House Health and Welfare Committee reviews governor's health-and-welfare budget, flags Medicaid forecasts and federal grants

BOISE, Idaho — The House Health and Welfare Committee on Feb. 10 received a full overview of the Department of Health and Welfare’s fiscal 2026 budget recommendation, with staff and the department outlining several large, technical drivers behind this year’s request and answering questions about federal grants and multi‑year projects.

Alex Williamson, budget and policy analyst with the Legislative Services Office, presented the governor’s recommendation and walked committee members through the department’s recent five‑year spending trends, the composition of trustee and benefit payments and the supplemental requests for fiscal 2025 and the enhancement requests for fiscal 2026. Williamson said about two‑thirds of the department’s budget is federally funded and pointed members to the LSO online dashboard for deeper detail.

Williamson and Idaho Department of Health and Welfare Director Alex Adams discussed a group of nondiscretionary population‑forecast adjustments (now described as population forecast adjustments) that are primarily Medicaid driven. The committee heard that changes in utilization, participant counts and the state’s federal medical assistance percentage (FMAP) are driving adjustments in both federal and state shares. Williamson said the state’s FMAP is shifting from 67.59 to 66.91, reducing the federal share and increasing general fund needs.

The committee also discussed a $77.2 million figure tied to a hospital assessment change and updates to the state’s upper payment limit methodology. Williamson explained the hospital assessment fund is a mechanism where hospitals provide the state’s share to draw federal reimbursement and the receipts are ultimately remitted back to hospitals; because the transactions touch state accounting records, appropriations are required.

On the Medicaid Management Information System (MMIS) replacement, Williamson said the procurement is a multi‑year project and, to date, the process was “fairly on track” though she offered to follow up with the Medicaid administrator with a current status. Representative Erickson raised concerns about on‑the‑ground reports and asked how the appropriation checks progress; Williamson said she would provide a more current update to the committee.

Committee members questioned a roughly $6.7 million federal supplemental tied to implementation of the Idaho Behavioral Health Plan. Williamson said the funds are federal grant awards that were appropriated but not yet spent because the plan’s implementation went live later than planned; the supplemental would provide spending authority to access those federal dollars.

Members also asked about ARPA and other federal grants feeding public health programs. Williamson laid out timelines: several ARPA awards are multi‑year (for example, a 5‑year public health infrastructure grant and a 4‑year vital statistics modernization grant). Director Adams said the department has exit strategies for discretionary grants should federal payments be rescinded and that entitlement funding (for example, Medicaid and child welfare) was not the intended target of recent federal guidance about pausing grant draws.

The governor’s recommendation includes a mix of base adjustments, supplementals and proposed enhancements that, if enacted, would increase the department’s total appropriation for fiscal 2026. Williamson said that, as presented, the governor’s recommendation would represent about a 10.7% increase over the fiscal 2025 original appropriation.

Votes at a glance: The committee approved minutes from Feb. 5, Feb. 6 and Feb. 10 on a voice vote after Representative Egbert moved to approve the minutes. The transcript records the motion and that the chair called for ayes and noes and that the motion passed by voice vote; the transcript does not list a roll‑call tally.