BOISE, Idaho (AP) — The House on Thursday approved amended Medicaid expansion legislation that removes Idaho recipients from coverage if they fail to meet work requirements.

Representatives voted 49-20 to approve the legislation, which they received from the Senate two days earlier. The House first approved amendments to the bill and a few hours later approved the amended bill as the two chambers attempt to reach a compromise that can win the approval of Republican Gov. Brad Little.

The amended bill removes able-bodied recipients for two months from Medicaid coverage. But recipients could immediately get back coverage if they get a job or prove they meet the requirements through training or school.

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A Senate committee last month killed legislation originating in the House that kicked people off Medicaid for failing to meet work requirements.

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The Senate “understood full well when they sent it over here that we had intentions of amending it,” said Republican House Speaker Scott Bedke during a break in proceedings. “So we have.”

“The biggest thing is just my disappointment in the argument they’re making that rural Idaho needs these work requirements to maintain pride,” said Democratic House Minority Leader Mat Erpelding after the House adjourned.

Voters authorized Medicaid expansion with an initiative in November with 61% of the vote after years of inaction by the Legislature.

The expansion will provide access to preventative health care services for an estimated 91,000 low-income residents. The federal government would cover 90% of the estimated $400 million cost.

The Senate previously passed an appropriations bill paying for Medicaid expansion as approved by voters with no work requirements. Little has included $20 million for the expansion in his budget.

But the House has refused to vote on the appropriations bill because many members want work and other requirements for Medicaid recipients.

Republican Rep. Barbara Ehardt said during the debate that she didn’t mind paying to make sure the young, the aged and the infirm had medical coverage. But “I am not willing nor do I think it is fair that I should have to be asked to continue to work four jobs, maybe five jobs, to pay for those people who are not working,” she said.

Republican Rep. Julianne Young said adding work requirements for able-bodied recipients was what voters sought when they read the voters’ guide that said the legislation would help “working Idahoans.”

“That is what the voters voted for,” she said. “I think we seriously have to question if this would have passed if it was for people who chose not to work.”

Other concerns among House members included the state getting stuck paying more if the federal government reduces its 90% portion of the Medicaid cost. That was the focus of another amendment approved Thursday that requires lawmakers to review Medicaid expansion if the federal government portion drops below 90%.

The bill, unlike other versions, has no work-training program or referral aspect, saving about $1.3 million in administrative costs.

“The only thing that’s in this bill is the part where we hire an enforcement squad to chase down the poorest people in the state and kick them off Medicaid,” said Democratic Rep. Ilana Rubel in arguing against the bill.

Last month, a federal judge in Washington, D.C., blocked Medicaid work requirements in Arkansas and Kentucky. The judge ruled that the requirement for low-income people posed numerous obstacles to getting health care that hadn’t been adequately resolved by federal and state officials.

That ruling appeared to play a part in sinking the House’s Medicaid expansion bill last month, and Rubel said the amended version would also likely be struck down by a federal court.

Earlier in the day, several amendments offered by Democrats failed in the Republican-dominated House. One of those would have ensured that individuals have access to job training, job-search resources and educational opportunities. Another amendment would have protected from discrimination job-seekers who are gay, lesbian or transgender.

The legislation now goes back to the Senate to see if that chamber agrees with the changes.