BOISE — Gov. Brad Little isn’t proposing adding a work requirement to the Medicaid expansion initiative Idaho voters passed in November, but he isn’t saying “No” to the idea either.

In his State of the State address Monday, Little reaffirmed his commitment to implementing Proposition 2 but said he wanted to use an “Idaho approach.”

“We need spring in our safety net so that there are multiple pathways for the gap population to move off Medicaid and onto private coverage,” he said.

While Little’s budget proposal doesn’t include funding for work requirements or other limits on coverage, his budget director Alex Adams told the Joint Finance-Appropriations Committee on Tuesday that Little could consider changes to the program.

“He’s open to those conversations and his staff intends to engage actively in those discussions,” Adams said.

Democrats and Medicaid expansion advocates are urging lawmakers to implement Proposition 2 without making any changes. Lauren Necochea, director of Idaho Voices for Children, said at a news conference Monday that adding work requirements could punish people who have mental illnesses, home-schooling mothers or people whose hours fluctuate because they work seasonal jobs.

“The Legislature’s only charge is to appropriate the state’s share as part of the Department of Health and Welfare budget,” she said.

Sen. Mark Nye, D-Pocatello, urged Republicans not to add any conditions to Medicaid expansion, saying they would be “extremely expensive to enforce and do not achieve any positive goals.”

“When Idahoans voted they were not asking for a complicated, wasteful, politicized solution,” Nye said in a news release. “They asked us to bring millions of federal dollars back to Idaho. They asked us to have compassion for those who need health care.”

House Health and Welfare Committee Chairman Fred Wood, R-Burley, told the Times-News on Monday he thinks a majority of House members back work requirements.

“I think we’re going to have to have that to get the funding,” he said.

States must get waivers from the Centers for Medicare and Medicaid Services to make changes to Medicaid. Numerous Republican-run states that have expanded Medicaid to cover people making up to 138 percent of the poverty level have also added additional restrictions on coverage. Work requirements, which often require someone to spend at least 80 hours a month either working or in school or job training, have been approved in several states, although they are only being enforced in Arkansas for now.

Another issue with adding requirements is paying for the administrative costs. The federal government pays 90 percent of the cost of expanded Medicaid. However, the federal match for any extra costs resulting from additional state requirements would almost certainly be less than 90 percent, budget analyst Sara Stover told JFAC.

The state needs to come up with $20 million to cover six months of Medicaid expansion this fiscal year, and it is projected to cost $40 million in the first full year after that. Little proposes moving $9.3 million from the health and prison budgets, which are providing health services now that expanded Medicaid is expected to cover, and the other $10.8 million from the Millennium Fund, an endowment created with the funds from the 1998 tobacco settlement.

Senate Health and Welfare Committee Chairman Fred Martin, R-Boise, said he likes Little’s proposal since it doesn’t take money from the general fund. One of the arguments against Medicaid expansion, he said, was that funding would compete with education or public safety. While the savings won’t happen immediately, expansion is expected to reduce state and local spending on indigent health care. Martin said he hopes this savings will help cover the cost of expansion in the future. The state budgeted $12.5 million for indigent care in 2018-2019, and Little is asking for $17.5 million for 2019-2020.

Martin didn’t rule out work requirements entirely but he said he would tread carefully when it comes to changing something voters approved. Sixty-five percent of his constituents, he said, voted for expansion.

“I’ll look at any amendment that’s beneficial to any bill, including Medicaid expansion,” he said. “I would be very cautious as a legislator to make any changes to the will of the people.”

Reporter Nathan Brown can be reached at 208-542-6757. Follow him on Twitter: @NateBrownNews.

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