BOISE, ID – The Idaho Senate Health and Welfare Committee on Monday advanced a bill that proposes sweeping policy changes to control Medicaid costs.
House Bill 345 calls for Idaho to seek work requirements for able-bodied Idahoans on Medicaid, and to give Idahoans eligible for Medicaid expansion access to tax credits to buy insurance on Idaho’s health care exchange.
The bill’s proposal for Medicaid work requirements — which requires federal approval to implement — has drawn the bulk of opposition.
“This bill truly does offer immediate savings for the taxpayers, as well as substantial long-term savings and stability to the Medicaid budget. And it deals with the entire budget itself,” said Rep. Jordan Redman, R-Coeur d’Alene, who is cosponsoring the bill along with the chairs of the Idaho Legislature’s health committees, and Sen. Carl Bjerke, R-Coeur d’Alene.
Despite largely negative opposition, the Senate Health and Welfare Committee on Monday advanced the bill to the full Senate — which could be one of the bill’s last legislative hurdles before potentially becoming law.
The new bill had unanimous support from House Republicans when the Idaho House passed it last week — a significant shift from another bill by Redman that would’ve likely repealed Medicaid expansion and narrowly passed the Idaho House last month.
To become law, Idaho bills must pass the House and Senate, and avoid the governor’s veto.
Bill proposes broader Medicaid changes
Beyond Medicaid expansion, the bill proposes broader policy changes for the entire Medicaid program — a health care assistance program that covers about 262,000 Idahoans, including low-income earners, people with disabilities, pregnant women, and some older people.
Almost 89,400 Idahoans are enrolled in Medicaid expansion, a voter-approved policy that raised the income eligibility cap.
But in the Senate Health and Welfare Committee hearing Monday, several members of the public said they worried about the bill’s provision to repeal agency administrative rules for Medicaid.
Idaho Department of Health and Welfare Deputy Director Juliet Charron, who oversees Idaho Medicaid, said the agency plans to stand up temporary rules if the bill passes.
“Rules serve a purpose. They provide a lot of important information for providers, for participants and stakeholders we work with. And so we certainly don’t want to disrupt that important structure that’s there, but we will need to make some updates coming from this bill,” Charron told the committee.
The new bill would also call for Idaho to plan to shift to management of Medicaid benefits to private companies, which is called managed care and is used by most states’ Medicaid programs. And the bill directs the state to end Idaho’s use of doctor-managed care, called value care, a unique model that has existed for a few years.
The bill could save Idaho $15.9 million in fiscal year 2026 and even more in the future, the bill’s fiscal note estimates. But the timing depends on federal approval, the fiscal note says.
Sen. Brandon Shippy, R-New Plymouth, said he was reluctantly supporting the bill, saying he had reservations about managed care.
“We may be creating a monster that … will live on perpetually here. And we might regret that,” he said in committee.
Bjerke, who is cosponsoring the new Medicaid cost bill, said “I hope it’s not a monster. I wouldn’t be part of it if I thought for a second that that was the case.”
Bjerke also said the testimony he heard against both major Medicaid bills this year was “almost identical.”
“There’s a sense I have that really there’s nothing short of keeping what we have right now, for some folks, that is going to be worth moving forward on. And I disagree with that,” he told the committee. “I think we have an obligation to the state. Who we have an obligation to are the least of us — the most vulnerable. That if we don’t get a handle on these programs, (it’s) those people that will be affected the most.”
Bill estimates millions in savings. But critics say Medicaid work requirements will be expensive.
Other states’ experiences and a federal watchdog report suggest costs for Medicaid work requirements are high, the Idaho Capital Sun previously reported.
Some advocates say Medicaid work requirements are costly and are effectively just administrative barriers to access the program — since almost half of Idahoans on Medicaid are already working. And many other Idahoans on Medicaid, advocates say, would be exempt from work requirements under exceptions the bill spells out, such as for parents of children age 6 and under, people with disabilities, college students, volunteers and caretakers.
The bill’s proposed work requirements are nearly identical to Arkansas’s work requirements, which saw one in four people lose coverage even though 95% of them met work requirements or were exempt, Idaho Voices for Children Senior Policy Associate Hillarie Hagen testified.
“We should learn from other states and recognize: These just don’t work as intended,” Hagen said.
Under the Trump administration, the federal Centers for Medicare and Medicaid Services approved work requirements in 13 states — for the first time in Medicaid’s history, according to KFF. The Biden administration rescinded the approvals. Several courts struck down states’ work requirement policies, according to the Center for Budget and Policy Priorities.
Idaho Senate Minority Leader Melissa Wintrow, D-Boise, was the only lawmaker on the Senate Health and Welfare Committee who voted against the bill.
“The work requirement causes me a little concern, a lot of concern. Only because I think the cost-containment could come is if people can’t get the paperwork filled out, or we don’t have the right software, or somebody misses up, then we’re going to miss somebody’s coverage,” she said. “And I would hope that that’s not what our intent is.”
Idaho hasn’t gotten federal approval for work requirements, exchange tax credit option
Many of the bill’s proposals require federal approval, and would likely take years to implement.
In 2019, Idaho failed to receive federal approval — then by the Trump administration — for Medicaid work requirements and an exchange tax credit option, which are similar to the new bill’s provisions.
If passed into law, the bill would take effect immediately through an emergency clause.
Republican Idaho lawmakers have long worried about the federal government reducing its high match rate for Medicaid expansion.
If the federal government cuts down on covering 90% of Medicaid expansion costs while the Idaho Legislature isn’t in session, the new Medicaid cost bill would give the Idaho Department of Health and Welfare director broad power to enact cuts to the program — until the Legislature reconvenes.
Congressional House Republicans recently approved a budget plan that calls for steep spending cuts that policy experts anticipate will require deep cuts to Medicaid.
The bill calls for Idaho to seek federal approval for patient “cost-sharing,” which would require Medicaid enrollees to essentially pay copayments for services they receive.
The bill also calls for Idaho to seek federal approval to no longer allow state health officials to automatically renew Medicaid for people based on publicly available information, or to use pre-populated forms. And the bill calls for Idaho to implement twice-yearly Medicaid expansion eligibility checks, up from the once-a-year eligibility checks Idaho Medicaid currently does.
This story first appeared on Idaho Capital Sun.