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Committee reviews Health & Welfare budget: Medicaid forecast, hospital assessment, MMIS and public-health grants
Summary
Analysts and the director briefed the House Health and Welfare Committee on a wide set of departmental budget issues including Medicaid population-forecast adjustments, a hospital assessment appropriation, the multi-year Medicaid MMIS procurement and several federal public-health grants and restorations.
The House Health and Welfare Committee received an overview of the Department of Health and Welfare budget that highlighted a mix of nondiscretionary forecast adjustments, ongoing implementation costs and federal grants.
Alex Williamson, budget and policy analyst with the Legislative Services Office, told the committee the department’s recent spending peak was driven largely by Medicaid adjustments and provider-rate changes. He said the agency’s FY24 appropriation rose sharply—about $670 million—largely driven by Medicaid population-forecast adjustments and changes to the hospital assessment and upper payment limit methodology.
Williamson said updated Medicaid population forecasts are a major driver of FY25 supplementals and FY26 maintenance requests. She explained the federal medical assistance percentage (FMAP) for Idaho moved from 67.59 to 66.91, a change that reduces federal support and shifts some cost to the state.
On hospital financing, Williamson and committee members discussed a hospital-assessment fund adjustment tied to upper-payment-limit changes. Williamson said the assessment resulted in increased federal drawdown that flows through state accounting records and therefore requires an appropriation; the governor’s package includes a roughly $77.2 million dedicated adjustment tied to the hospital-assessment mechanism.
Committee members asked about the Medicaid Management Information System (MMIS) replacement procurement. Williamson said the MMIS replacement is a multi-year project now in its third year; the Federal–State split on MMIS upgrades is roughly 90 percent federal and 10 percent state, she said. Representatives requested a procurement status update; Williamson said she would follow up with the Medicaid administrator for current progress and to confirm that contractual milestone checks remain in place.
Members also questioned supplemental items tied to the Idaho Behavioral Health Plan. Williamson explained there were federal grants appropriated for behavioral-health implementation, but implementation lagged (the original go-live was July 2022), so some federal grant cash remained unused and the department is seeking spending authority to access those funds; a mental-health-services/behavioral health supplemental cited in the packet was about $6,743,000 in federal funds.
Public-health grants funded with ARPA and other federal sources were discussed. Williamson walked members through several grant timelines: a Public Health Infrastructure grant (year 3 of 5), a Vital Statistics Data Modernization grant (year 2 of 4), WIC system modernization (year 2 of 3) and other public-health data modernization grants. The committee asked what would happen if federal grant funding were rescinded; Williamson said unused appropriations would result in larger reversions if cash were not available, and Director Adams said discretionary grants have exit strategies and the department would not transfer discretionary grant programs to state general fund.
Representative Razor described his review of public-health programs and identified specific items he recommended removing or relocating (for example refugee health screening and some aging-related programs); Director Adams said the legislature sets policy and the department implements it.
Williamson noted the governor’s initiative line for the Idaho Child Care Program and summarized that the governor’s FY26 recommendation would increase the department’s appropriation to roughly $6 billion all funds and would represent a roughly 10.7% increase over the FY25 original appropriation. She called the department’s online dashboard (legislature.idaho.gov/lso/bpa/budgetinformation) a resource for historical appropriation and expenditure data.
Votes at a glance: the committee approved minutes from Feb. 5, Feb. 6 and Feb. 10 on a motion from Representative Egbert; no roll-call was taken.
Ending: Committee members said they will meet tomorrow to consider recommendations to JFAC and requested further procurement and grant-status follow-ups from staff.
