Healthcare (Medicaid)

This bill creates a Medicaid exemption from prior approval requirements for healthcare providers who mentor medical students. Practitioners in family medicine, psychiatry, or OB/GYN qualify if they provide 360+ hours of preceptorship (with 60% in rural/underserved areas) to graduate students at Idaho institutions. Idaho's Department of Health and Welfare verifies hours and grants a 12-month exemption starting the next calendar year. The exemption is limited to 100 providers per specialty annually and may be revoked if claims fail risk-based quality reviews.

Idaho's H 729, the "Idaho Dental Plan Transparency Act," requires dental health insurance plans (excluding Medicaid, CHIP, short-term plans, and direct primary care) to annually report their "dental loss ratio" (DLR) to the Idaho Department of Insurance. The DLR shows what percentage of premium dollars go directly toward patient dental care versus administrative costs, calculated using specific rules that exclude overhead and other expenses. Starting in 2027, plans must submit these reports by July 31, and the Department will publish the data publicly on a searchable website by January 1 each year for consumers to compare. This law aims to increase transparency about how dental plan premiums are used, without changing coverage or costs.

H 759 revises Idaho's Medicaid provider payment rules to reduce costs and increase transparency. It sets payment rates at 90% of Medicare rates for most services (up to 100% for primary care), requires annual cost surveys for home-based services with 15% audits, and mandates public reporting of survey results by December 31 each year. The bill directly affects residential habilitation providers, hospitals, and other Medicaid service providers by requiring them to allocate funds to direct care wages and meet spending thresholds. Key mechanisms include new reimbursement rates for hospitals (e.g., 101% for in-state critical access hospitals), a three-year budget reduction target for hospital payments, and nullifying specific administrative rules after 2026.

This bill requires Idaho's Department of Health and Welfare to study policy options for two Medicaid groups: workers with disabilities who can no longer work due to age or disability, and individuals in home care programs facing high out-of-pocket costs. The study will examine ways to prevent participants from losing savings or coverage when transitioning between programs, and to keep people in community settings instead of institutions. The department must report findings by December 2026, including federal approval needs, cost impacts, and recommendations for maintaining work incentives while reducing institutionalization. The bill does not change current Medicaid rules but directs a review of potential improvements.

This Idaho bill (H 529) allows health insurance policyholders to pay cash directly to providers for covered services at a negotiated discounted price, with that payment counting toward their out-of-pocket deductible and annual maximum. It requires health carriers to count such cash payments toward these limits if the patient negotiated a lower price than the insurance plan’s allowed amount and provides required documentation. The law applies to in-network or out-of-network providers but excludes dental/vision plans, Medicaid, Medicare, and certain short-term policies. Providers must accept cash as full payment and cannot bill patients or insurers for the difference. The provisions take effect July 1, 2026.