Idaho Medicaid covers adults ages 19 to 64 at or below 138% of the Federal Poverty Level after voters approved expansion in 2018 and coverage began January 1, 2020. Terminations still happen in 2026 for three common reasons: a renewal packet that went unanswered, income data that now shows earnings above the 2026 limit of $22,025 for a single adult, or a change in household size. The Idaho Department of Health and Welfare (IDHW) runs Idaho Medicaid, and a termination notice arrives by mail or in your online account. That notice is the most important document you will handle, because it carries your end date, your appeal rights, and the proof you need for a Marketplace Special Enrollment Period. Federal rules treat loss of Medicaid as a qualifying life event, so you can shop on Your Health Idaho, the state-based Marketplace at yourhealthidaho.org, without waiting for Open Enrollment. The clock is 90 days, and it is worth starting on the day the notice arrives rather than the day coverage ends.
Idaho Medicaid rules are changing in 2027, which raises the stakes for anyone who loses coverage in late 2026. IDHW has announced that expansion work requirements start January 1, 2027, requiring about 80 hours a month of work, community service, or approved training, or earnings of roughly $580 a month, with exemptions for groups such as pregnant and postpartum adults and caregivers of young children. Federal law (H.R. 1, enacted in 2025) also moves expansion adults to renewals every six months for renewals after December 31, 2026, so paperwork terminations are likely to grow. KFF analysis of H.R. 1 notes that adults denied Medicaid for not meeting work requirements can also lose access to Marketplace premium tax credits, so keeping documentation clean matters. For a 2026 loss, the standard rules still apply: Marketplace SEP of 90 days, Medicaid reapplication year-round, and CHIP for children. The steps below show how to protect coverage on both tracks, what to submit, and how to compare a Your Health Idaho plan against the other options.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
Idahoans who lose Medicaid in 2026 most often run into these avoidable problems:
- Waiting to see if the appeal succeeds before shopping. The 90-day Marketplace SEP keeps running during an appeal, so file the hearing request and pick a Your Health Idaho plan in parallel.
- Letting the 30-day fair hearing deadline pass. Idaho Medicaid appeals are timed from the notice date, not the coverage end date, so a late request can forfeit a termination that was actually an error.
- Using 2025 income instead of projected 2026 income. Premium tax credits are based on projected 2026 household income, and a wrong estimate can create a repayment bill when you reconcile Form 1095-A.
- Skipping the first premium payment. A Your Health Idaho plan is not active until the carrier receives payment, which leaves you uninsured despite finishing the application.
- Buying a short-term plan instead of a Marketplace plan. Short-term plans can deny pre-existing conditions and do not qualify for premium tax credits or a Marketplace SEP.
Why Idaho Medicaid Coverage Ends in 2026 and What Triggers the SEP
Idaho Medicaid terminations in 2026 fall into three groups, and each calls for a different response. Procedural terminations happen when IDHW does not receive a renewal form or verification by the deadline, even though the household may still qualify. Procedural terminations are the most likely to be reversed by a prompt reply or a fair hearing. Income-based terminations happen when data from employers, the IRS, or the Social Security Administration shows earnings above 138% FPL ($22,025 for one adult in 2026). Household changes, such as a child leaving the home, a move out of Idaho, or gaining other coverage, produce the third group. Under federal Marketplace rules at healthcare.gov, any of these losses is a qualifying life event that opens a Special Enrollment Period. The temporary unwinding SEP that CMS offered after the pandemic ended in 2024, so the standard 90-day Marketplace SEP is the rule that applies today. Keep the IDHW notice as your qualifying event document.
Idaho Medicaid Income Limits and Your Health Idaho Subsidies in 2026
Idaho Medicaid income limits and Marketplace subsidies form a ladder in 2026. Adults ages 19 to 64 qualify for Idaho Medicaid at or below 138% of the Federal Poverty Level, which is $22,025 for one adult and $45,540 for a family of 4 under the 2026 HHS ASPE guidelines. Between 138% and 400% FPL, Your Health Idaho enrollees qualify for premium tax credits, and the 2026 ceiling is $63,840 for one adult and $132,000 for a family of 4. The 400% cliff returned for 2026 when the enhanced credits from ARPA and the Inflation Reduction Act expired on January 1, 2026, so incomes just over the line receive no credit. Silver plans carry cost-sharing reductions for incomes up to 250% FPL, which is $39,900 for one adult in 2026. Compare the table above with your projected 2026 household income, and check the Medicaid income limits and ACA income limits pages before choosing between reapplying and shopping.
CHIP and children's Medicaid follow a higher income rule than adult coverage in Idaho. Children in households up to roughly 185% FPL qualify for Idaho Medicaid or CHIP in 2026, so a child can keep coverage even when a parent moves to a Your Health Idaho plan. Applications for children are accepted year-round at idalink.idaho.gov, with no Special Enrollment Period needed. Families with a mix of eligibility, such as a parent on a Marketplace plan and children on CHIP, should apply for everyone in one household application so IDHW and Your Health Idaho assign each person to the right program. Tax filers who receive premium tax credits will get Form 1095-A in early 2027 to reconcile 2026 credits on their federal return. Parents who lose coverage should confirm each child by name on the new application, since a child already enrolled in Idaho Medicaid or CHIP does not need a Marketplace plan. Medicaid.gov lists state CHIP income standards if your household size or income changes during 2026.
