S14332026 Regular Session

Relates to the appropriation to the Department of Health and Welfare for fiscal years 2026 and 2027.

APPROPRIATIONS -- HEALTH AND WELFARE -- MEDICAID -- Relates to the appropriation to the Department of Health and Welfare for fiscal years 2026 and 2027.

APPROPRIATIONS HEALTH AND WELFARE MEDICAID

IntroducedIn CommitteeFloor VoteEnacted

STATEMENT OF PURPOSE

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RS33811 / S1433 This appropriation to the Department of Health and Welfare for the Division of Medicaid provides enhancements to the FY 2027 maintenance budget that include appropriations for the continuation of the 5-year MMIS procurement process (enhancement #4), the Estate Recovery program (enhancement #5), the Medicaid Program Integrity Unit (enhancement #6), appropriation to support the addition of a new contract staff in the Department of Administration (enhancement #21), adjustments to the Hospital Assessment Fund (including aligning funds pursuant to House Bill 345 of 2025 and the creation of a new budgeted program to track supplemental payments in enhancement #22), and population forecast adjustments.

FISCAL NOTE

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This appropriation provides an additional $493,354,800 to the maintenance appropriation provided to the Department of Health and Welfare for the Division of Medicaid. Table 1 shows incremental adjustments to the division found in the bill, of which $127,722,500 is onetime, and $365,632,300 is ongoing. Table 2 shows all the adjustments leading to the FY 2027 total appropriation. The total FY 2027 budget for the Division of Medicaid is $5,542,529,600. Additionally Table 2 shows the mid-year adjustments to the FY 2026 budget for the Division of Medicaid. The total increase to the FY 2026 budget is $107,244,000 and includes appropriation adjustments for the updated Medicaid forecast and changes to the Hospital Assessment Fund. The total FY 2026 increase found in this bill is offset by a $61,426,800 reduction found in Senate Bill 1331, the 2026 Idaho Rescissions Act, for a net FY 2026 increase of $45,817,200 for the Division of Medicaid. Table 1. FTP Gen Ded Fed Total 4. MMIS Procurement Ye

BILL TEXT

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LEGISLATURE OF THE STATE OF IDAHO Sixty-eighth Legislature Second Regular Session - 2026 IN THE SENATE SENATE BILL NO. 1433 BY FINANCE COMMITTEE AN ACT1 RELATING TO THE APPROPRIATION TO THE DEPARTMENT OF HEALTH AND WELFARE; AP-2 PROPRIATING ADDITIONAL MONEYS TO THE DEPARTMENT OF HEALTH AND WELFARE3 FOR THE DIVISION OF MEDICAID FOR FISCAL YEAR 2027; REDUCING THE APPRO-4 PRIATION TO THE DEPARTMENT OF HEALTH AND WELFARE FOR THE DIVISION OF5 MEDICAID FOR FISCAL YEAR 2027; APPROPRIATING ADDITIONAL MONEYS TO THE6 DEPARTMENT OF HEALTH AND WELFARE FOR THE DIVISION OF MEDICAID FOR FISCAL7 YEAR 2026; REDUCING THE APPROPRIATION TO THE DEPARTMENT OF HEALTH AND8 WELFARE FOR THE DIVISION OF MEDICAID FOR FISCAL YEAR 2026; AND DECLARING9 AN EMERGENCY AND PROVIDING EFFECTIVE DATES.10

Be It Enacted by the Legislature of the State of Idaho:11

SECTION 1. In addition to any other appropriation provided by law,12 there is hereby appropriated to the Department of Health and Welfare for the13 Division of Medicaid the following amounts to be expended according to the14 designated programs and expense classes from the listed funds for the period15 July 1, 2026, through June 30, 2027:16 FOR17 FOR18 TRUSTEE AND OPERATING19 BENEFIT EXPENDITURES20 PAYMENTS TOTAL I. MEDICAID ADMINISTRATION AND MEDICAL MGMT:21 FROM:22 Medicaid Management Information Systems Dedicated23 Fund24 $10,272,100 $10,272,100 Cooperative Welfare (Dedicated)25 Fund26 1,715,800 1,715,800 Cooperative Welfare (Federal)27 Fund28 94,244,800 $486,000 94,730,800 TOTAL29 $106,232,700 $486,000 $106,718,700 II. COORDINATED MEDICAID PLAN:30 FROM:31 Cooperative Welfare (General)32 Fund33 $16,914,400 $16,914,400 Cooperative Welfare (Federal)34 Fund35 31,522,700 31,522,700 TOTAL36 $48,437,100 $48,437,100

2 FOR1 FOR2 TRUSTEE AND OPERATING3 BENEFIT EXPENDITURES4 PAYMENTS TOTAL III. ENHANCED MEDICAID PLAN:5 FROM:6 Cooperative Welfare (General)7 Fund8 $33,127,700 $33,127,700 Cooperative Welfare (Federal)9 Fund10 61,738,400 61,738,400 TOTAL11 $94,866,100 $94,866,100 IV. BASIC MEDICAID PLAN:12 FROM:13 Cooperative Welfare (General)14 Fund15 $42,163,300 $42,163,300 Cooperative Welfare (Dedicated)16 Fund17 37,087,600 37,087,600 Idaho Millennium Income18 Fund19 25,000,000 25,000,000 Cooperative Welfare (Federal)20 Fund21 125,168,800 125,168,800 TOTAL22 $229,419,700 $229,419,700 V. EXPANSION MEDICAID PLAN:23 FROM:24 Cooperative Welfare (General)25 Fund26 $52,555,000 $52,555,000 Cooperative Welfare (Dedicated)27 Fund28 29,518,500 29,518,500 TOTAL29 $82,073,500 $82,073,500 VI. HOSPITAL ASSESSMENT:30 FROM:31 Hospital Assessment32 Fund33 $601,781,000 $601,781,000 GRAND TOTAL34 $106,232,700 $1,057,063,400 $1,163,296,100

