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Committee introduces bill to raise outlier‑claim thresholds for VCOs in Medicaid
Summary
Representative Jordan Redmond introduced RS32085 to increase the threshold for outlier claims submitted by VCOs, moving the floor from $100,000 to $250,000, then to $500,000 and $1 million in subsequent years, with the sponsor saying the change aims to stabilize Medicaid budgeting.
Representative Jordan Redmond introduced RS32085, a bill that would raise the threshold for outlier claims submitted by value care organizations (VCOs) in Idaho’s Medicaid program.
Redmond said an outlier claim is any claim by a VCO above a threshold currently set at $100,000. He said the recent year had 473 outlier claims, 466 of which exceeded $100,000 and seven of which exceeded $500,000. The RS would increase the minimum threshold to $250,000 the first year, $500,000 the next year and $1 million the year after.
"This is one of the ways that we can create stability within our Medicaid budget," Redmond said, and he said the proposal was one of the recommendations in the Medicaid Managed Care Task Force minority report dated February 2023.
Representative Kaler moved to introduce RS32085. Chairman VanderWaata called the voice vote and said the motion passed.
The sponsor framed the change as a budget‑stability measure and cited the task force minority report, signed by multiple lawmakers, as background. No fiscal note or text of the RS was discussed on the record at introduction; committee members did not enter a detailed policy debate during the introduction.
Votes at introduction: motion to introduce RS32085 — moved by Representative Kaler; outcome: approved by voice vote (tally not specified).
