(1)The department of health and welfare is authorized to and shall submit to the centers for medicare and medicaid services the following state plan amendments and waivers no later than July 1, 2026:
(a)Work-requirements for able-bodied adults enrolled in medicaid in which no individual shall be eligible to participate in the medicaid program pursuant to section 56-267, Idaho Code, unless the individual is:
(i)Working twenty (20) hours or more per week, averaged monthly;
(ii)Participating in and complying with the requirements of a work program twenty (20) hours or more per week, as determined by the department;
(iii)Volunteering twenty (20) hours or more per week, as determined by the department;
(iv)Meeting any combination of working and participating in a work program for a total
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(1) The department of health and welfare is authorized to and shall submit to the centers for medicare and medicaid services the following state plan amendments and waivers no later than July 1, 2026:
(a) Work-requirements for able-bodied adults enrolled in medicaid in which no individual shall be eligible to participate in the medicaid program pursuant to section 56-267, Idaho Code, unless the individual is:
(i) Working twenty (20) hours or more per week, averaged monthly;
(ii) Participating in and complying with the requirements of a work program twenty (20) hours or more per week, as determined by the department;
(iii) Volunteering twenty (20) hours or more per week, as determined by the department;
(iv) Meeting any combination of working and participating in a work program for a total of twenty (20) hours or more per week, as determined by the department; or
(v) Participating and complying with the requirements of a work-fare program, unless the individual is:
1. Younger than nineteen (19) years of age;
2. Older than sixty-four (64) years of age;
3. Medically classified as physically or mentally unfit for employment;
4. Pregnant;
5. A parent or caretaker responsible for the care of a dependent child younger than six (6) years of age;
6. A parent or caretaker personally providing the care for a dependent with a serious medical condition or with a disability, as determined by the department;
7. Receiving unemployment compensation and complying with the work requirements as part of the federal-state unemployment compensation system;
8. Participating in a drug addiction or alcohol treatment and rehabilitation program; or
9. Enrolled at least part-time in a college, university, or vocational education program.
(b) Allow persons eligible for medicaid under section 56-267, Idaho Code, who have a modified adjusted gross income at least at or above one hundred percent (100%) of the federal poverty level to receive the advance premium tax credit to purchase a qualified health plan through the Idaho health insurance exchange established by chapter 61, title 41, Idaho Code, instead of enrolling in medicaid, except that the person may choose to enroll in medicaid instead of receiving the advance premium tax credit to purchase a qualified health plan.
(c) Implement the following changes to eligibility determination:
(i) Suspend requirements to renew eligibility automatically based on available information and pre-populated forms; and
(ii) Implement biannual redetermination for persons eligible for medicaid under section 56-267, Idaho Code.
(d) Implement the following changes to benefits:
(i) No funds shall be used to fulfill any contract or commercial transaction with any health care provider or health care facility under the terms of which such health care provider or health care facility agrees to provide services prohibited under section 18-1506C, Idaho Code; and
(ii) No funds shall be used to fulfill any gender reassignment procedures, including treatment and surgery for any resident eighteen (18) years of age or older.
(2) An individual is exempt from the provisions of any state plan amendment or waiver pursuant to this section if the individual is an American Indian or Alaska native who is eligible for services through the Indian health service or through a tribal program pursuant to the Indian self-determination and education assistance act or the Indian health care improvement act.