This bill establishes new requirements for Medicaid eligibility in Idaho, affecting individuals aged 19 to 65 who are not pregnant, not receiving Social Security benefits, and not otherwise eligible for coverage. It mandates that the state verify applicants' work status, income, residency, identity, and immigration status through official documentation and third-party data sources rather than accepting self-attestation. The legislation requires the Department of Health and Welfare to verify compliance with work requirements quarterly and to receive regular data updates from state and federal agencies to monitor changes in recipients' circumstances. Additionally, the bill restricts exemptions from work requirements to specific medical conditions certified by healthcare professionals and prohibits managed care organizations from granting exemptions.
This bill removes Medicaid eligibility expansion provisions from Idaho law, affecting individuals who previously qualified for expanded Medicaid coverage under the Affordable Care Act. The legislation repeals specific sections of the Idaho Code that allowed for broader Medicaid eligibility and established limits on legislative approval for such expansions. Key provisions include preventing individuals eligible for Medicaid or health insurance from receiving financial assistance under the expanded program as it existed on March 1, 2022, while allowing applications received through March 31, 2022, to be processed under the prior rules. The bill also directs that any funds saved by counties through these changes may be used for additional aid to public health districts, with the changes taking effect on January 1, 2028.
This bill establishes the Merit-Based Health Care Act in Idaho, which requires healthcare providers participating in Medicaid to make employment and contracting decisions based on merit and professional qualifications rather than ideological or discriminatory practices. The law defines specific prohibited actions, including the use of state Medicaid funds for diversity, equity, and inclusion training or policies that focus on race or sex-based preferences, while explicitly allowing compliance with federal civil rights laws and legitimate clinical training. Healthcare providers who violate these provisions could face civil penalties ranging from $5,000 to $100,000 depending on company size, and the attorney general can investigate complaints from health care professionals who claim retaliation for refusing to participate in prohibited DEI activities.
This bill establishes the Merit-Based Health Care Act in Idaho, which requires health care providers participating in Medicaid to base employment and contracting decisions on individual merit and professional qualifications rather than ideological or discriminatory practices. The law specifically prohibits the use of state Medicaid funds to support diversity, equity, and inclusion initiatives, bias training, or other policies that consider race or sex in hiring, promotion, or compensation decisions. Providers must comply with these requirements as a condition of their Medicaid agreements, and violations can result in civil penalties ranging from $5,000 to $100,000 depending on the size of the organization and the number of violations. The bill also includes a limited private right of action allowing health care professionals to sue if they face retaliation for refusing to participate in prohibited DEI conduct.
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.
