IdahoIdaho sets Medicaid clinic rates when covered services change
Idaho’s health department must submit state plan amendments by October 1, 2026, for rate adjustments tied to qualifying changes in clinic services.
What it does
Federally qualified health centers and rural health clinics may receive Medicaid rate adjustments when covered services change and the cost per visit rises by at least 4.5%. A cost increase alone does not qualify.
The department reviews applications and sends applicants a draft rate calculation to review. Applicants may appeal the final rate within 30 days of the department’s decision.
The identified Medicaid rule becomes void on October 1, 2026. Clinics that began changing services before then may finish under the department rule that applied when they started.
Argument forClinics may receive rates that reflect changes in covered services, with payments reconciled from the first day of the change.
Argument againstClinics may wait six months and meet a 4.5% cost threshold before applying, which could delay a rate adjustment after services change.
More detail
The health department adjusts prospective payment rates when a clinic’s covered services change. This applies to federally qualified health centers and rural health clinics when the type, intensity, duration, or number of covered services changes. Adding, dropping, or expanding a covered service may qualify. A cost change alone does not count as a change in services. A clinic’s application must show at least a 4.5% cumulative or aggregate change in cost per medical or dental visit compared with its current rate. Clinics may apply after providing the changed services and incurring costs for six uninterrupted months. They must apply by the last day of the third month after that period, and may apply no more than once per fiscal year. The health department must submit the required state plan amendments by October 1, 2026.
The health department reviews rate applications, shares a draft calculation, and issues a final rate that applicants may appeal. The review process applies to clinics applying for a rate adjustment based on a change in services. Applications must include a description of the service changes and their relation to the clinic’s overall services, a full cost report for the first six months, and any reasonably necessary supplemental data requested by the department. The department may accept, reject, or adjust a request. Applicants may take up to two weeks to provide requested records; that response time does not count toward the department’s review period. The department has 90 days to review an application, not counting time spent waiting for requested records. Applicants get 60 days to review the draft calculation, and the department must issue the final rate within 45 days after that review period. The rate applies from the first day of the service change, and the department reconciles payment differences through the completion date.
The law makes the identified Medicaid rule void and lets some clinics finish under the earlier process. The rule concerns Medicaid plan benefits under IDAPA 16.03.26, Section 307, Subsection 03. Clinics that began a change in services before October 1, 2026, may finish under the department rule that applied when they began. The law takes effect upon passage and approval. The identified rule becomes void on October 1, 2026.
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Where it stands
- Introduced
- Passed 1st Chamber
- Passed 2nd Chamber
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Apr 2Signed by Governor Brad Little on 04/02/26 Session Law Chapter 308 Effective: 04/02/2026; 07/01/2026 IDAPA Sunset Clause - SECTION 2Became Law
- Apr 1Reported delivered to Governor at 6:50 p.m. on 04/01/26To Governor
- Vote recorded Rules Suspended: Ayes 62 Nays 3 Abs/Excd 5, read in full as required –. Result: pass.Lower
- Apr 1Reported signed by the Speaker & ordered delivered to GovernorMinor
- Apr 1Received from Senate; Signed by Speaker; Returned to SenateMajor
- Apr 1Reported enrolled; signed by President; to House for signature of SpeakerMajor
- Apr 1Returned From House Passed; referred to enrollingMinor
- Apr 1Rules Suspended: Ayes 62 Nays 3 Abs/Excd 5, read in full as required – PASSED - 67-0-3AYES – Alfieri, Barbieri, Beiswenger, Berch, Bingham, Boyle, Bruce, Burgoyne, Cannon(Cannon), Cayler, Cheatum, Church, Cornilles, Crane(12), Crane(13), Dygert, Egbert(Beazer), Ehardt, Ehlers, Erickson, Fuhriman, Furniss, Galaviz, Gannon, Garner, Green, Hall(Stone), Handy, Harris, Hawkins, Haws, Healey, Hill(Hill), Holtzclaw, Hostetler, Leavitt, Manwaring, Marmon, Mathias, McCann, Mendive, Mickelsen, Miller, Mitchell, Monks, Nelsen, Palmer, Petzke, Pickett, Pohanka, Price, Rasor, Raybould, Raymond, Redman, Rubel, Sauter, Scott, Shepherd, Shirts(Batt), Tanner(13), Thompson, Vander Woude, Veile, Weber, Wisniewski, Mr. SpeakerNAYS – NoneAbsent – Skaug, Tanner(14), WheelerFloor Sponsor - Vander WoudeTitle apvd - to SenatePassed 2nd Chamber
- Apr 1Reported out of Committee with Do Pass Recommendation, Filed for Second ReadingMinor
- Mar 26Read First Time, Referred to Health & WelfareMinor
- Vote recorded Read third time in full –. Result: pass.Upper
- Mar 26Received from the Senate, Filed for First Reading
- Mar 26Read third time in full – PASSED - 33-0-2AYES – Adams, Anthon, Bernt, Bjerke(Bjerke), Blaylock, Burtenshaw, Carlson, Den Hartog, Foreman, Galloway, Grow, Guthrie, Harris, Hart, Keyser, Kohl, Lakey, Lenney, Lent, Nichols, Okuniewicz, Rabe, Ruchti, Semmelroth, Shippy, Taylor, Toews, VanOrden, Ward-Engelking, Wintrow, Woodward, Zito, ZuiderveldNAYS – NoneAbsent and excused – Cook, RicksFloor Sponsor - VanOrdenTitle apvd - to HousePassed 1st Chamber
- Mar 25Read second time; filed for Third ReadingMinor
- Mar 24Reported out of Committee with Do Pass Recommendation; Filed for second readingMinor
- Mar 19Reported Printed; referred to Health & Welfare
- Mar 18Introduced; read first time; referred to JR for PrintingIntroduced
Healthcare