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JFAC briefed on Medicaid supplementals and 2026 enhancements totaling hundreds of millions
Summary
Analysts outlined five fiscal‑2025 supplementals and multiple 2026 enhancement requests for Idaho Medicaid including external quality review funding, capitation adjustments, hospital assessment processing and MMIS procurement; members were given itemized dollar amounts and asked for follow‑up on market responses and legal requirements.
BOISE — During the Feb. 26 Joint Finance‑Appropriations Committee meeting, Legislative Services analyst Alex Williamson reviewed five requested fiscal 2025 supplementals and multiple 2026 enhancement requests for the Division of Medicaid, including federal and state fund components.
Williamson said the first supplemental was a one‑time request (noted in the packet at roughly $1.3 million) to meet the Centers for Medicare & Medicaid Services (CMS) requirement for an annual external quality review (EQR) of managed‑care plans. She told members the department posted two RFPs that failed to draw responses and that a subsequent request for information suggested a market‑rate gap versus historical payments.
Another supplemental would support system configuration and onboarding for the Idaho Behavioral Health Plan (IBHP) vendor; Williamson described a one‑time federal interest in benefit payments item she quantified at about $113.8 million. She also said a capitation rate increase tied to the behavioral health plan would add roughly $108.8 million one‑time (federal funds) split across plans — the analyst gave a breakout in the budget book: about $33 million in expansion, $1.9 million coordinated, $14.8 million enhanced and roughly $58 million basic.
Williamson told the committee a supplemental related to processing the hospital assessment fund was requesting about $190 million (entrusting benefit payments), with approximately $77 million from dedicated hospital assessment funds and about $113 million in federal funds. She linked that request to technical methodology changes from Senate Bill 1350 (2022) that altered the UPL calculation used for hospitals and skilled nursing facilities.
For 2026, Williamson called out the Medicaid Management Information System (MMIS) procurement — the department is in year three of five — and listed the state portion set aside in the MMIS Dedicated Fund at about $11.7 million and the federal portion at about $105 million. Ongoing enhancement requests included required CMS surveys (CAHPS) and actuary and contract funding tied to the KW lawsuit settlement and the resource allocation tool.
Director Alex Adams and Deputy Director Juliette Sharon answered committee questions about vendor responses and implementation timelines and confirmed the department considers many of these requests as responses to federal requirements or legal obligations rather than discretionary expansions.
Ending — Committee members asked for additional detail on the failed EQR RFPs, the MMIS timeline and the legal drivers for selected ongoing requests; analysts and department staff said they will follow up with documents posted on SharePoint and email clarifications.