Idaho Medicaid Changes in 2027 and What They Mean for a 2026 Coverage Loss
Idaho Medicaid expansion enters a new rulebook on January 1, 2027, and 2026 decisions should account for it. IDHW plans to begin reviewing work requirements for expansion adults whose coverage periods end on or after that date, and federal law under H.R. 1 requires six-month renewals for expansion adults starting with renewals after December 31, 2026. More frequent renewals mean more chances for a missed form to cause a procedural termination, so set up online account alerts and keep your mailing address current with IDHW. KFF analysis of H.R. 1 also warns that people denied Medicaid for work-requirement noncompliance may be barred from Marketplace premium tax credits. Anyone who loses coverage now for another reason keeps the full 90-day SEP and subsidy access, which is one more reason to act before Day 90 rather than waiting for the 2027 rules. Adults who expect to work, study, or volunteer at the required level in 2027 should start keeping pay stubs, timesheets, and attendance records now, because those records speed up any renewal review.
Frequently Asked Questions
What is the Special Enrollment Period after losing Idaho Medicaid?
The Marketplace SEP after losing Idaho Medicaid lasts 90 days from the date your coverage ends. For example, if Idaho Medicaid ends November 30, 2026, you can enroll on Your Health Idaho from December 1, 2026 through February 28, 2027. You can also select a plan up to 60 days before the end date so coverage starts without a gap. Idaho residents enroll through yourhealthidaho.org rather than healthcare.gov. After the window closes, you generally must wait for Open Enrollment, which begins November 1, 2026 for 2027 coverage. Idaho Medicaid itself has no enrollment window, so you can reapply at any time if your income qualifies.
How do I document the loss of Idaho Medicaid for a Marketplace SEP?
Your Idaho Medicaid termination notice from the Idaho Department of Health and Welfare is the main proof of the qualifying life event. Upload it to your Your Health Idaho account if the application requests verification, and keep a copy for your records. You will also need Social Security numbers for everyone applying, proof of Idaho residence, and projected 2026 income documents such as pay stubs, an unemployment award letter, or a self-employment estimate. If you cannot find the notice, log in to your online Idaho Medicaid account or call 1-877-456-1233 to request a copy. Submit documents promptly, because missing verification can cancel an enrollment even when the SEP window was met.
What happens if I miss the 90-day SEP after losing Idaho Medicaid?
Missing the 90-day Marketplace SEP means you cannot buy a Your Health Idaho plan until Open Enrollment, which begins November 1, 2026 for 2027 coverage, unless another qualifying life event opens a new SEP. Coverage from Open Enrollment starts January 1, 2027, so any months in between would be uninsured. Two protections remain. First, Idaho Medicaid accepts applications year-round, so you can reapply whenever your income is at or below 138% FPL ($22,025 for one adult in 2026). Second, children can apply for Idaho Medicaid or CHIP at any time. The safest approach is to pick a plan before Day 90, even if you are still appealing.
Can I get retroactive Idaho Medicaid coverage if I reapply?
Idaho Medicaid can cover medical bills from up to three months before the month you apply, if you met the eligibility rules in those months, under the federal retroactive coverage provision described at medicaid.gov. Federal law in 2025 (H.R. 1) shortens that lookback for expansion adults to one month for applications starting in 2027, so a 2026 application keeps the longer window. If an appeal succeeds, coverage is restored back to the termination date with no gap. A Your Health Idaho plan is never retroactive. It starts the first of the month after you select a plan, or the first of the month after your Medicaid ends if you select before the loss date.
What is the difference between COBRA and a Marketplace plan after losing Idaho Medicaid?
COBRA applies only if you also lost employer-based coverage, because Medicaid has no COBRA option. COBRA keeps your old employer plan at 102% of the full premium, roughly $400 to $900 a month for an individual and $1,200 to $2,800 for a family in 2026, with a 60-day election window. A Your Health Idaho plan costs far less for most people after premium tax credits, and loss of Medicaid opens the 90-day Marketplace SEP either way. Choose COBRA mainly to keep a specific specialist or a deductible already met in 2026. Otherwise, compare Your Health Idaho plans first, since subsidies and cost-sharing reductions often beat COBRA on price.
What Idaho-specific rules apply when I lose Medicaid in 2026?
Idaho runs its own state-based Marketplace, Your Health Idaho, so enrollment happens at yourhealthidaho.org or 1-855-944-3246 instead of healthcare.gov. Idaho Medicaid is run by the Idaho Department of Health and Welfare, with applications at idalink.idaho.gov and 1-877-456-1233. The department allows 30 days from the notice date to request an appeal or fair hearing. Expansion adults qualify at or below 138% FPL ($22,025 for one adult in 2026), and Idaho plans to start work requirements on January 1, 2027, with exemptions for groups such as pregnant adults and caregivers of young children. Check the department's Medicaid expansion page for current rules.
Do I still qualify for Idaho Medicaid after my coverage ended?
Idaho Medicaid expansion covers adults ages 19 to 64 with household income at or below 138% FPL, which is $22,025 for one adult, $29,863 for two, $37,702 for three, and $45,540 for four in 2026. Income is measured as MAGI, including wages, self-employment income, and unemployment benefits. If your projected 2026 income is under the line, reapply at idalink.idaho.gov, because a data error or missed form may have caused the termination. If your income is above the line, a Your Health Idaho plan with premium tax credits is the next stop, and the household-size table on this page shows the 2026 limits for larger families.
What happens to my children's coverage if I lose Idaho Medicaid?
Children's coverage is evaluated separately from adult coverage. Idaho Medicaid and CHIP cover children in households up to roughly 185% FPL in 2026, a higher line than the 138% FPL adult limit. A parent's termination does not automatically end a child's coverage, and children can apply at idalink.idaho.gov at any time of year with no SEP required. If your child lost coverage too, request a fair hearing within 30 days of the notice and reapply right away. Families who earn too much for CHIP can add children to a Your Health Idaho plan during the same 90-day SEP window opened by the family's loss of Medicaid.