SECTION 2. Notwithstanding any other provision of law to the contrary,35 the appropriation made to the Department of Health and Welfare for the Divi-36

3 sion of Medicaid is hereby reduced by the following amounts according to the1 designated programs from trustee and benefit payments from the listed funds2 for the period July 1, 2026, through June 30, 2027:3 I. COORDINATED MEDICAID PLAN:4 FROM:5 Hospital Assessment Fund6 $103,577,700 Cooperative Welfare (Dedicated) Fund7 1,445,100 Cooperative Welfare (Federal) Fund8 85,532,500 TOTAL9 $190,555,300 II. ENHANCED MEDICAID PLAN:10 FROM:11 Hospital Assessment Fund12 $4,172,700 Cooperative Welfare (Federal) Fund13 4,958,600 TOTAL14 $9,131,300 III. BASIC MEDICAID PLAN:15 FROM:16 Hospital Assessment Fund17 $115,270,400 Cooperative Welfare (Dedicated) Fund18 1,023,000 Cooperative Welfare (Federal) Fund19 140,359,600 TOTAL20 $256,653,000 IV. EXPANSION MEDICAID PLAN:21 FROM:22 Cooperative Welfare (General) Fund23 $46,676,200 Hospital Assessment Fund24 25,064,800 Cooperative Welfare (Dedicated) Fund25 1,525,700 Cooperative Welfare (Federal) Fund26 140,335,000 TOTAL27 $213,601,700 GRAND TOTAL28 $669,941,300

SECTION 3. In addition to the appropriation made in Section 1, Chap-29 ter 209, Laws of 2025, and any other appropriation provided for by law, there30 is hereby appropriated to the Department of Health and Welfare for the Divi-31 sion of Medicaid the following amounts to be expended according to the desig-32 nated programs and expense classes from the listed funds for the period July33 1, 2025, through June 30, 2026:34

4 FOR1 FOR2 TRUSTEE AND OPERATING3 BENEFIT EXPENDITURES4 PAYMENTS TOTAL I. MEDICAID ADMINISTRATION AND MEDICAL MGMT:5 FROM:6 Cooperative Welfare (Federal)7 Fund8 $1,535,300 $486,000 $2,021,300 II. COORDINATED MEDICAID PLAN:9 FROM:10 Cooperative Welfare (General)11 Fund12 $28,468,900 $28,468,900 Cooperative Welfare (Federal)13 Fund14 18,049,600 18,049,600 TOTAL15 $46,518,500 $46,518,500 III. ENHANCED MEDICAID PLAN:16 FROM:17 Cooperative Welfare (General)18 Fund19 $40,277,100 $40,277,100 Cooperative Welfare (Federal)20 Fund21 25,536,000 25,536,000 TOTAL22 $65,813,100 $65,813,100 IV. BASIC MEDICAID PLAN:23 FROM:24 Cooperative Welfare (General)25 Fund26 $22,938,000 $22,938,000 Medicaid Budget Stabilization27 Fund28 8,507,700 8,507,700 Cooperative Welfare (Dedicated)29 Fund30 15,165,200 15,165,200 Cooperative Welfare (Federal)31 Fund32 19,936,800 19,936,800 TOTAL33 $66,547,700 $66,547,700

5 FOR1 FOR2 TRUSTEE AND OPERATING3 BENEFIT EXPENDITURES4 PAYMENTS TOTAL V. EXPANSION MEDICAID PLAN:5 FROM:6 Cooperative Welfare (General)7 Fund8 $908,400 $908,400 VI. HOSPITAL ASSESSMENT:9 FROM:10 Hospital Assessment11 Fund12 $601,781,000 $601,781,000 GRAND TOTAL13 $1,535,300 $782,054,700 $783,590,000

SECTION 4. Notwithstanding any other provision of law to the contrary,14 the appropriation made to the Department of Health and Welfare for the Divi-15 sion of Medicaid in Section 1, Chapter 209, Laws of 2025, is hereby reduced by16 the following amounts according to the designated programs from trustee and17 benefit payments from the listed funds for the period July 1, 2025, through18 June 30, 2026:19 I. COORDINATED MEDICAID PLAN:20 FROM:21 Hospital Assessment Fund22 $103,577,700 Cooperative Welfare (Dedicated) Fund23 1,445,100 Cooperative Welfare (Federal) Fund24 85,532,500 TOTAL25 $190,555,300 II. ENHANCED MEDICAID PLAN:26 FROM:27 Hospital Assessment Fund28 $4,172,700 Cooperative Welfare (Federal) Fund29 4,958,600 TOTAL30 $9,131,300 III. BASIC MEDICAID PLAN:31 FROM:32 Hospital Assessment Fund33 $115,270,400 Cooperative Welfare (Dedicated) Fund34 1,023,000

6 Cooperative Welfare (Federal) Fund1 140,359,600 TOTAL2 $256,653,000 IV. EXPANSION MEDICAID PLAN:3 FROM:4 Hospital Assessment Fund5 $25,064,800 Cooperative Welfare (Dedicated) Fund6 1,525,700 Cooperative Welfare (Federal) Fund7 193,415,900 TOTAL8 $220,006,400 GRAND TOTAL9 $676,346,000

SECTION 5. An emergency existing therefor, which emergency is hereby10 declared to exist, Sections 3 and 4 of this act shall be in full force and ef-11 fect on and after passage and approval, and Sections 1 and 2 of this act shall12 be in full force and effect on and after July 1, 2026.13