Republican Idaho Gov. Brad Little has signed a bill that adds work requirements and other sideboards to Idaho’s Medicaid expansion. Voters approved the expansion—giving Medicaid health insurance to all low-income adults in Idaho—with a 61% vote in November. Instead of funding the expansion or repealing it, the Idaho Legislature took up bills to change it. Lawmakers passed the latest version of their sideboards legislation on Friday, after weeks of intense deliberation. The governor received it Monday.

When the Idaho Senate came to order on Monday morning, it seemed that the work requirements many Idaho Republicans wanted to tack on to voter-approved Medicaid expansion might be dead in the water.

After all, a federal judge last week struck down such work requirements in Arkansas and Kentucky.

But the Republicans pressed on, undeterred. Senators on Monday introduced a series of amendments to an existing bill. Unlike the work requirements that have been discussed in Idaho and other states, failure to comply wouldn’t mean losing Medicaid. People still would have coverage. They would just have a co-pay imposed on them — such as $5 to $30 for a doctor’s appointment — until they complied. Some people would be exempt, such as parents, caregivers and those filing for disability.

A House panel on Wednesday sent the latest Medicaid expansion bill in the Idaho Legislature on to the House floor, but without a recommendation to pass it.

The bill — from Nampa Republican Rep. John Vander Woude — includes controversial provisions, such as a work requirement. It also requires people who are just above the poverty line to buy private health insurance plans from Idaho’s insurance exchange.