IdahoH 08632026 regular legislative sessionHouseWALLET

MEDICAID – Amends existing law to revise provisions regarding provider payment.

Sponsored By: HEALTH AND WELFARE COMMITTEE

Signed by Governor

MEDICAID

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 0 benefits, 0 costs, 4 mixed.

Hospital Medicaid rates and past reductions

Medicaid pays hospitals by a share of cost: 101% for in‑state critical access hospitals, 87% for out‑of‑state hospitals, 100% for state‑owned hospitals, and 95% per diem for out‑of‑state IMD hospitals. The Department also reduces total hospital reimbursements to save $3.1 million in state fiscal year 2020 and $8.72 million in state fiscal year 2021, excluding certain hospitals named in law. Until July 1, 2021, a private freestanding mental health hospital that is an IMD was capped at 91% of the current Medicare rate within federal limits.

Medicaid rates tied to Medicare or costs

For services with a Medicare match, Medicaid pays up to 100% of the Medicare rate for primary care codes and 90% for other codes. For services without a Medicare match, the Department sets rates by rule using cost surveys and other data, subject to legislative approval and funding. These rates must include set‑asides for direct care worker wages and related costs, and providers must spend at least the appropriated amount each year. If a provider does not, the Department can require a corrective plan, close intake, or end the provider agreement. Certain services must complete yearly cost surveys, with at least 15% of responses audited, and a public summary due by December 31 each year starting in 2027. Any provider rate change also requires a line‑item budget request and legislative approval.

Shift to value-based Medicaid payments

The Department may make payment deals that reward quality and better health, and they must be cost‑neutral or cost‑saving. It may also seek federal waivers to support value‑based models, including fully capitated, provider‑run managed care. Beginning July 1, 2021, the Department works with in‑state hospitals to replace cost‑based pay with value‑based methods for inpatient and outpatient care, with budgets needing legislative approval. A hospital quality program raises or lowers adjustment payments based on agreed‑upon quality measures. Starting with the 2024 performance period, federally qualified health centers and their controlled organizations face no financial downside risk in these value‑based agreements.

Two Medicaid rule sections end 2026

Two Medicaid Plan Benefits rules (IDAPA 16.03.26 sections 051 and 052) are null and void on and after July 1, 2026. Those rule sections no longer have any force starting that date.

Sponsors & Cosponsors

Sponsor

HEALTH AND WELFARE COMMITTEE
Affiliation unavailable

Cosponsors

Julie VanOrden
Republican • Senate
John Vander Woude
Republican • House

Roll Call Votes

All Roll Calls

Yes: 79 • No: 23

House vote • 3/23/2026

House Floor Vote

Yes: 19 • No: 15

House vote • 3/12/2026