Legislature introduces tweaked Medicaid cost bill with work requirements

BOISE (Idaho Capital Sun) — Idaho House lawmakers introduced a revised version of a bill intended to control Medicaid costs. 

After an unusually long debate about whether to formally introduce the bill, which would make the bill available online to the public, the Idaho House Health and Welfare Committee on a unanimous voice vote Friday introduced House Bill 345.

The bill, a revised version of the “compromise” legislation, House Bill 328, which was introduced Tuesday, proposes a range of sweeping Medicaid reforms — without the threat of repealing Medicaid expansion, a voter-passed law. 

The new bill is expected to have a full committee hearing next week. It calls for Idaho to seek work requirements for able-bodied Idahoans on Medicaid, and let Idahoans eligible for Medicaid expansion access tax credits to purchase insurance on Idaho’s health care exchange. 

The new bill makes mostly minor changes to the original cost-control bill, including exempting students attending college and vocational school from work requirements, bill cosponsor Rep. Jordan Redman, R-Coeur d’Alene, told the committee.

The new bill would also call for Idaho to plan to shift to management of Medicaid benefits to private companies, which is called managed care and is used by most states’ Medicaid programs. And the bill directs Idaho to end Idaho’s use of doctor-managed care, called value care, a unique model that has existed for a few years.

Many of the bill’s proposals require federal approval, and would likely take years to implement. In 2019, Idaho failed to receive federal approval — then by the Trump administration — for Medicaid work requirements and an exchange tax credit option, which are similar to the new bill’s provisions. 

The bill could save Idaho $15.9 million in fiscal year 2026 and even more in the future, the bill’s fiscal note estimates. But the timing depends on federal approval, the fiscal note says.

The bill has not been considered by the Idaho House of Representatives or Senate. To become law, Idaho bills must pass the House and Senate, and avoid the governor’s veto.

If passed into law, the bill would take effect immediately through an emergency clause. 

Sen. Zuiderveld unsuccessfully tried to revive Medicaid expansion repeal-or-reform bill

But the bill doesn’t include several provisions from an earlier Medicaid expansion repeal-or-reform bill by Redman. If passed, that bill would likely repeal Medicaid expansion in Idaho. 

But even if that bill becomes law and Idaho gets approval for all 11 policy demands, the bill could cap Medicaid expansion enrollment at less than half of current levels — and kick off people who’ve been enrolled in the program for three years. 

Senate Health and Welfare Committee Chairwoman Julie VanOrden, R-Pingree, has stopped the bill from advancing in the Senate – after it narrowly passed the House. 

But on Thursday, Sen. Glenneda Zuiderveld, R-Twin Falls, unsuccessfully tried to schedule the bill for a hearing in committee — citing the rising costs of Medicaid and the bill’s House passage.

“This issue is too important for one person to decide for all of Idaho,” she told the Sun in a written statement via text message. “We were all sent here to make decisions for our districts and Idaho.”

Zuiderveld is a second-term legislator. 

Generally, Idaho Legislature committee chairs have wide discretion on deciding to grant hearings for bills assigned to their committees. That effectively gives committee chairs power to halt bills from advancing in one legislative chamber even if it passed the other chamber.

But Zuiderveld told the Sun rules allow ”us to move bills out of drawers.” She did not reply to the Sun’s question about whether she’d attempt the motion again. The committee’s next meeting is Monday.

In an interview late Thursday, VanOrden — who has served in the Idaho Legislature for nearly 10 years, including three terms in the House and is in her third term in the Senate  — said she’d never seen her chair power tested in such a way. She was not at the meeting, she told the Sun, but returned minutes later to immediately adjourn the committee meeting.

“She didn’t come and talk to me beforehand and say, ‘This is what I’m going to do.’ I think it’s very disrespectful. … I think it’s unethical to do something like that,” VanOrden told the Sun.

