Idaho Bills
11 bills · 2025 Regular Session
Relates to the appropriation to the Department of Health and Welfare for fiscal years 2025 and 2026.
This appropriation to the Department of Health and Welfare for the Division of Medicaid provides enhancements to the FY 2026 maintenance budget that include appropriations for the Hospital Assessment Fund, the federally required Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, expenses for the Adult Developmental Disabilities Resource Allocation model required by court order, actuary contract amendments, the federally required External Quality Review contract for Managed Care Organizations, year four of the MMIS procurement process, and population forecast adjustments. This bill also provides the appropriation to move Extended Employment Services from Services for the Developmentally Disabled to the Division of Medicaid as part of the department's overall reorganization. This bill includes the fiscal impact of House Bill 345, the Medicaid Reform and Cost-Containment Act, which establishes sideboards on Medicaid expansion. The fiscal impact of House Bill 345 includes onetime development costs for waivers and ongoing implementation costs if those waivers are approved. Supplemental appropriations for FY 2025 include appropriation for the federally required External Quality Review contract, the Idaho Behavioral Health Plan (IBHP) system configuration changes that were part of the calendar year 2024 go-live implementation, the updated Medicaid forecast, IBHP capitation rate increases, and the Hospital Assessment Fund. This bill includes 5 sections of language providing guidance on federal funding limitations and directing the division to explore a value-based outpatient addiction treatment, work towards aligning contract periods with the state fiscal year, and provide annual reports to the Legislature on the Emergency Medicaid plan.
Carl Bjerke · SD-005
40 – 30
Amends existing law to require certain federal waivers for continued medicaid expansion eligibility.
This legislation safeguards Idaho’s Medicaid program by ensuring its sustainability, prioritizing resources for needy populations and promoting fairness and accountability. It establishes conditions for the continued expansion of Medicaid eligibility for able-bodied adults, aligning the program with the principles of self-sufficiency, fiscal responsibility, and integrity. Key provisions include: 1) Work Requirements: Able-bodied adults must work, train, or volunteer at least 20 hours per week, mirroring existing requirements for other welfare programs in Idaho. 2) Enrollment Caps: The number of able-bodied adult enrollees will not exceed the population of seniors or individuals with disabilities, ensuring resources prioritize the most vulnerable. 3) Improper Payment Controls: The Department of Health and Welfare must reduce improper Medicaid payment rates to 5% or less. 4) Verification of Eligibility: Enrollee eligibility will be reviewed biannually. 5) Time-Limited Benefits: Able-bodied adults will be subject to a three-year lifetime limit on Medicaid benefits. 6) Optional Private Coverage: Enrollees above 100% of the federal poverty level may opt for federally subsidized private health insurance. This conditional approach strengthens Idaho’s Medicaid program while maintaining flexibility. If the federal government or state agencies fail to meet these requirements, the legislation ensures Medicaid dollars are redirected to serve the truly needy.
Jordan Redman · HD-003B
38 – 32
Amends, repeals, and adds to existing law to provide that legislative approval is required for certain state plan amendments and waivers and to provide legislative approval for certain state plan amendments and waivers.
The Medicaid Reform and Cost-Containment Act strengthens Idaho’s Medicaid program by controlling cost, ensuringitslong-termsustainability, protectingruralhealthcareaccess, andimplementingnecessarysafeguards against fraud and abuse. By requiring legislative oversight of Medicaid waivers and amendments, this legislation ensures that critical safety net providers, including rural emergency hospitals and community-based clinics, continue to serve Idaho’s most vulnerable populations. This act prioritizes cost containment by establishing sideboards on Medicaid expansion to maintain fiscal responsibility while ensuring resources are directed to those most in need. Furthermore, it provides a trigger for cost management if Medicaid is changed at the federal level. By balancing healthcare access with financial accountability, this legislation keeps Idaho’s Medicaid program sustainable, efficient, and focused on delivering high-quality care while preventing unnecessary dependency on government services.
John Vander Woude · HD-022A
29 – 6
Amends and repeals existing law to end eligibility for Medicaid for certain persons.
Thislegislationrepeals§56-267ofIdahoCode,MedicaidExpansion,thecostsofwhichhavebeenconsiderably more than originally projected. Additional changes are made to §31-3502 and §56-263 where the expansion is referenced.
