More Changes to Medicaid Expansion Bills

Update on Medicaid Expansion Bills

The original bill is H 138 and the modified version is bill H 328.

Both Idaho bills, 328 and 138, aim to reform and control costs within the state's Medicaid program, but they approach this goal with distinct strategies and priorities. Here's a breakdown of the key differences:

Bill 328: The Medicaid Reform and Cost-Containment Act

• Focus:
  • Emphasis on fiscal responsibility and long-term sustainability.
  • Protecting rural healthcare access and ensuring services for vulnerable populations.
  • Controlling costs through legislative oversight of waivers, cost-sharing, and potential federal-level changes.
  • Fraud and abuse prevention.
• Key Provisions:
  • Legislative oversight of Medicaid waivers and amendments.  
  • Cost containment through sideboards on Medicaid expansion.
  • Trigger mechanisms for cost management based on federal changes.
  • Changes to patient cost sharing.
  • Removal of primary care case management.
• Fiscal Impact:
  • Projects net savings, with specific figures provided for FY 2026 and FY 2027 onwards.
  • Anticipates additional savings from longer-term Medicaid waivers.
  • One time development cost.
• Overall Approach:
  • Aims to fine-tune the existing Medicaid program for efficiency and sustainability, while maintaining essential services.

Bill 138: Medicaid Expansion, Conditions

• Focus:
  • Emphasis on "self-sufficiency," "fiscal responsibility," and "integrity."
  • Conditional continuation of Medicaid expansion for able-bodied adults.
  • Implementing stricter eligibility requirements and cost-saving measures.
• Key Provisions:
  • Work requirements for able-bodied adults.
  • Enrollment caps to prioritize seniors and individuals with disabilities.
  • Strict improper payment controls.
  • Biannual eligibility verification.
  • Time-limited benefits for able-bodied adults.
  • Optional private coverage for those above a certain poverty level.
• Fiscal Impact:
  • Projects potentially larger savings than Bill 328.
  • Savings depend on whether the conditions for continued expansion are met.
  • Possible savings from 109 million to 163 million depending on if expansion is repealed, or if the conditions are met.
  • Medicaid Stabilization fund provides 3 million for implementation.
• Overall Approach:
  • A more restrictive approach, tying continued Medicaid expansion to stringent requirements and potentially reversing expansion if those requirements are not met.

In essence:

• Bill 328 seeks to manage costs and improve efficiency within the existing Medicaid framework.  
• Bill 138 aims to fundamentally reshape Medicaid expansion, imposing stricter eligibility criteria and potentially reversing expansion if those criteria are not met. Bill 138 is much more focused on work requirements, and enrollment caps.  

A summary of H 328 can be read here:
https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2025/legislation/H0328SOP.pdf

The full text is available here: 
https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2025/legislation/H0328.pdf

A summary of H 138 can be read here: 
https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2025/legislation/H0138SOP.pdf

The full text is available here:  
https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2025/legislation/H0138.pdf