This bill updates Idaho Medicaid rules to increase transparency and oversight of payments to healthcare providers, particularly those serving people with disabilities. It establishes specific payment rates based on Medicare equivalents for most services, requires annual cost surveys with audits for residential habilitation providers, and mandates that providers spend allocated funds on direct care worker wages or face potential penalties. The legislation also introduces value-based payment options for certain providers, sets reimbursement percentages for different hospital types, and requires the state to reduce general fund spending on hospital payments by specified amounts. Additionally, it declares certain existing administrative rules null and void as of July 1, 2026, and requires all future provider rate changes to receive legislative approval through the budget process.
This bill allocates $200,000 from the state's General Fund to the Idaho Legislature for fiscal year 2026 to support the operations of the Medicaid Review Panel. The funding covers operating expenses from July 1, 2025, through June 30, 2026, and includes authority to carry forward any unused funds for nonrecurring expenses in the following fiscal year. The legislation also declares an emergency to allow the appropriation to take effect immediately upon passage, ensuring the panel can continue its work without interruption.
This bill establishes new requirements for Medicaid eligibility in Idaho, affecting individuals aged 19 to 65 who are not pregnant, not receiving Social Security benefits, and not otherwise eligible for coverage. It mandates that the state verify applicants' work status, income, residency, identity, and immigration status through official documentation and third-party data sources rather than accepting self-attestation. The legislation requires the Department of Health and Welfare to verify compliance with work requirements quarterly and to receive regular data updates from state and federal agencies to monitor changes in recipients' circumstances. Additionally, the bill restricts exemptions from work requirements to specific medical conditions certified by healthcare professionals and prohibits managed care organizations from granting exemptions.
This bill removes Medicaid eligibility expansion provisions from Idaho law, affecting individuals who previously qualified for expanded Medicaid coverage under the Affordable Care Act. The legislation repeals specific sections of the Idaho Code that allowed for broader Medicaid eligibility and established limits on legislative approval for such expansions. Key provisions include preventing individuals eligible for Medicaid or health insurance from receiving financial assistance under the expanded program as it existed on March 1, 2022, while allowing applications received through March 31, 2022, to be processed under the prior rules. The bill also directs that any funds saved by counties through these changes may be used for additional aid to public health districts, with the changes taking effect on January 1, 2028.
This bill appropriates state and federal funds to the Idaho Department of Health and Welfare and the State Independent Living Council for fiscal year 2027, covering programs like Medicaid, child welfare, mental health services, and substance abuse treatment. It establishes specific funding amounts for various divisions including youth safety, early learning, family partnerships, and benefit payments, while also limiting the number of authorized full-time equivalent positions. The legislation includes requirements for program integrity, monthly Medicaid tracking reports, and cost-sharing for certain services, and directs how specific funds must be used for initiatives like smoking cessation, opioid response, and rural physician incentives.
This bill expands Medicaid eligibility in Idaho to include adults under 65 with incomes at or below 133% of the federal poverty level who currently lack other coverage. It requires the state to submit necessary plan amendments to the federal government within 90 days and ensures eligibility is not delayed while waiting for federal approval. The legislation includes provisions to maintain federal funding levels and requires a review of the program if federal support decreases, while also mandating community engagement requirements by December 2026 before enrollment becomes effective.
This bill appropriates specific funding amounts to Idaho's Medicaid program for fiscal years 2026 and 2027, affecting the Department of Health and Welfare's Division of Medicaid. It allocates money from various state and federal funds to support different Medicaid plans, including Basic, Enhanced, Coordinated, and Expansion plans, as well as administrative costs and hospital assessments. The legislation also reduces certain appropriations from the Hospital Assessment Fund and other sources for these same programs during the covered periods. Once signed into law, the bill directs how these funds will be distributed and spent to cover Medicaid benefits and operational expenses for eligible Idaho residents.
This bill allows family members to provide personal care services to eligible Medicaid recipients in Idaho, subject to legislative approval. It authorizes the Department of Health and Welfare to seek federal permission for legally responsible individuals to deliver up to 25 hours of care per week, with oversight by the department. The law limits the total number of family caregivers to 1,000 at any time and ensures that individuals needing more than 25 hours of care can still receive additional support from non-family providers. The bill also directs the department to create rules for managing a wait list for these services.
This bill directs Idaho state funding from the Millennium Income Fund for fiscal year 2027 toward substance abuse prevention and treatment programs, with a specific focus on youth under 18 and high-risk adults. It appropriates $150,000 to support community-based recovery centers in several cities, defining these centers as nonprofit organizations that provide free or low-cost recovery services at least 25 hours per week. The legislation also clarifies that Millennium Fund money cannot be used for Medicaid claims and establishes oversight requirements, including quarterly funding distributions and mandatory reporting to ensure funds are used properly. Additionally, the bill provides extra funding to various state agencies for children's trust programs, drug policy initiatives, and youth assessment centers.
This Idaho bill requires health insurance companies to allow patients to pay discounted cash prices for covered medical services directly to providers. When patients pay these negotiated lower prices out of pocket, the amounts count toward their insurance deductibles and annual out-of-pocket limits, provided they submit proof to their insurer. The law applies to most health plans but excludes specific types like Medicaid, Medicare supplements, dental, vision, and short-term insurance. It also ensures providers accept the cash payment as full payment and cannot bill patients or insurers for additional amounts.
