in you, you figure out what the priority is in your business, and that’s where you focus your money,” VanOrden told the Sun.
But Wintrow and Idaho Falls Republican Sen. Kevin Cook warned that the disability provider pay cuts may be going too deep. In the Legislature’s budget committee, they both proposed other options to get to $22 million in Medicaid cuts — which other lawmakers rejected.
Some lawmakers saw the disability provider pay cuts as an alternative to repealing Medicaid expansion.
That’s how Nampa Republican Rep. John Vander Woude, the chairman of the House Health and Welfare Committee, cast it.
When Vander Woude first brought an earlier version of the bill, his committee voted to delay a decision on the bill. Days later, he brought what he said was an alternative: A bill to repeal Medicaid expansion. The next day, his committee approved a new bill for disability cuts.
But not everyone was on board with an expansion repeal. It wasn’t on the governor’s list of options for Medicaid cuts, and he’s hinted he wouldn’t support the move. VanOrden has said she wouldn’t either.
Idaho adopts strict Medicaid expansion work requirements
President Donald Trump’s One Big Beautiful Bill Act, signed into law in July, meant people on Medicaid expansion would need to prove they are working to keep coverage by 2027. Idaho has long wanted Medicaid work requirements.
But states could decide how far back people enrolled will need to prove their work history.
This year, Idaho Republican lawmakers chose the longest period of time allowed: Three months. Some say that’s longer than other conservative states picked.
VanOrden, who cosponsored House Bill 913 for Medicaid work requirements, said lawmakers picked the longest lookback period to ensure people on Medicaid expansion actually need it.
That would show, she said, “That they were working but having trouble finding insurance. Not that they were finding a job so that they could get on the program.”
In debate on the bill, Wintrow called it “an attempt to do a backdoor repeal of Medicaid expansion.”
Medicaid work requirements and other changes in the “Big Beautiful Bill” could kick 20,000 to 34,000 Idahoans off Medicaid expansion by 2028, according to a recent analysis by the Urban Institute and the Robert Wood Johnson Foundation. That’s lower than what some other researchers estimate.
Idaho Medicaid expansion covers nearly 79,000 Idahoans. About 48% of able-bodied adults on Idaho Medicaid are working, according to a December report by the Idaho Department of Health and Welfare.
Advocates say Medicaid work requirements are effectively costly administrative barriers to access the program. The rules, they say, could kick working Idahoans off the program because many would fail to submit the right paperwork.
In Idaho, there’s precedent for that.
In 2024, as Idaho health officials finished reviewing the eligibility of everyone on Medicaid after the end of pandemic-era rules that effectively barred states from removing even ineligible people from Medicaid, about 40% of Idahoans on Medicaid were removed for not replying to the state’s requests for information, the Idaho Capital Sun reported.
That process, called Medicaid unwinding or redetermination, will likely foreshadow the state’s experience with work requirements, Matlock said.
“We anticipate Idahoans on Medicaid expansion to have a similar experience as they did during the unwinding process,” she told the Sun. “We often heard families and Idahoans talk about not understanding the new rules, the changes and struggled to navigate the process, (and) call center wait times were very high.”
The work requirements are even more complex than the unwinding process, Matlock added.
Idaho’s Medicaid work requirements are set to take effect by the end of this year, unless Gov. Brad Little vetoes House Bill 913.
After patients died, lawmakers restored a critical Medicaid mental health program
Lawmakers on the budget committee, called the Joint Finance-Appropriations Committee, exempted Medicaid from extra 1-2% cuts it enacted for other areas of state government.
That came after the Idaho Department of Health and Welfare warned the committee that additional cuts could require eliminating services not required by law, like those on the governor’s list of Medicaid cut options, or delaying Medicaid payments, which could force providers to “close their doors.”
Lawmakers also wrestled with the impacts of one cut made after the governor’s order for budget cuts last year.
In less than three months since an Idaho Medicaid contractor cut a mobile treatment program for people with severe mental illness, four patients died, the Idaho Capital Sun reported. In the 18 months before the cut, providers say just one patient died. The program was designed for people who have struggled in routine treatment settings.
But lawmakers passed, and the governor quickly signed, a bill to reinstate funding for the mobile treatment program, called the Assertive Community Treatment program, and peer support services, which help people navigate mental health treatment.
The fallout of the cuts caught the attention of the New York Times, which sent a reporter to Idaho to interview families and providers of the people who died.
“They realized, well, that was a mistake,” Bonneville County Sheriff Sam Hulse, president of the Idaho Sheriffs’ Association, told the New York Times. “You started seeing deaths occurring in the community. We started seeing the numbers in the crisis system rise. The very thing we told them would happen was beginning to happen.”
Wintrow called it “pretty shameful that it took four deaths to actually get the Legislature’s attention to reinstate pretty important programs.”
“It happened because this Legislature chose to cut the revenue over the last four years so hard. And then last year in particular, $453 million worth — which we the Democrats, were yelling at the top of our lungs, ‘Don’t do.’ And even the governor said, ‘Don’t do,’” Wintrow said. “But they did it anyway, knowing that this would be the problem that we would have, and that would justify these significant base reductions in all state agencies.”
Idaho Capital Sun is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christina Lords for questions: info@idahocapitalsun.com.