Bill > S1312

This bill revises how healthcare providers are paid for services under the state's Medicaid program, which is a public assistance program providing health coverage to low-income individuals. For services with a Medicare equivalent, payments to providers will be up to 100% of the current Medicare rate for primary care and 90% for other services. For home and community-based services that do not have a Medicare equivalent, providers will undergo annual cost surveys, with a portion of responses audited, and payment rates will be developed to cover direct care worker wages, employee-related expenses, program costs, and administrative expenses, with providers required to spend at least the allocated amount on direct care wages and related expenses annually, facing corrective actions if they fail to do so. The bill also outlines specific reimbursement rates for various types of hospitals, including critical access, out-of-state, and state-owned facilities, and mandates reductions in general fund needs for hospital payments. Furthermore, it authorizes the department to enter into agreements with providers for value-based payments, which are designed to be cost-neutral or cost-saving and tied to measurable quality and positive health impacts, with specific exemptions for federally qualified health centers from financial risk in these agreements. Finally, the bill declares that certain administrative rules related to Medicaid plan benefits will become void on July 1, 2026.

Health and Social Services, Justice

Health and Welfare Committee (Senate)

https://legislature.idaho.gov/sessioninfo/2026/legislation/S1312/