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Committee introduces bill to raise Medicaid 'outlier' threshold for value care organizations
Summary
Representative Jordan Redmond introduced RS32085 to raise the dollar threshold that defines an "outlier" claim for value care organizations in Idaho Medicaid, proposing phased increases to reduce budget volatility.
Representative Jordan Redmond, R.-District 3 of Kootenai County, asked the committee to introduce RS32085, a proposal to raise the dollar threshold for outlier claims submitted by value care organizations (VCOs) under Idaho Medicaid.
Redmond told the committee that an "outlier claim" is any VCO claim exceeding a preset amount, currently $100,000. He said the state recorded 473 outlier claims last year; 466 exceeded $100,000 and seven exceeded $500,000. RS32085 would raise the threshold to $250,000 in the first year, $500,000 in the second year and up to $1 million in the third year, which the sponsor characterized as a way to stabilize the Medicaid budget.
"This is one of the ways that we can create stability within our Medicaid budget," Redmond said, and he noted the proposal tracks a recommendation in the minority report from the Medicaid Managed Care Task Force (02/2023) signed by Redmond, Chairman VanderWaata, Representative Dore Healy and Josh Tanner.
Representative Kaler moved to introduce RS32085; the motion passed by voice vote. Committee members did not take final action on policy language; the introduction advances the measure to a formal committee hearing, where fiscal impact, data and stakeholder testimony will be considered.
