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IdahoH 08632026 regular legislative sessionHouse

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

5 provisions identified: 1 benefits, 0 costs, 4 mixed.

Value-based Medicaid payments, FQHCs avoid risk

The Department can make Medicaid payment deals that pay for quality and better health results. These deals must be cost‑neutral or save money. The Department may seek federal waivers, including for fully capitated, provider‑based managed care. Starting with the 2024 performance period, federally qualified health centers and organizations they own and control do not take financial downside risk in these deals.

Hospital Medicaid pay shifts toward value

Hospital payments follow set shares of cost: in‑state critical access hospitals get 101%, state‑owned hospitals 100%, out‑of‑state hospitals 87%, and out‑of‑state mental‑disease hospitals 95% per day. The Department must work with Idaho hospitals to replace cost‑based pay with value‑based pay for most in‑state hospitals starting July 1, 2021, with budgets approved by the Legislature. A quality program can raise or lower hospital adjustment payments based on agreed measures. The Department had to cut overall hospital reimbursements to save $3.1 million in SFY 2020 and $8.72 million in SFY 2021. For private IMD mental health hospitals, a 91% of Medicare inpatient cap applied only through July 1, 2021.

Medicaid pays up to Medicare; lawmakers approve

For services with a Medicare code, Medicaid pays up to 100% of Medicare for primary care and 90% for other codes. If a service has no Medicare code, the Department can set rates by rule, but the Legislature must approve the rules. Any change to provider rates only takes effect if lawmakers fund it in the budget. This sets clear ceilings and keeps rate changes under legislative control.

More Medicaid dollars to caregiver wages

The Department runs yearly cost surveys for residential habilitation, personal care, developmental disability agency services, community‑supported employment, and targeted service coordination. At least 15% of survey responses are audited each year. Rates must set aside money for direct care worker wages, employee costs, program costs, and admin costs. Providers must spend at least the budgeted amounts on direct care worker pay and related employee expenses each year. If they fail, the Department can require a corrective plan, stop new client intake, or end the provider agreement. A public report on audit results is due each year by December 31, starting December 31, 2027.

Two Medicaid plan rules end July 2026

Two Medicaid Plan Benefits rules in IDAPA 16.03.26, Sections 051 and 052, are null and void on and after July 1, 2026. What this means for you depends on what those sections covered.

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

Senate vote • 3/23/2026

Senate Floor Vote

Yes: 19 • No: 15

House vote • 3/12/2026

House Floor Vote

Yes: 60 • No: 8

Actions Timeline

  1. Reported Signed by Governor on March 26, 2026 Session Law Chapter 161 Effective: 03/26/26 SECTION 1-2; 07/01/26 IDAPA Sunset Clause - SECTION 3

    3/30/2026

  2. Delivered to Governor at 4:39 p.m. on March 25, 2026

    3/26/2026

  3. Returned Signed by the President; Ordered Transmitted to Governor

    3/25/2026Senate

  4. Signed by President; returned to House

    3/25/2026Senate

  5. Received from the House enrolled/signed by Speaker

    3/25/2026Senate

  6. Reported Enrolled; Signed by Speaker; Transmitted to Senate

    3/24/2026House

  7. Returned from Senate Passed; to JRA for Enrolling

    3/24/2026House

  8. Read third time in full – PASSED - 19-15-1

    3/23/2026Senate

  9. Read second time; filed for Third Reading

    3/20/2026Senate

  10. Reported out of Committee with Do Pass Recommendation; Filed for second reading

    3/19/2026Senate

  11. Introduced, read first time; referred to: Health & Welfare

    3/13/2026Senate

  12. Received from the House passed; filed for first reading

    3/13/2026Senate

  13. Read Third Time in Full – PASSED - 60-8-2

    3/12/2026House

  14. Read second time; Filed for Third Reading

    3/11/2026House

  15. Reported Printed; Filed for Second Reading

    3/10/2026House

  16. Introduced, read first time, referred to JRA for Printing

    3/10/2026House

Bill Text

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