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H 345

MEDICAID – Amends, repeals, and adds to existing law to provide that legislative approval is required for certain state plan amendments and waivers and to provide legislative approval for certain state plan amendments and waivers.

68th Legislature, 1st Regular Session (2025)

House Bill H 345 requires legislative approval for Medicaid changes, ensuring cost control and access to care, while aiming for $15.9M savings in FY 2026.

Reported Signed by Governor on March 19, 2025 Session Law Chapter 118 Effective: 03/19/2025; 07/01/2025 IDAPA Sunset Clause - SECTION 9, 10, 11, & 12
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Bill Summary · H 345

Summary of House Bill H 345: Medicaid Legislative Approval

Purpose and Intent

House Bill H 345 aims to enhance the sustainability and efficiency of Idaho's Medicaid program by instituting legislative oversight for certain state plan amendments and waivers. The bill seeks to control costs, protect access to healthcare in rural areas, and implement safeguards against fraud and abuse, ensuring that Medicaid resources are directed to the most vulnerable populations in Idaho.

Key Provisions

The bill includes several significant changes to the existing Medicaid framework:

  1. Legislative Approval Requirement:

    • The Idaho Department of Health and Welfare must obtain legislative approval before seeking or implementing any Medicaid state plan amendments or waivers that would:
      • Expand coverage to additional individuals or classes.
      • Increase net costs to the state.
    • This requirement does not apply to amendments or waivers already authorized or implemented by July 1, 2025.

  2. Specific Areas Requiring Approval:

    • Rural Emergency Hospital Designation: Approval is needed for amendments that recognize and reimburse services provided by rural emergency hospitals.
    • Medicaid Cost-Sharing: The bill allows for participant cost-sharing in Medicaid programs, aligning with levels established by other states.
    • Comprehensive Medicaid Managed Care: Legislative approval is required for implementing a comprehensive managed care plan.
    • Medicaid Expansion Limits: The bill introduces work requirements for able-bodied adults enrolled in Medicaid, stipulating that individuals must work, volunteer, or participate in a work program for at least 20 hours per week to maintain eligibility.

  3. Repeal and Amendments:

    • The bill repeals previous provisions related to legislative approval of waivers and state plan amendments and amends various sections of the Idaho Code to reflect these changes.

  4. Administrative Rules:

    • Certain administrative rules in IDAPA are declared null and void, ensuring that the new legislative framework takes precedence.

Impact

  • Healthcare Providers: The bill is designed to protect critical safety net providers, including rural emergency hospitals and community clinics, ensuring they can continue serving vulnerable populations.
  • Cost Management: The legislation anticipates net savings of approximately $15.9 million in FY 2026 and $27.2 million in FY 2027, with ongoing savings expected from the implementation of cost-sharing and the removal of primary care case management.
  • Legislative Oversight: By requiring legislative approval for significant changes, the bill aims to enhance accountability and transparency in Medicaid operations.

Procedural Timeline

  • Introduced: February 28, 2025
  • Signed by Governor: March 19, 2025
  • Effective Date: March 19, 2025, with specific provisions taking effect on July 1, 2025.

This legislation represents a significant shift in how Medicaid is managed in Idaho, emphasizing fiscal responsibility while aiming to maintain access to essential healthcare services for the state's most vulnerable residents.

Compiled from official sources — confirm details with the bill’s official record.

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