Idaho Medicaid budget rises as committee considers $376 million forecast adjustment and $190 million hospital-assessment request

The Joint Finance-Appropriations Committee reviewed the Division of Medicaid’s budget on Feb. 26, hearing that state and federal factors have pushed Medicaid spending well above earlier forecasts and prompted multiple supplemental and ongoing requests.

Alex Williamson, budget and policy analyst with Legislative Services, told the committee the division expended about $4.27 billion of the roughly $4.56 billion appropriated for fiscal 2024 and that a $367 million population-forecast adjustment is in the governor’s 2026 enhancement package. "These populations are assumed to be in average health with average levels of disease," Williamson said, explaining variation in per-enrollee costs across plan types.

Why it matters: Medicaid is an entitlement and the state has limited discretion over eligibility and required services. The committee heard multiple one-time and ongoing supplemental requests and enhancements intended to meet federal requirements and to reflect updated hospital assessment and utilization calculations.

Most significant requests and drivers - Hospital assessment supplemental and ongoing request: $190,000,000 (trustee/benefit payments); transcript breakout shows $77,000,000 from the dedicated hospital assessment fund and $113,000,000 from federal funds. The department said changes resulting from 2022’s Senate Bill 1350 altered methodology for upper payment limit (UPL)…