BOISE, Idaho (AP) - Idaho officials on Friday submitted a work-requirement waiver to the U.S. Department of Health and Human Services for Medicaid expansion, and they say four other waivers will likely be submitted by December.

The Idaho Department of Health & Welfare is also taking public comments on another waiver, taking steps to fix problems with a rejected waiver, and is negotiating with the federal agency.

Waivers are required when a state wants to deviate from standard Medicaid rules. Idaho lawmakers earlier this year added restrictions to voter-approved Medicaid expansion passed in November, each requiring a waiver.

The work waiver would require recipients age 19 to 59 to work 20 hours a week to remain eligible for Medicaid. There are exemptions for medical conditions.

The waivers could take months to process, with final decisions occurring after enrollment begins Nov. 1 and coverage starts Jan. 1. But those dates will remain valid.

“Medicaid expansion will happen on Jan. 1, 2020, regardless of the status of the waivers,” said Idaho Department of Health and Welfare spokeswoman Niki Forbing-Orr.

She said if waivers are approved past the deadlines, the agency would work to inform those affected.

Voters authorized Medicaid expansion with an initiative that passed with 61% of the vote after years of inaction by the Idaho Legislature.

The expansion provides Medicaid to people earning up to a maximum of 138% of the federal poverty level. That maximum is about $17,000 a year for one person and $35,500 for a family of four.

Of Idaho’s estimated 1.8 million residents, about 286,000 as of Sept. 1 were covered by Medicaid, according to the Idaho Department of Health and Welfare. Medicaid expansion would add an estimated 90,000 people costing $400 million, with the federal government paying 90%.

There are five waivers in all, including the work waiver.

Federal officials in August rejected a waiver request as incomplete that would allow Idaho residents who qualify for the expansion to stay on the state’s health insurance exchange.

“This waiver remains a high priority for Idaho, and Idaho is already taking steps to submit additional information,” the state agency said in an update posted on its website Thursday.

A similar waiver is on hold because federal officials say it may not be necessary, state officials report.

The state agency is taking public comments on a fourth waiver requiring referrals for family planning services such as birth control, abortions or pregnancy care.

A fifth waiver expected to be released for public comment in November would allow Medicaid recipients to receive inpatient treatment for mental health and substance abuse disorders at a freestanding psychiatric hospital. Currently, those services are only available in the psychiatric unit of a full-service hospital.

On a related front, Idaho lawmakers have been discussing how to pay the roughly $40 million it will cost the state for the expansion, but nothing has been finalized.

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