Josh Tanner · HD-014B
Amends existing law to provide that certain value-based payment agreements align with the fiscal year.
This legislation stipulates any agreements between the Department of Health and Welfare and providers shall have a one-year duration from July 1 through June 30 of the ensuing fiscal year. Agreements made before July 1, 2025, maintain their original terms until expiration or renewal.
John Vander Woude · HD-022A
States findings of the Legislature and calls on the U.S. Department of Health and Human Services to review and expeditiously approve pending Medicaid waivers.
ThisjointmemorialtothePresidentandU.S.CongressreaffirmstheIdahoLegislature’scommitmenttoplacing critical sideboards on the Medicaid program. In 2019 the Legislature enacted four (4) modifications of the federal program with an eye toward restraining costs and improving health care services for recipients. It directed the Department of Health & Welfare to seek waiver approval for the modifications from the Center for Medicare and Medicaid Services. Those petitions were duly submitted by the Department of Health & Welfare by the fall of 2019. Yet the federal government has yet to provide the State of Idaho with an official response. This memorial seeks to gain the new Administration’s help in securing approval for the four waivers.
Jordan Redman · HD-003B
Amends existing law to provide stop-loss thresholds for value care organizations.
This legislation modifies Idaho Code section 56-265 to raise the minimum risk sharing level within agreements between the Idaho Department of Health & Welfare and Value Care Organizations (VCOs).
Jordan Redman · HD-003B
Amends existing law to provide minimum risk-sharing levels for value care organizations.
This legislation modifies §56-265 of Idaho Code to raise the minimum risk sharing level within agreements between the Idaho Department of Health and Welfare and Value Care Organizations.
Jordan Redman · HD-003B
Amends, repeals, and adds to existing law to provide that legislative approval is required for certain state plan amendments and waivers and to provide legislative approval for certain state plan amendments and waivers.
The Medicaid Reform and Cost-Containment Act strengthens Idaho’s Medicaid program by controlling cost, ensuring its long-term sustainability, protecting rural healthcare access, and implementing necessary safeguards against fraud and abuse. By requiring legislative oversight of Medicaid waivers and amendments, this legislation ensures that critical safety net providers, including rural emergency hospitals and community-based clinics, continue to serve Idaho’s most vulnerable populations. This act prioritizes cost containment by establishing sideboards on Medicaid expansion to maintain fiscal responsibility while ensuring resources are directed to those most in need. Furthermore, it provides a trigger for cost management if Medicaid is changed at the federal level. By balancing healthcare access with financial accountability, this legislation keeps Idaho’s Medicaid program sustainable, efficient, and focused on delivering high-quality care while preventing unnecessary dependency on government services.
John Vander Woude · HD-022A
Adds to existing law to provide that the Department of Health and Welfare shall not prohibit licensed or registered health care providers from providing services covered by the state Medicaid program.
This bill clarifies in statute that Medicaid will not limit practice authority conferred by the legislature and licensing boards, and that services covered by Medicaid can be provided by any legislatively-authorized provider who completes a Medicaid provider agreement.
Jordan Redman · HD-003B
34 – 0
States findings of the Legislature and directs the Department of Health and Welfare to convene a council to coordinate and develop revisions to the skilled nursing facility upper payment limit.
This resolution directs the Idaho Department of Health and Welfare to convene a stakeholder council to develop necessary revisions to Idaho’s Skilled Nursing Facility (SNF) Medicaid reimbursement system. The goal is to ensure compliance with federal requirements while improving financial stability and operational efficiency for skilled nursing facilities. The resolution calls for integrating Upper Payment Limit (UPL) reimbursements into daily Medicaid rates, requiring Managed Care Organizations (MCOs) to adopt a minimum fee schedule, and shifting the nursing facility fee assessment from annual to quarterly payments. These changes will provide SNFs with a more stable and predictable revenue stream, ensuring financial sustainability and reliable care for patients. Additionally, the resolution directs the Division of Medicaid to secure CMS approval and report findings and recommendations to the 2026 Idaho Legislature for potential legislative action. These reforms will enhance Idaho’s long-term care infrastructure, ensuring continued access to high-quality skilled nursing services.
Marco Erickson · HD-033B