Idaho expands Medicaid eligibility for low-income residents under 65

On February 12, 2025, the Idaho House introduced House Bill 215, a significant piece of legislation aimed at reforming the state's Medicaid program. The bill seeks to enhance care coordination, particularly for high-risk pregnancies and individuals with chronic diseases, while also expanding Medicaid eligibility for low-income residents.

The primary provisions of House Bill 215 include the establishment of primary care medical homes to improve care coordination, mandatory enrollment in special needs plans for high-risk, high-cost disabled adults and children, and the integration of behavioral health benefits into managed care contracts. Additionally, the bill proposes a tiered case management fee structure to support populations with chronic diseases and aims to eliminate duplicative practices that lead to unnecessary costs.

A notable aspect of the bill is its directive for the Idaho Department of Health and Welfare to seek federal approval for a waiver that would require Medicaid participants to obtain referrals for family planning services from their designated medical homes. This provision has sparked debate among lawmakers, with some expressing concerns about potential barriers to accessing essential health services.

The bill also includes a provision to expand Medicaid eligibility to individuals under 65 with a modified adjusted gross income at or below 133% of the federal poverty level. This expansion aligns with federal guidelines and aims to provide coverage to those who currently lack access to healthcare services.

Opposition to House Bill 215 has emerged from various stakeholders, including some lawmakers who argue that the expansion of Medicaid could strain state resources and lead to increased costs in the long term. Proponents, however, argue that the bill will ultimately improve health outcomes and reduce overall healthcare costs by providing preventive care and better management of chronic conditions.

The implications of House Bill 215 are significant, as it addresses critical gaps in healthcare access for vulnerable populations in Idaho. Experts suggest that if passed, the bill could lead to improved health outcomes for many residents, potentially reducing emergency room visits and hospitalizations associated with untreated health issues.

As the legislative process unfolds, House Bill 215 will be closely monitored for amendments and debates that may shape its final form. The bill's progress will be pivotal in determining the future of Medicaid services in Idaho and the state's commitment to expanding healthcare access for its residents.