Bill > H0845

This bill establishes rules for hospitals making "presumptive eligibility" determinations for Medicaid, a government health insurance program for low-income individuals. Qualified hospitals will be allowed to make these initial determinations, which allow patients to receive immediate medical care while their full eligibility is processed. The bill requires hospitals to notify the state department of each presumptive eligibility decision within five business days, help patients complete their full Medicaid applications, and clearly inform patients in writing that their presumptive eligibility will end if they don't submit a full application by the end of the following month, or continue until a final decision is made if they do. The state department will set performance standards for these determinations, including checking if hospitals met timeframes, if patients submitted full applications, and if those patients were ultimately found eligible for Medicaid. Violations of these standards will be tracked, with the first violation resulting in a written notice, a second violation requiring mandatory training for hospital staff, and a third violation within a year leading to the hospital losing its ability to make presumptive eligibility determinations. The bill also outlines an appeals process for hospitals that dispute a violation finding and declares an emergency, making the provisions effective on July 1, 2026.

Health and Social Services

Health and Welfare Committee (House)

https://legislature.idaho.gov/sessioninfo/2026/legislation/H0845/