Committee examines Medicaid forecast adjustments, hospital assessment and MMIS procurement; behavioral health grants posted as supplemental

Legislative Services budget analyst Alex Williamson told the Idaho House Health and Welfare Committee that roughly two‑thirds of a recent $670 million increase in the Department of Health and Welfare’s appropriation was driven by Medicaid adjustments, including updated population forecasts, provider rate increases and changes to the upper‑payment limit and hospital assessment methodology.

“That jump that you see between fiscal year 2022 and 2023…that was an increase of about $670,000,000. About two thirds of that was the result of adjustments in Medicaid,” Alex Williamson said.

Key items discussed:

- Medicaid population forecast adjustments: Williamson and committee members discussed the role of updated utilization, enrollment and acuity assumptions. The department requested an updated Medicaid forecast supplemental of roughly $113,000,000 for fiscal‑year 2025.

- Hospital assessment and upper‑payment limit: The committee reviewed a package of changes that increased the amount of federal reimbursement the state can draw. Alex Williamson identified a hospital assessment entry of about $77,200,000 that appears as dedicated funds in the request; the state’s appropriations record must reflect these flows even though funds are ultimately remitted back to hospitals.

- MMIS procurement: The committee discussed the multi‑year Medicaid Management Information System (MMIS) replacement, which the analyst said is in year three of procurement. Williamson noted the federal/state split is roughly 90% federal and 10% state for implementation costs. Representative Erickson and others asked about implementation problems; Williamson said she would follow up with the Medicaid administrator for a current status.

- Behavioral health contract implementation grants: A $6,743,000 supplemental (federal funds) was described as spending authority to access previously awarded federal grants tied to the Idaho Behavioral Health Plan, which went live in July 2024. Williamson said implementation delays left grant cash unused and the supplemental would give the department authority to spend those dollars.

Committee members pressed staff on checks in the appropriation process: Representative questions referenced prior legislative conditions (for example, payment tranches tied to implementation milestones) and asked how future appropriations will be conditioned on vendor milestones. Williamson said she would follow up with the Medicaid administrator and noted Senator Cook has been active on MMIS oversight.

Ending: The committee did not adopt final decisions on Medicaid supplements during the hearing; staff said they will return with more detailed follow‑ups, including updates on MMIS progress and conditions used to release payments.