Joint finance committee hears Medicaid budget: $45.8M supplemental, MMIS procurement, estate‑recovery backlog debated

The Joint Finance‑Appropriations Committee on Monday heard a two‑hour presentation and extended questioning on Idaho Medicaid’s budget and line‑item requests, including a governor‑recommended $45.8 million supplemental for fiscal 2026 and a $235.3 million ongoing population‑forecast adjustment for fiscal 2027.

Alex Williamson, budget and policy analyst for Legislative Services, told the committee the Division of Medicaid’s FY2025 appropriation exceeded $5.13 billion and that about 98% of Medicaid spending is for benefit payments. "Of the $5,130,000,000 available to the division in fiscal year 2025, they expended 95% of that," Williamson said, and walked the committee through plan‑level expenditures and a five‑year appropriation‑to‑expenditure history.

Why the supplemental and the FY2027 increase are so large was the central focus of lawmakers’ questions. Williamson described three supplemental requests for 2026 — alignment of the hospital assessment fund tied to House Bill 345, claims payment adjustments and an updated forecast — and said the governor’s recommendation nets to a $45.8 million supplemental after a 4% provider‑rate adjustment. She explained the HB345 alignment moves roughly $349.7 million from federal to a dedicated hospital assessment fund to match how the federal match must be deposited.

Deputy Director Sasha O’Connell,…