House committee advances Medicaid reform bill after hours of testimony; sponsors say waivers will preserve expansion

Representative Jordan Redmond, R‑Kootenai County, introduced House Bill 138 to the House Health and Welfare Committee, saying the measure is meant to “put Medicaid back on track, protect taxpayers, and make sure people who need it most get the care that they deserve.” The committee heard more than 30 witnesses and spent several hours questioning the sponsor and other members before sending the bill to the House floor with a due‑pass recommendation on a party‑line, 8–7 roll‑call vote.

Redmond said the bill does not repeal Medicaid expansion and instead seeks a package of federal waivers and other changes to reduce what he described as “waste” in the program. He told the committee he wants limits and “sideboards” for the expansion population, including an enrollment cap “the lower of 50,000 or the aggregate number of elderly and disabled enrollees,” a 36‑month time limit for able‑bodied adults, and work or community‑engagement requirements of roughly 20 hours per week administered by the Idaho Department of Health and Welfare.

The bill would direct the department to apply for a suite of federal waivers (discussed in testimony as both "1115" and "1332/1332‑style" waivers). Redmond said the fiscal note includes $3 million from the Medicaid Budget Stabilization Fund for one‑time implementation and waiver application costs and estimated about $2 million in ongoing administrative costs, while several witnesses and at least one department representative testified that waiver work could cost more — a figure of roughly $3.8 million in one version of the estimate and as many as 17 FTEs for ongoing reporting and implementation tasks.

Much of the committee's questioning focused on program size, cost, and practical effects. Redmond cited a projection in the legislative budget book showing a governor's FY2026 request of $1,361,100,400 for Medicaid expansion and said the program had grown faster than original projections. He also said the expansion population had an estimated improper‑payment rate “almost 19%,” and that the bill would require lowering that rate toward a 5% target used in other states.

Opponents argued the bill would functionally repeal expansion even if some waivers were granted. Dozens of public witnesses — including physicians, hospital and advocacy groups, recovery‑services providers, and Medicaid enrollees — urged the committee to reject HB138. Key testimony included:

- Fred Birnbaum, Idaho Freedom Foundation, who argued expansion was a fiscal emergency and urged reform; - Brandon Mickelson, Idaho Academy of Family Physicians, who said repeal would raise costs for hospitals and harm rural access; - Peter Crane, family physician in Montpelier, who said many expansion enrollees are working families and that coverage prevented higher‑cost emergency care; - Brian Whitlock, president, Idaho Hospital Association, who opposed repeal and said the hospital tax and upper‑payment‑limit program supply roughly the state match for expansion; and - multiple patients and caregivers who described needing expansion coverage for surgeries, chronic care and behavioral health supports.

Witnesses for and against the bill repeatedly disputed the magnitude and direction of fiscal effects. Supporters said reform and waivers could save state dollars while preserving coverage for the most vulnerable; opponents said repeal or the bill’s triggers would shift costs to hospitals, counties, public safety, and would reduce access to mental‑health and substance‑use treatment. Multiple witnesses pointed to recent state and university analyses that reach different conclusions about net economic impact and job growth related to expansion.

Committee action and disposition

- Representative Wheeler moved to lay HB138 on the table; Representative Wheeler explained he wanted a “hard reset” on this version of the bill. That motion prompted extended debate and public testimony. Later motions included a substitute to send the bill to the floor with a due‑pass recommendation and an amended substitute to hold in committee at the chair’s discretion.

- After debate and two roll calls the committee voted to send House Bill 138 to the House floor with a due‑pass recommendation on a roll call of 8 in favor, 7 opposed.

What remains unsettled

Sponsor Redmond and several committee members acknowledged legal and practical uncertainty about whether the federal government would approve the full set of waivers requested in the bill. Committee members and witnesses also asked the department to provide more detailed cost estimates for waiver applications and for administering work requirements, as well as clearer plans for people who could lose coverage under the proposed caps or time limits.

Representative Redmond told the committee he intends the provisions as “safeguards” to preserve expansion while imposing state control and accountability. Several committee members urged more study and stakeholder discussion before the House floor debate.

Provenance

Transcript span (topicintro): Representative Jordan Redmond opens discussion of HB138 at 00:07:48 (transcript block starting 468.365) — excerpt: "My name is Jordan Redmond representing District 3 in Kootenai County. Today, I bring before the committee House Bill 138."

Transcript span (topfinish): Final roll call and adjournment at 02:56:03 (transcript block starting 10619.395) — excerpt: "Roll call shows 8 in favor, 7 against. House Bill 138 is sent to the floor with a due pass recommendation."