(CNN) Idaho voters approved Medicaid expansion in the fall, but Republican state lawmakers are now trying to add several restrictions to it.
The move follows similar action in Utah last month, where GOP lawmakers approved legislation limiting the scope of a measure also passed in November's midterms. Voters in a total of four states have turned to the ballot box to get around Republican lawmakers who've refused to adopt the Obamacare provision expanding Medicaid.
Idaho's legislature is considering a bill that would mandate certain newly eligible enrollees to work 120 hours a month to maintain their benefits, far higher than most state work requirement proposals.
The bill would also direct the state health department to ask participants about drug use so they can be referred to treatment. And it seeks to allow those just above the poverty line to get federal subsidies to purchase private coverage on the Obamacare exchange.
Under the bill, the Medicaid expansion would be eliminated entirely if federal reimbursement ever falls below 90% of the program cost.
Several of these measures require federal approval and would cost the state nearly $1.6 million a year, nearly all of which stems from administering the work mandate.
Some 91,000 people would gain coverage and the state would receive $400 million in federal matching funds under the ballot measure, which passed with 61% of the vote in November. Expansion is set to begin next year.
Butch Otter, the Republican governor at the time, endorsed the initiative days before the election, saying he supports broadening health insurance to those who need it. His successor, Brad Little, has said he will honor the will of the people, but pursue efforts to contain health care costs and move people off Medicaid and into private coverage.
The goal of the bill, which will be heard by a committee on Friday and could be voted on by the House as soon as next week, is to provide residents the opportunity to escape poverty, said Rep. John Vander Woude, the bill's sponsor. He has already consulted with Little and the state Senate.
"Some people think it's a roadblock. I think it's assistance," said Vander Woude, noting that many recipients are likely already working. "It will move them up the income ladder to become self-sufficient."
Advocates of expansion, however, said the legislation could strip coverage from more than 10,000 Idahoans and cost the state and local governments millions of dollars, in part to cover the health care needs of the uninsured.
"There was a very clear message sent by voters," said Luke Mayville, co-founder of Reclaim Idaho, which led the charge on the ballot measure, noting that it won in 29 of 35 legislative districts. "There should be no question of what voters want."
In Utah, Republican lawmakers pushed through a measure aimed at restricting coverage to those at or below the poverty line, instead of up to 138% of that threshold, as is standard under the Obamacare provision to expand Medicaid. The poverty line is roughly $12,500 for an individual and $25,750 for a family of four.
Utah's law, which is still awaiting federal approval, would also add work requirements, place a per-capita cap on spending and close the program to new enrollees if costs exceed the funds budgeted.
Medicaid expansion is proceeding in two other states where voters approved it. Maine Gov. Janet Mills, a Democrat, implemented the program in January after her Republican predecessor, Paul LePage, blocked it for more than a year. And expansion is expected to go into effect next year in Nebraska after residents approved a ballot measure in November.