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Representative Redmond asks OPE to review Medicaid hospital billing and plan selection in Idaho
Summary
Representative Jordan Redmond presented two health‑related OPE requests: a study of Medicaid hospital billing patterns (including upcoding concerns since the 2021 payment change) and a study of plan selection and uninsured Idahoans; the Department of Health and Welfare said it is requesting budget resources to analyze DRGs and hospitals.
Representative Jordan Redmond told the committee he submitted two separate study requests on health topics. On Medicaid hospital billing he said, "upcoding is present in almost 15 percent of hospital stays," and asked OPE to examine whether diagnosis‑based payments adopted in 2021 have changed hospital billing patterns and whether those trends affect premium rates.
State Medicaid Administrator Sasha O'Connell, deputy director at the Department of Health and Welfare, told the committee the department has requested additional budget resources to analyze DRGs (diagnosis related groups) and hospital billing but currently lacks capacity for a comprehensive analysis. "We do have a request, underway, in our budget for additional resources to look at DRGs and hospitals," O'Connell said, and she welcomed OPE's expertise to inform next steps.
Redmond also presented a constituent‑driven proposal for an OPE study of Your Health Idaho plan selection to better understand the number and reasons for uninsured Idahoans and the taxpayer cost of uncompensated care; OPE staff described these studies as feasible (the Medicaid billing review as larger in scope than the plan selection study). Neither study was among the top two projects on the committee ballot, but both were discussed and OPE noted feasibility and potential staffing implications.