Asked whether the Medicaid expansion repeal-or-reform bill is dead for the session, which is Statehouse terminology for a bill that doesn’t have a chance of passing this year, VanOrden told the Sun no.

“Bills aren’t dead until the session is done — for one thing. … But there are a number of us on this side of the rotunda, working with some of the legislators on the other side of the rotunda to have a replacement bill,” VanOrden told the Sun. 

VanOrden is co-sponsoring the new Medicaid cost control bill, along with Redman, House Health and Welfare Committee Chairman John Vander Woude, R-Nampa, and Sen. Carl Bjerke, R-Coeur d’Alene, who is vice chair of the Senate health committee. 

VanOrden believed the expansion repeal-or-reform bill would likely repeal Idaho Medicaid expansion. She said most of Senate leadership was worried about the repeal-or-reform bill. 

“I wouldn’t want to have Medicaid expansion just disappear right now,” VanOrden told the Sun. “I think that would be very devastating for our state.”

If federal government reduces Medicaid expansion match rate, bill would give broad cost cutting power to Idaho Health and Welfare director 

The new Medicaid cost-control bill has a provision to address if the federal government reduces its financial matching rate for Medicaid expansion, which is 90% compared to Idaho’s typical federal Medicaid match rate of 70%.

If the federal financial participation rate in Medicaid expansion reduces outside of a state legislative session, the bill directs the Idaho Department of Health and Welfare to “take any action necessary to offset the increase in state funding,” such as by cutting optional benefits or reducing provider payment rates. 

“Such actions shall be taken until such time as the state legislature may convene and determine a proper course of action,” the bill says. 

In an interview after the committee meeting, Vander Woude said the director’s decisions would be subject to legislative review and are “not absolute.”

“Part of the reason I did something like that is I was here in 2009 when we had to make budget cuts. And the director wouldn’t help us at all with any suggestions,” Vander Woude told the Sun.

Republican Idaho lawmakers have long worried about the federal government reducing its high match rate for Medicaid expansion. 

“I suspect there’s a chance that it will,” Vander Woude told the Sun. But he said he didn’t know what the Idaho Health and Welfare Department director, who is currently Alex Adams, would do. 

The bill also calls for Idaho to seek federal approval to no longer allow state health officials to automatically renew Medicaid for people based on publicly available information, or to use pre-populated forms. That process is commonly called “ex-parte renewals” in health policy jargon.

Idaho House health committee had first planned to not formally introduce cost bill, but rebuffed over transparency concerns

As the House Health and Welfare Committee hearing started Friday, Vander Woude told the committee no motion was intended on the new Medicaid cost-control bill. Formally introducing the bill would delay the committee’s plan for a full hearing on Monday, he said, because of time needed for legislative printing processes.

But he said he wanted the public to have time to review the bill. 

Vander Woude noted the Idaho Legislature was three weeks from the March 21 target date to adjourn for the year, which is called sine die.

“I don’t think we reach it, but … I don’t want to be the one that keeps us,” Vander Woude said in committee. 

But after Idaho House Minority Leader Ilana Rubel, D-Boise, raised concerns about how the public would be able to access the bill if it wasn’t formally introduced, the committee agreed to formally introduce it. 

Idaho draft bills are not posted on the Idaho Legislature’s website — until committees formally vote to introduce them. 

After Rubel raised her concern, several lawmakers on the committee wrangled over how to make the bill publicly available without formally introducing it.

The committee ultimately agreed to formally introduce the bill on a motion made by Rep. Megan Egbert, D-Boise.

“I know you guys didn’t do what I asked you to,” Vander Woude told the committee as the meeting ended, and several lawmakers laughed. 

“But understand, I have no angst on that at all,” Vander Woude said. “I’m just trying to make sure that the process runs smoothly and that we get this done. And so I guess if we have to wait an extra day, we’ll have to wait an extra day. I agree. I don’t want the perception that we’re trying to hide something and not put it out in public.”

Idaho Capital Sun is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christina Lords for questions: info@idahocapitalsun.com.

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