Bill > H0108

This bill amends Idaho's Medicaid provider payment law to establish specific stop-loss thresholds for value care organizations (VCOs), which are healthcare providers that are paid based on the value and quality of care they deliver. The bill introduces a graduated stop-loss threshold system over three performance years: for the year starting July 1, 2026, the threshold will be $250,000; for the year starting July 1, 2027, it will increase to $500,000; and for the year starting July 1, 2028 and subsequent years, it will be set at $1 million. A stop-loss threshold protects healthcare providers from excessive financial risk by limiting their potential losses in a value-based payment arrangement. The bill aims to support the state's existing efforts to transition from traditional cost-based reimbursement to value-based payment methods in Medicaid, which are designed to incentivize healthcare providers to deliver high-quality, cost-effective care. The legislation will go into full effect on July 1, 2025, and is intended to help manage financial risks for healthcare providers participating in Idaho's Medicaid value care organization programs.

Health and Social Services

Health and Welfare Committee (H)

https://legislature.idaho.gov/sessioninfo/2025/legislation/H0108/