Idaho Bills

Adds to existing law to establish provisions regarding Medicaid eligibility requirements and verification.

RS33718 / H0912 This legislation establishes comprehensive oversight for Idaho’s Medicaid program, which accounts for a significant portion of the state’s annual budget. This bill updates Idaho law to match federal Medicaid standards under the One, Big, Beautiful Bill Act (P.L. 119-21). These changes strengthen the program’s integrity and provide clearer rules for accountability. These reforms are designed to protect Medicaid for eligible Idaho residents while safeguarding taxpayer dollars from financial penalties; specifically, federal law now mandates that if Idaho’s eligibility error rate exceeds 3%, the state faces an anticipated penalty of nearly $30 million for every additional percentage point. To mitigate financial risks, the bill replaces self-attestation with a structured framework requiring three months of verified prior work activity for enrollment, followed by quarterly compliance checks, biannual eligibility redeterminations for able-bodied adults. State agencies are also prohibited from implementing additional optional exemptions without explicit legislative approval. Furthermore, the act clarifies that Medicaid is reserved for lawful Idaho residents by requiring the use of the federal SAVE database to verify immigration status and mandating that cases involving unlawful status be referred to federal authorities. To prevent improper payments, the bill requires ongoing cross-checks against state and federal databases—including tax, wage, death record, and address verification systems—to identify changes in circumstances and promptly remove deceased individuals from the rolls.

Adds to existing law to establish provisions regarding Medicaid prior authorization exemptions for certain preceptorships.

This legislation establishes a prior authorization exemption for certain physicians who provide substantial preceptorship training to graduate medical students in Idaho, particularly in rural and underserved communities. Physicians practicing in primary care, psychiatry, or obstetrics and gynecology who provide at least 360 hours of qualifying preceptorship in a calendar year, with at least 60 percent of those hours occurring in qualified rural areas, are eligible for a twelve-month exemption from prior authorization requirements for medically necessary services billed to Idaho Medicaid managed care plans and state-contracted insurers. The bill directs the Department of Health and Welfare to verify reported preceptorship hours and administer the exemption and allows insurers to rescind exemptions if claims fail to meet medical necessity standards. Annual participation is limited to one hundred physicians per eligible specialty. The legislation is intended to encourage physician participation in training programs, strengthen Idaho's healthcare workforce pipeline, and improve access to care in rural and underserved areas.

Amends existing law to revise provisions regarding provider payment.

This bill is brought to increase transparency for taxpayers and support appropriation reductions for Medicaid rates paid to residential habilitation providers. Medicaid pays more than $176.5 million in General Funds to help people with disabilities live independently with residential habilitation and other home and community-based services. The Governor’s Recommendation calls for the Legislature to pursue policy changes to support the Department of Health and Welfare in achieving budget reductions for Medicaid, including an option to reduce rates for residential habilitation. In 2022, the Legislature appropriated funds (FY 2023 DU-7 KW Settlement – Svc. Enhance.) to increase payment rates for these services to implement a new service array and budget tool associated with the KW lawsuit. These funds are no longer appropriate since a court order halted implementation of the new services and budget tool. To support ongoing accountability for taxpayer dollars and ensure the Legislature has needed information to effectuate its appropriation responsibilities, this bill requires the department to report to this body how those funds are used.

Amends and repeals existing law to remove provisions relating to Medicaid eligibility expansion.

RS33468 / H0850 This legislation repeals §56-267 and §56-2205 of Idaho Code, Obamacare Expansion, the costs of which have been considerably more than originally projected. Additional changes are made to §31-3502 where the expansion is referenced.

Amends existing law to revise provisions regarding provider payment.

This bill is brought to increase transparency for taxpayers and support appropriation reductions for Medicaid rates paid to residential habilitation providers. Medicaid pays more than $176.5 million in General Funds to help people with disabilities live independently with residential habilitation and other home and community-based services. The Governor’s Recommendation calls for the Legislature to pursue policy changes to support the Department of Health and Welfare in achieving budget reductions for Medicaid, including an option to reduce rates for residential habilitation. In 2022, the Legislature appropriated funds (FY 2023 DU-7 KW Settlement – Svc. Enhance.) to increase payment rates for these services to implement a new service array and budget tool associated with the KW lawsuit. These funds are no longer appropriate since a court order halted implementation of the new services and budget tool. To support ongoing accountability for taxpayer dollars and ensure the Legislature has needed information to effectuate its appropriation responsibilities, this bill requires the department to report to this body how those funds are used.

Adds to existing law to provide legislative approval for certain family personal care services.

This legislation directs the Department of Health and Welfare to seek a federal waiver to reinstitute the family personal care services (FPCS) program. This program would permit trained, legally responsible family members to be compensated for the provision of services to a disabled family member requiring a high level of care when another caregiver is not available. The FPCS program was in effect in Idaho from April 15, 2020 until July 15, 2025, when it was terminated due to department concern about over-utilization and lack of usage limits, with the representation made by the Department of Health and Welfare at the time of program termination that the intent was to reinstitute the program with limits and controls. This bill would limit FPCS to 1000 total participants for 25 hours per week. All eligible participants would have to be eligible for personal care services (PCS) to be provided by a non-legally-responsible provider.

Adds to existing law to establish provisions regarding hospital presumptive eligibility determinations.

RS33456 / H0845 Hospital presumptive eligibility is a Medicaid program that allows hospitals to provide services to uninsured patients by presuming that they are likely eligible for the program. Without proper guardrails, however, this program is vulnerable to abuse. Hospitals receive reimbursement for services provided to presumptively eligible patients regardless of whether those individuals are ultimately determined to qualify for Medicaid. Nationally, up to 70 percent of individuals deemed presumptively eligible were later found to be ineligible for Medicaid after services had already been rendered and billed to taxpayers. This legislation establishes a three-strikes quality assurance system for hospital presumptive eligibility, authorizing the Department of Health and Welfare to discipline hospitals that misuse the program. These reforms help ensure that presumptive eligibility is reserved for individuals who are truly eligible for Medicaid.

Adds to existing law to direct the Department of Health and Welfare to conduct a study of options regarding certain Medicaid programs.

The Medicaid for Workers with Disabilities (MWD) program (Idaho Code §56-209n) is health insurance for people who work and have a disability. This program is intended to help people with disabilities work, earning more money and keeping health insurance, to support independent living. Many people with disabilities would like to continue to work beyond the age of 65 and maintain these benefits and supports. After age 65, many people who want to continue to work are kicked off the program and then must face higher costs shares that sometimes quadruple. In order to keep people living independently in their homes, and avoid the high costs of institutionalization, this legislation directs the Department of Health and Welfare to identify and evaluate options, no later than December 1, 2026, within existing federal Medicaid authority that prioritizes the continuity for individuals enrolled in or transitioning from the Medicaid for Workers with Disabilities program.

Relates to the appropriation to the Department of Health and Welfare for fiscal years 2026 and 2027.

RS33811 / S1433 This appropriation to the Department of Health and Welfare for the Division of Medicaid provides enhancements to the FY 2027 maintenance budget that include appropriations for the continuation of the 5-year MMIS procurement process (enhancement #4), the Estate Recovery program (enhancement #5), the Medicaid Program Integrity Unit (enhancement #6), appropriation to support the addition of a new contract staff in the Department of Administration (enhancement #21), adjustments to the Hospital Assessment Fund (including aligning funds pursuant to House Bill 345 of 2025 and the creation of a new budgeted program to track supplemental payments in enhancement #22), and population forecast adjustments.