Bill Description: House Concurrent Resolution 30 (HCR30) states findings of the Legislature and directs the Medicaid Review Panel to study the implementation of comprehensive Medicaid managed care.
Rating: 0
Analyst Note:
This resolution enables the Legislature to follow through on establishing the requirements for implementation of Medicaid managed care as required by House Bill 345 of 2025. From the Department of Health and Welfare website: “In March 2025, the Idaho legislature passed House Bill 345 (“H345”), which will change how Medicaid works in our state – moving from the traditional fee-for-service system to a managed care model. The department is hosting listening sessions so that you can share your needs and experiences with healthcare.”
No doubt that medical providers and insurers will be attending the listening sessions attempting to steer this new process in a favorable direction.
On its face, managing the process for providing Medicaid services would seem more cost effective than a pure fee-for-service model. Currently Idaho uses a mixture of fee-for-service and managed care for some of the services. For example behavioral health, dental and non-emergency transportation services are provided through contracts.
The challenge is getting a comprehensive contract that is effective in reining in costs. The roadmap provided to the Medicaid Review Panel says nothing about how actual cost savings will be achieved. And the track record on cost savings is mixed, not surprisingly since over 40 states used the managed model and costs continue to rise.
Because this is a complex process, hiring a contractor/facilitator is probably necessary, but support for this resolution hinges upon the belief that a managed care model will save money. If not, this process will merely delay needed reform as legislators are told to give it a chance to work.
Current: Fee-for-Service Model
• Medicaid members find doctors and other providers who accept Medicaid to meet specific care needs.
• The state pays providers directly for each covered service (e.g., visit, test, or procedure) provided to Medicaid members.
Future State: Comprehensive Managed Care
• Medicaid members will choose and enroll in a private health plan that will provide insurance coverage for the services they need.
• The state will pay private health insurance companies, called Managed Care Organizations (MCOs), a set monthly amount for each enrolled Medicaid member.
