Idaho Medicaid budget grows amid pandemic fallout, provider rate changes and hospital assessment adjustments

The Joint Finance-Appropriations Committee heard a detailed briefing Feb. 26 on the Division of Medicaid’s budget, including multiple supplementals and 2026 enhancement requests that together reflect rising costs driven by the 2020 Medicaid expansion rollout, provider rate increases and changes to how the state calculates hospital reimbursements.

Alex Williamson, budget and policy analyst with Legislative Services, told the committee the division administered five budgeted programs and that the expansion plan — adults up to 138% of the federal poverty limit, which began in January 2020 — is a major driver of costs. “This will probably feel like information overload,” Williamson said as she began her presentation.

Why it matters: Idaho Medicaid appropriations have increased significantly in recent years; of the $4.56 billion appropriated for fiscal 2024, the division expended about $4.27 billion, Williamson said. Most spending — more than 98% in fiscal 2024 — is for trustee and…