BOISE, Idaho (AP) — Idaho has so far balked at expanding Medicaid health coverage for low-income residents, a key piece of President Barack Obama's insurance overhaul left optional for states by the Supreme Court.

But the Department of Health and Welfare doesn't want to get caught flat-footed, if lawmakers and Gov. C.L. "Butch" Otter decide otherwise. Consequently, officials there are now asking insurers for advice about helping provide expanded Medicaid coverage for roughly 104,000 adults who earn less than 138 percent of the poverty line — and how they'd go about doing it.

Otter insists Medicaid expansion hinges on big changes, to ensure new recipients take responsibility and make good health care choices. And debate over the subject in the 2014 Legislature could mirror 2013's bitter and polarizing discussions over a state-based insurance exchange.