T56CH22
Title 56 > T56CH22
Sections (7)
56-2201
TITLE 56 PUBLIC ASSISTANCE AND WELFARE CHAPTER 22 LEGISLATIVE APPROVAL FOR MEDICAID STATE PLAN AMENDMENTS AND WAIVERS 56-2201. legislative approval required. Notwithstanding any provision of law to the contrary, the state department of health and welfare shall not seek or implement a medicaid state plan amendment or a waiver pursuant to section 1115 or 1915 of the social security act that would expand coverage to any additional individuals or class of individuals or would increase any net cost to the state without first obtaining approval from the legislature. Such approval must be provided in statute and, to be effective, must be listed in this chapter. The provisions of this section shall not affect any state plan amendment or waiver program previously authorized by statute or already implemented as of July 1, 2025. The provisions of this section shall not apply to any medicaid state plan amendment or waiver program that does not expand coverage to any individuals or class of individuals and does not increase any net cost to the state. The department of health and welfare shall provide regular updates to the medicaid legislative review panel on a schedule determined by the cochairs and shall seek input from the medicaid legislative review panel to design any waivers submitted to the centers for medicare and medicaid services on behalf of the state. History: [56-2201, added 2025, ch. 118, sec. 2, p. 621.]
56-2202
TITLE 56 PUBLIC ASSISTANCE AND WELFARE CHAPTER 22 LEGISLATIVE APPROVAL FOR MEDICAID STATE PLAN AMENDMENTS AND WAIVERS 56-2202. legislative approval — rural emergency hospital designation and reimbursement. The department of health and welfare is authorized to and shall submit a state plan amendment to the centers for medicare and medicaid services allowing the recognition and reimbursement of medicaid services provided by a rural emergency hospital. For the purposes of this section, rural emergency hospital has the same meaning as provided in 42 U.S.C. 1395x(kkk)(2). History: [56-2202, added 2025, ch. 118, sec. 2, p. 622.]
56-2203
TITLE 56 PUBLIC ASSISTANCE AND WELFARE CHAPTER 22 LEGISLATIVE APPROVAL FOR MEDICAID STATE PLAN AMENDMENTS AND WAIVERS 56-2203. legislative approval — medicaid cost-sharing. (1) The department of health and welfare is authorized to and shall submit a state plan amendment to the centers for medicare and medicaid services to include participant cost-sharing as a condition of participation in a medical assistance program, to the extent allowed under federal law, that is at least to the levels developed by other states and up to the maximum charged by other states. (2) The department of health and welfare shall: (a) Take such actions as are necessary to implement the provisions of this section; (b) Begin the application process for federal approval of the state plan amendment required by this section no later than July 1, 2026; and (c) Continue any existing cost-sharing under the medicaid state plan in effect at the time of the passage of this act until supplanted by the new state plan amendment required by this section. History: [56-2203, added 2025, ch. 118, sec. 2, p. 622.]
56-2204
TITLE 56 PUBLIC ASSISTANCE AND WELFARE CHAPTER 22 LEGISLATIVE APPROVAL FOR MEDICAID STATE PLAN AMENDMENTS AND WAIVERS 56-2204. legislative approval — comprehensive medicaid managed care. (1) The department of health and welfare is authorized to and shall submit to the centers for medicare and medicaid services all state plan and waiver authorities required to implement a plan for comprehensive medicaid managed care. (2) The department of health and welfare shall: (a) Take such actions as are necessary to implement the provisions of this section; (b) Submit the application for federal approval of the state plan amendments and waivers required by this section no later than July 1, 2026; (c) Continue any existing managed care under the medicaid state plan and its waivers in effect at the time of the passage of this act until supplanted by the new comprehensive managed care plan required under this section; (d) Undertake cost containment strategies, such as bidding multi-year contracts with predetermined inflationary adjustments or withholding a percentage of capitation if managed care organizations do not meet these cost containment targets; and (e) Engage medicaid providers and participants in the substance and design of a comprehensive managed care plan. History: [56-2204, added 2025, ch. 118, sec. 2, p. 622.]
