All Roll Calls
Yes: 90 • No: 15
IdahoH 03452025 regular legislative sessionHouseWALLET
MEDICAID – 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.
Sponsored By: HEALTH AND WELFARE COMMITTEE
Signed by Governor
MEDICAID
Personalized for You
How does this bill affect your finances?
Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
12 provisions identified: 4 benefits, 6 costs, 2 mixed.
Federal funding cuts trigger Medicaid reductions
The law sets a response when the federal share of Medicaid expansion costs falls below its 90% commitment outside a legislative session. Idaho's health department must offset the added state cost. Its actions can include lowering provider payments or ending optional benefits for the affected expansion population. These actions continue until lawmakers can convene and decide what to do.
Tighter Medicaid work and renewal rules
By July 1, 2026, Idaho must seek federal approval for work or community-activity rules for covered Medicaid expansion adults. Qualifying activities include work, work programs, volunteering, combinations of activities, and workfare. The applicable work or work-program standard is at least 20 hours weekly, averaged monthly. Listed workfare exemptions cover people under 19 or over 64, medical inability to work, pregnancy, and specified parents and caretakers. They also cover qualifying unemployment recipients, addiction or alcohol treatment participants, and students enrolled at least part-time in college or vocational education. Eligible American Indians and Alaska Natives with specified Indian Health Service or tribal access are exempt. The law also directs Idaho to stop automatic renewals based on available information and pre-filled forms, and review expansion eligibility twice yearly.
Medicaid seeks rural emergency hospital coverage
Idaho must submit a Medicaid plan amendment to recognize and pay for services at qualifying rural emergency hospitals. Facilities must meet the federal definition of a rural emergency hospital. The change supports Medicaid-covered services at those facilities once federally approved. The law sets no payment amount or submission deadline.
New marketplace option for Medicaid adults
By July 1, 2026, Idaho must seek federal approval for an additional insurance choice for eligible Medicaid expansion adults. The option covers people with modified adjusted gross income at or above 100% of the federal poverty level who qualify for advance premium tax credits. They can use those credits to buy a qualified plan through Idaho's health insurance exchange instead of Medicaid. Medicaid remains a choice. The law does not set credit amounts, and exchange plans can have different premiums and out-of-pocket costs.
Idaho seeks higher Medicaid cost sharing
By July 1, 2026, Idaho must begin seeking federal approval to make cost sharing a condition of Medicaid participation. Amounts must be at least at levels developed by other states and may reach the highest amounts those states charge. Federal law limits the charges. Existing cost sharing stays in place until the new plan amendment replaces it, despite repeal of cost-sharing rules beginning July 1, 2025. The law does not set new dollar amounts for participants.
Medicaid funding restrictions target certain treatments
Idaho must seek Medicaid changes barring payment for gender reassignment procedures, including treatment and surgery, for residents age 18 or older. The department must also seek a ban on Medicaid-funded contracts or transactions involving services prohibited under Idaho Code Section 18-1506C. These changes restrict Medicaid funding for affected care. They do not themselves require individuals to buy or pay for treatment.
Medicaid changes plans and ends programs
By July 1, 2026, Idaho must submit the federal requests needed for comprehensive Medicaid managed care. Current managed care continues until replaced, and providers and participants must help design the new plan. Required cost controls can include multi-year competitive contracts with preset inflation adjustments or withholding plan payments when cost targets are missed. Separately, Healthy Connections value care and primary care case management contracting and payments must end by January 1, 2026. Beginning July 1, 2025, rules for Medicaid Basic, Enhanced, and Medicare/Medicaid Coordinated Plan Benefits no longer apply. Those rule repeals do not specify replacement benefits or household cost changes.
Medicaid seeks protections for practitioner authority
Idaho must submit a Medicaid plan amendment by July 1, 2025, protecting practitioners' authority to practice as Idaho law allows. The provision does not identify which practitioners receive protection. It also does not specify changes to patient costs or access.
Health centers avoid Medicaid payment risks
Federally qualified health centers and organizations they own and control are exempt from financial risk in covered value-based payment agreements. The protection begins with the 2024 performance period and continues for future periods. Idaho can use value-based agreements designed to keep costs neutral or save money, and seek provider-based managed-care waivers. The law does not specify a direct change to patient charges or benefits.
