MEDICAID – Adds to existing law to provide legislative approval for the Department of Health and Welfare to submit a state plan amendment regarding change in encounter rate due to change in scope of services.

Medicaid rate updates for community and rural clinics

Beginning October 1, 2026, Idaho updates how Medicaid sets per-visit rates for community health centers and rural clinics when their services change. A change in scope means adding, dropping, or expanding services, or changing their type, intensity, duration, or number; higher costs alone do not count. You may apply for a new rate after six straight months of the change if your cost per medical or dental visit rose at least 4.5% versus your current rate. Try to notify the department 60 days before a planned change; there are no penalties for this notice. File by the last day of the third month after those six months, and only one change-in-scope request is allowed per fiscal year. The department reviews in 90 days (pausing for up to two weeks if it requests more documents), sends a draft rate for 60 days of your review, then issues a final rate within 45 days; you can appeal within 30 days. Any approved rate is retroactive to the first day you started the change, and the state reconciles payments back to that date, including for managed care. The department must submit required Medicaid plan changes by October 1, 2026, and the prior Medicaid rule is void on that date; clinics that began changes before then may finish under the old rule.