S 1312 revises Idaho's Medicaid payment rules for healthcare providers, directly affecting hospitals, mental health facilities, and home care services. It sets payment rates at 100% of Medicare for primary care and 90% for other services where Medicare equivalents exist, while requiring annual cost surveys (with 15% audits) for services without Medicare rates. The bill mandates providers to allocate funds to staff wages and employee costs, reduces general fund needs by $3.1 million in FY2020 and $8.72 million in FY2021, and transitions most hospitals to value-based payment systems by July 2021. It also nullifies specific administrative rules (IDAPA 16.03.26) after July 2026.
This bill requires Idaho's Department of Health and Welfare to study policy options for two Medicaid groups: workers with disabilities who can no longer work due to age or disability, and individuals in home care programs facing high out-of-pocket costs. The study will examine ways to prevent participants from losing savings or coverage when transitioning between programs, and to keep people in community settings instead of institutions. The department must report findings by December 2026, including federal approval needs, cost impacts, and recommendations for maintaining work incentives while reducing institutionalization. The bill does not change current Medicaid rules but directs a review of potential improvements.
