BOISE — A bill has been introduced to put work requirements on Medicaid expansion enrollees and other limits on voter-approved Medicaid expansion.

The House Health and Welfare Committee voted Monday, with all the Republicans in favor and the Democrats opposed, to print the bill being sponsored by Rep. John Vander Woude, R-Nampa, clearing the way for a full hearing later.

Vander Woude’s bill would ask for a federal waiver to put a 20-hour-a-week work or job training requirement on Medicaid expansion enrollees, similar to the one that already exists for food stamp recipients. People with children under 18 would be exempted.

“That was a good step, I thought, to have parents home when the kids are teenagers,” Vander Woude said.

It would also ask for a waiver to let people making between 100 percent and 138 percent of the poverty level, if they choose, get private insurance through the Your Health Idaho state exchange instead of Medicaid.

“It will allow the people a choice to stay on their current policies that they now have,” Vander Woude said.

Vander Woude’s bill would also end Medicaid expansion if the federal share of the cost covered dips below 90 percent, unless the Legislature acts to continue it.

Almost 61 percent of Idaho voters approved a ballot measure in Idaho to expand Medicaid to everyone making up to 138 percent of the poverty level. Many Republican lawmakers had opposed Medicaid expansion for years, and ever since the initiative passed have been talking about ways to put limits on it. Democrats and Medicaid expansion advocates have been urging lawmakers to implement Medicaid expansion without any changes.

Assistant Minority Leader Rep. Ilana Rubel, D-Boise, said putting limits on Medicaid expansion such as what Vander Woude is proposing would go against what voters wanted.

“In this case, we have a really rare and extensive insight into the will of the voters that we don’t typically have on most bills,” she said.

Rubel also said she had “grave concerns” about the fiscal impact note, which says the ongoing administrative costs would be $1.765 million a year, of which the state would pick up $1.486 million and the federal government the rest. Rubel said she worried it would lead to increased county indigent health care spending on people who are kicked off Medicaid due to not fulfilling the work requirement. Rep. Muffy Davis, D-Ketchum, asked if Vander Woude had done a cost-benefit analysis on whether the state would save money despite the extra administrative costs.

“I believe there’s always a benefit if we can help people move off a government program and be self-sustaining,” Vander Woude replied.

The waivers Vander Woude is requesting would have to be approved by the federal Centers for Medicare and Medicaid Services before they could be implemented. Waivers for work requirements have been approved in numerous states, as have “IMD waivers,” which Vander Woude is also requesting, which let the state spend Medicaid funds on institutional mental health care.

Waivers to let people making between 100 and 138 percent of the poverty level get exchange insurance have been proposed in other states but none have been approved yet.