Lawmakers control major Medicaid coverage changes
Idaho's health department needs legislative approval before seeking or implementing Medicaid changes that expand coverage or increase net state costs. Approval must be written into state law and listed in the new Medicaid approval chapter. Programs authorized by statute or operating by July 1, 2025, are exempt, as are changes that do neither. The chapter also exempts American Indians and Alaska Natives eligible for specified Indian Health Service or tribal services. The law takes effect immediately, but specific changes have separate deadlines.
Medicaid sets provider payment limits
Medicaid pays primary care codes up to 100% of current Medicare rates and other codes at 90%, where Medicare equivalents exist. Rates without Medicare equivalents are set by rule; the text also specifies a 91% freestanding mental-health hospital cap through July 1, 2021. By July 1, 2026, Idaho must submit a plan paying hospital-acquired and physician-owned practices equally for equivalent outpatient services. Equal rates apply when services do not depend on hospital technology and no evidence-based reason supports different rates. Critical access and rural emergency hospitals are exempt as federal rules allow. Annual budgets must list provider rate adjustments separately, and changes require legislative funding.
Hospital payments support Medicaid state funding
By July 1, 2027, Idaho must seek federal approval for directed payments to qualifying behavioral-health or comprehensive managed-care entities. Thirty percent must support general-fund Medicaid needs, with ongoing spending authority and payments subject to federal limits. The hospital assessment fund also has ongoing spending authority for its listed purposes, including supplemental upper-limit payments. Qualifying behavioral health hospitals assessed for the state behavioral health plan are exempt from the separate upper-limit assessment. The text also requires hospital reimbursement cuts producing state general-fund savings of $3.1 million for FY2020 and $8.72 million for FY2021.
Sponsors & Cosponsors
Sponsor
HEALTH AND WELFARE COMMITTEE
Affiliation unavailable
Cosponsors
Jordan Redman
Republican • House
Julie VanOrden
Republican • Senate
Roll Call Votes
Senate vote • 3/11/2025
Senate Floor Vote
Yes: 29 • No: 6
House vote • 3/6/2025
House Floor Vote
Yes: 61 • No: 9
Actions Timeline
Reported Signed by Governor on March 19, 2025 Session Law Chapter 118 Effective: 03/19/2025; 07/01/2025 IDAPA Sunset Clause - SECTION 9, 10, 11, & 12
3/20/2025Delivered to Governor at 10:55 a.m. on March 14, 2025
3/17/2025Returned Signed by the President; Ordered Transmitted to Governor
3/14/2025SenateSigned by President; returned to House
3/13/2025SenateReceived from the House enrolled/signed by Speaker
3/13/2025SenateReported Enrolled; Signed by Speaker; Transmitted to Senate
3/13/2025HouseReturned from Senate Passed; to JRA for Enrolling
3/12/2025HouseRules Suspended (2/3 Vote - Read in full as required) – PASSED - 29-6-0
3/11/2025SenateReported out of Committee with Do Pass Recommendation; Filed for second reading
3/11/2025SenateIntroduced, read first time; referred to: Health & Welfare
3/7/2025SenateReceived from the House passed; filed for first reading
3/7/2025SenateRead Third Time in Full – PASSED - 61-9-0
3/6/2025HouseRead second time; Filed for Third Reading
3/5/2025HouseReported out of Committee with Do Pass Recommendation, Filed for Second Reading
3/4/2025HouseReported Printed and Referred to Health & Welfare
3/3/2025HouseIntroduced, read first time, referred to JRA for Printing
2/28/2025House
Bill Text
Bill Text
Related Bills
H 0436, URBAN RENEWAL – Amends and adds to existing law to provide for the dissolution of urban renewal agencies and termination of urban renewal plans and to allow fire protection districts and ambulance service districts to opt out of certain urban renewal financing provisions.
H 0396, EDUCATION – Amends and adds to existing law to revise provisions regarding transportation funding for public schools.
H 0356, STATE ASSETS – Amends and adds to existing law to revise provisions regarding who may own certain property, to provide for prohibition on lease or purchase of certain land or dwellings, and to provide for prohibition on access to state assets.
H 0445, APPROPRIATIONS – DEPARTMENT OF WATER RESOURCES – Relates to the appropriation to the Department of Water Resources for fiscal year 2026.
H 0397, EDUCATION – Amends existing law to revise provisions regarding civics instruction.
H 0439, APPROPRIATIONS – DEPARTMENT OF ADMINISTRATION – Relates to the appropriation to the Department of Administration for fiscal year 2026.