WASHINGTON — The voters of Utah and Idaho, two deeply Republican states, defied the will of their political leaders in November and voted to expand Medicaid under the Affordable Care Act. Now those leaders are striking back, moving to roll back the expansions — with encouragement, they say, from the Trump administration.

Utah’s ballot measure, approved with support from 53 percent of voters, would expand Medicaid to cover people with incomes up to 138 percent of the poverty level — up to about $16,750 a year for an individual — and pay the state’s share with a small increase of the sales tax. Under the ballot initiative, 150,000 people are expected to gain coverage, starting April 1.

In Idaho, more than 60 percent of voters supported a ballot measure to expand Medicaid.

But in both states, the Republican Legislatures are looking for ways to roll back those votes.

The bill barreling through the Utah Legislature was “an effort to override the will of the people,” said Matthew Slonaker, the executive director of the Utah Health Policy Project, a nonprofit group that supported the full expansion of Medicaid.

Utah lawmakers, worried that the sales tax increase might not fully cover the costs, are rushing through a bill that would limit the expansion of Medicaid to people with incomes less than or equal to the poverty level, about $12,140 for an individual.

State officials say that the bill, which is estimated to cover 90,000 people, could be on the desk of Gov. Gary R. Herbert, a Republican, in a week or two.

Idaho lawmakers are considering restrictions, such as work requirements, to limit the reach of the voters’ will.

In both cases, state Republicans may need Washington’s help. Utah’s legislative plan is contingent on federal approval of a waiver that would allow the state to get extra federal money without the full expansion of Medicaid envisioned in the Affordable Care Act.

The federal government and the states have historically shared the costs of Medicaid, with the federal government paying a larger share in states with low per capita income. In Utah, the federal government pays about 70 percent of what Medicaid spends on health care.

By contrast, under the Affordable Care Act, the federal government pays at least 90 percent of the cost of care for people made eligible for Medicaid by the full expansion of the program. Utah and some other states want the enhanced federal payments for a smaller expansion — to anyone up to the poverty level.

To date, the federal government has not approved such proposals — even though some Trump administration officials want to allow the “partial expansion” of Medicaid as a way to head off full expansion in additional states, which could be more expensive for the federal government.

Paul Edwards, a deputy chief of staff for Mr. Herbert, said that the governor and other state officials had had many conversations with Trump administration officials, including people at the White House and at the Centers for Medicare and Medicaid Services.

“The governor came away quite encouraged,” Mr. Edwards said. “The most important conversations have been on the telephone between Governor Herbert and Seema Verma,” the administrator of the federal Medicaid agency.

“We are in close contact with C.M.S., and we are encouraged by what we are hearing,” Mr. Edwards said. “But no one has put anything into writing.”

The Trump administration has repeatedly promised to provide more “flexibility” for state Medicaid programs, but a federal health official declined to characterize the discussions with Utah.

Utah’s bill would put limits on the growth of per capita costs in the Medicaid program and would freeze enrollment if the cost of the Medicaid expansion was projected to exceed the amount of money provided in appropriations by the Legislature, restrictions “outside the spirit” of the ballot initiative, Mr. Slonaker said.

The bill also says that Utah will seek federal permission to impose work requirements on Medicaid beneficiaries, like those approved by the Trump administration in several other states.

The Utah Medicaid program now covers parents with dependent children in households with incomes up to 60 percent of the poverty level. Adults without dependent children are generally ineligible, with a few exceptions. People with incomes from 100 percent to 400 percent of the poverty level can obtain subsidies in the form of tax credits to help them pay premiums for private insurance in the federal marketplace.

One of Utah’s main goals is to eliminate a gap in coverage. Many poor people are now eligible for neither Medicaid nor subsidized private insurance.

State Representative James A. Dunnigan, a Republican who is leading efforts to replace the ballot initiative, said the revenue provided by the sales tax increase would not be adequate to pay the state’s share of the cost of a full Medicaid expansion after two years.

The fiscal mismatch will be “a runaway train wreck,” Mr. Dunnigan said in an interview. “We balance our budget here every year. We value our triple-A bond rating and our reputation as one of the nation’s best managed states.”

People with incomes of 100 percent to 138 percent of the poverty level will still be able to get subsidies for private coverage in the insurance exchange, he said.

Mr. Dunnigan said he, too, had been encouraged by his discussions with the Trump administration. “I would not be pursuing this unless I thought there was a high likelihood that the federal government will approve it,” he said.

If President Trump approves Utah’s request for enhanced federal matching payments with a partial expansion of Medicaid, other states are sure to press similar requests.

Arkansas, for example, expanded Medicaid to 138 percent of the poverty level in 2014. But it has requested federal permission to roll back coverage to 100 percent of the poverty level.

Massachusetts, concerned about the cost of its expanded Medicaid program, has also asked for permission to reduce eligibility for certain adults to 100 percent of the poverty level, saying it would be better for them to obtain subsidized commercial insurance.

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