56-2205
TITLE 56 PUBLIC ASSISTANCE AND WELFARE CHAPTER 22 LEGISLATIVE APPROVAL FOR MEDICAID STATE PLAN AMENDMENTS AND WAIVERS 56-2205. legislative approval — medicaid expansion limits. (1) The department of health and welfare is authorized to and shall submit to the centers for medicare and medicaid services the following state plan amendments and waivers no later than July 1, 2026: (a) Work-requirements for able-bodied adults enrolled in medicaid in which no individual shall be eligible to participate in the medicaid program pursuant to section 56-267 , Idaho Code, unless the individual is: (i) Working twenty (20) hours or more per week, averaged monthly; (ii) Participating in and complying with the requirements of a work program twenty (20) hours or more per week, as determined by the department; (iii) Volunteering twenty (20) hours or more per week, as determined by the department; (iv) Meeting any combination of working and participating in a work program for a total of twenty (20) hours or more per week, as determined by the department; or (v) Participating and complying with the requirements of a work-fare program, unless the individual is: 1. Younger than nineteen (19) years of age; 2. Older than sixty-four (64) years of age; 3. Medically classified as physically or mentally unfit for employment; 4. Pregnant; 5. A parent or caretaker responsible for the care of a dependent child younger than six (6) years of age; 6. A parent or caretaker personally providing the care for a dependent with a serious medical condition or with a disability, as determined by the department; 7. Receiving unemployment compensation and complying with the work requirements as part of the federal-state unemployment compensation system; 8. Participating in a drug addiction or alcohol treatment and rehabilitation program; or 9. Enrolled at least part-time in a college, university, or vocational education program. (b) Allow persons eligible for medicaid under section 56-267 , Idaho Code, who have a modified adjusted gross income at least at or above one hundred percent (100%) of the federal poverty level to receive the advance premium tax credit to purchase a qualified health plan through the Idaho health insurance exchange established by chapter 61, title 41 , Idaho Code, instead of enrolling in medicaid, except that the person may choose to enroll in medicaid instead of receiving the advance premium tax credit to purchase a qualified health plan. (c) Implement the following changes to eligibility determination: (i) Suspend requirements to renew eligibility automatically based on available information and pre-populated forms; and (ii) Implement biannual redetermination for persons eligible for medicaid under section 56-267 , Idaho Code. (d) Implement the following changes to benefits: (i) No funds shall be used to fulfill any contract or commercial transaction with any health care provider or health care facility under the terms of which such health care provider or health ca
56-2206
TITLE 56 PUBLIC ASSISTANCE AND WELFARE CHAPTER 22 LEGISLATIVE APPROVAL FOR MEDICAID STATE PLAN AMENDMENTS AND WAIVERS 56-2206. legislative approval — practice authority protection. The department of health and welfare is authorized to and shall submit a state plan amendment to the centers for medicare and medicaid services by July 1, 2025, allowing for practice authority protection to the extent permitted by state law. History: [56-2206, added 2025, ch. 118, sec. 2, p. 624.]
56-2207
TITLE 56 PUBLIC ASSISTANCE AND WELFARE CHAPTER 22 LEGISLATIVE APPROVAL FOR MEDICAID STATE PLAN AMENDMENTS AND WAIVERS 56-2207. legislative approval — site-neutral payments. The department of health and welfare is authorized to seek and shall submit a state plan amendment by July 1, 2026, that sets reimbursement rates for hospital-acquired physician practices at the same rate as physician-owned medical practices for all equivalent outpatient health services where the service is not dependent on the hospital facility’s associated technologies and in the absence of any evidence-based rationale. The department shall except critical access hospitals and rural emergency hospitals to the extent allowable. History: [56-2207, added 2025, ch. 118, sec. 2, p. 624.]