JFAC approves $415.2 million in FY2025 Medicaid supplementals and $674.2 million in FY2026 Medicaid enhancements

The Joint Finance‑Appropriations Committee voted to approve a set of FY2025 supplementals totaling $415,226,800 and a FY2026 Medicaid budget package totaling $674,192,600, taking actions the committee described as funding accrued Medicaid obligations and making several ongoing appropriations and reporting requirements.

Budget and policy analyst Alex Williamson, Legislative Services, opened the discussion saying, “For the record, my name is Alex Williamson, budget and policy analyst with legislative services. Kicking things off we are going to look at the division of Medicaid and the Department of Health and Welfare this morning.” The committee moved through multiple line items as a collective motion rather than individually.

The supplementals the committee approved for fiscal year 2025 include funding to meet federal requirements and cover higher‑than‑expected Medicaid costs. Williamson told the committee the managed‑care external quality review is a federal requirement and requested $1,350,000 in one‑time funding for the state’s four managed‑care plans. She described other FY2025 supplementals as implementation or residual cost items, including configuration and go‑live costs for the Idaho Behavioral Health Plan, and an updated Medicaid expenditure forecast. As Williamson summarized the forecast change, she explained, “So they gave it their best shot a year ago when they made the forecast. They underestimated—more people used it or the people that did use it had higher costs. These are the residual costs that they are projecting for the next 3 months.”

The FY2025 supplemental totals the following fund split as presented on the record: $511,400 from the general fund, $77,243,700 from dedicated funds, and $337,471,700 from federal funds for a total of $415,226,800. The committee adopted the supplemental package on a roll call that produced, as announced from the clerk, a Senate vote of 7 ayes and 3 nays and a House vote of 6 ayes, 3 nays and 1 absent and excused; the chair announced the motion will go forward as a bill with a new "pass" recommendation.

The committee then considered the FY2026 enhancements and ongoing items. Key elements included: - Making the hospital assessment fund ongoing (the assessment supports drawing federal funds under an upper payment limit methodology; Williamson described the state and hospitals’ actions as enabling access to federal matching funds). - Funding ongoing external quality review work required for managed‑care organizations. - Additional funding for the MMIS (Medicaid Management Information System) procurement to free cash set aside in the dedicated MMIS fund as project milestones are completed. - An actuary contract amendment to add approximately $1.1 million in appropriation to pay for actuarial services used for capitation rate setting, forecasting and risk evaluation. - A $376,124,900 population‑forecast adjustment that incorporates FMAP changes, caseload, utilization and pricing assumptions for FY2026.

Representative Furness, who moved the FY2026 package, and other members discussed drivers of the increase. As one member summarized the nature of forecasting and supplements, Williamson and members noted that if the division overestimates next year, the state could see a reversion; if it underestimates, a supplemental would be needed to cover costs. Senator Cook emphasized the operational need for actuarial expertise, saying, “The actuary, we can't live without them. We'll be running totally blind without them.”

The FY2026 motion listed funding splits on the record of $70,141,900 from the general fund, $88,963,700 from dedicated funds, and $515,087,000 from federal funds, totaling $674,192,600. The committee approved the FY2026 package by roll call with the same announced tally as the prior vote: Senate 7 ayes, 3 nays; House 6 ayes, 3 nays, 1 absent and excused. The chair announced that the motion will go forward as a bill with a new pass recommendation.

Language and reporting directives tied to the budget actions were also adopted by unanimous consent. The adopted language requires the Department of Health and Welfare, Division of Medicaid to do the following and report back to JFAC by specified dates: explore a value‑based payment model for outpatient addiction treatment and report findings by Jan. 15, 2026; transition Medicaid contract periods to align with the state fiscal year and report progress by Jan. 15, 2026; provide an annual emergency Medicaid report on clients served and total expenditures (annual report due to JFAC no later than Sept. 15 following each fiscal year). The language package also includes standard federal‑funding restriction language and other conditions and limitations shown on the committee screen; a member raised that the new reporting requirements add workload to existing staff because no additional staff dollars were provided.

Votes at a glance FY2025 Medicaid supplementals (one‑time): Passed; announced roll‑call result — Senate 7 ayes, 3 nays; House 6 ayes, 3 nays, 1 absent and excused. Total appropriation shown on the record: $415,226,800 (general $511,400; dedicated $77,243,700; federal $337,471,700). Motion made by Senator Wintrow; seconded by Representative Handy. FY2026 Medicaid enhancements and ongoing appropriations: Passed; announced roll‑call result — Senate 7 ayes, 3 nays; House 6 ayes, 3 nays, 1 absent and excused. Total appropriation shown on the record: $674,192,600 (general $70,141,900; dedicated $88,963,700; federal $515,087,000). Motion made by Representative Furness; seconded by Senator Burkey.

Why this matters: Committee members characterized the actions as funding legally required reviews and accrued Medicaid obligations, funding IT modernization and actuarial work that underpins rate setting, and providing the ongoing hospital assessment structure needed to draw federal matching funds. The vote sends both packages forward as bills with a new pass recommendation for floor consideration and implements reporting directions aimed at monitoring implementation and costs.

The committee adjourned with instructions to meet in work groups the following morning to continue budget work.