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LEGISLATURE
OF
THE
STATE
OF
IDAHO
Sixty-eighth
Legislature
Second
Regular
Session
-
2026
IN
THE
HOUSE
OF
REPRESENTATIVES
HOUSE
BILL
NO.
912
BY
WAYS
AND
MEANS
COMMITTEE
AN
ACT
1
RELATING
TO
MEDICAID;
AMENDING
CHAPTER
2,
TITLE
56,
IDAHO
CODE,
BY
THE
AD
-
2
DITION
OF
A
NEW
SECTION
56
-
276,
IDAHO
CODE,
TO
ESTABLISH
PROVISIONS
3
REGARDING
MEDICAID
WORK
REQUIREMENTS;
AMENDING
CHAPTER
2,
TITLE
56,
4
IDAHO
CODE,
BY
THE
ADDITION
OF
A
NEW
SECTION
56
-
277,
IDAHO
CODE,
TO
5
ESTABLISH
PROVISIONS
REGARDING
MEDICAID
ELIGIBILITY
VERIFICATION;
6
AMENDING
CHAPTER
2,
TITLE
56,
IDAHO
CODE,
BY
THE
ADDITION
OF
A
NEW
SEC
-
7
TION
56
-
278,
IDAHO
CODE,
TO
ESTABLISH
PROVISIONS
REGARDING
INELIGIBLE
8
ALIENS;
AMENDING
CHAPTER
2,
TITLE
56,
IDAHO
CODE,
BY
THE
ADDITION
OF
9
A
NEW
SECTION
56
-
279,
IDAHO
CODE,
TO
ESTABLISH
PROVISIONS
REGARDING
10
MULTISTATE
ENROLLMENT;
AMENDING
CHAPTER
2,
TITLE
56,
IDAHO
CODE,
BY
THE
1
1
ADDITION
OF
A
NEW
SECTION
56
-
280,
IDAHO
CODE,
TO
ESTABLISH
PROVISIONS
12
REGARDING
DECEASED
ENROLLEES;
AMENDING
CHAPTER
2,
TITLE
56,
IDAHO
CODE,
13
BY
THE
ADDITION
OF
A
NEW
SECTION
56
-
281,
IDAHO
CODE,
TO
ESTABLISH
PROVI
-
14
SIONS
REGARDING
RETROACTIVE
ELIGIBILITY;
AND
DECLARING
AN
EMERGENCY.
15
Be
It
Enacted
by
the
Legislature
of
the
State
of
Idaho:
16
SECTION
1.
That
Chapter
2,
Title
56,
Idaho
Code,
be,
and
the
same
is
17
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
18
ignated
as
Section
56
-
276,
Idaho
Code,
and
to
read
as
follows:
19
56
-
276.
MEDICAID
WORK
REQUIREMENTS.
(1)
As
used
in
this
section:
20
(a)
"Applicable
individual"
means
an
individual
who
is
eligible
21
to
enroll
under
the
state
medicaid
program
pursuant
to
42
U.S.C.
22
1396a(a)(10)(A)(i)(VIII)
or
who
is
otherwise
eligible
to
enroll
or
23
is
enrolled
under
a
waiver
of
such
plan
that
provides
coverage
that
is
24
equivalent
to
minimum
essential
coverage
and
has
attained
the
age
of
25
nineteen
(19)
and
is
under
sixty
-
five
(65)
years
of
age,
is
not
preg
-
26
nant,
is
not
entitled
to
or
enrolled
for
benefits
under
part
A
of
title
27
XVIII
of
the
social
security
act,
or
enrolled
for
benefits
under
part
B
28
of
title
XVIII
of
the
social
security
act,
and
is
not
otherwise
eligible
29
to
enroll
under
such
plan,
and
is
subject
to
work
requirements.
30
(b)
"Department"
means
the
Idaho
department
of
health
and
welfare.
31
(c)
"Work
requirements"
means
the
requirements
established
by
42
32
U.S.C.
1396a(xx).
33
(2)
No
later
than
December
31,
2026,
the
department
shall
implement
34
work
requirements
for
applicable
individuals.
35
(a)
No
applicable
individual
shall
be
enrolled
in
medicaid
unless,
at
36
the
time
of
application,
the
individual
demonstrates
compliance
with
37
the
work
requirements
for
the
three
(3)
consecutive
months
immediately
38
preceding
the
month
during
which
the
individual
applies.
The
depart
-
39
ment
shall
require
documentary
evidence
and
shall
not
accept
self
-
at
-
40
testation
at
the
time
of
application.
41
2
(b)
The
department
shall
verify
an
applicable
individual's
compliance
1
with
work
requirements
through
state
wage
data,
education
or
training
2
program
enrollment,
or
verified
volunteer
service
documentation.
The
3
department
shall
verify
an
applicable
individual's
compliance
with
4
work
requirements
on
an
ongoing
basis,
at
least
quarterly
between
re
-
5
determination
periods,
and
shall
not
accept
self
-
attestation.
Such
6
verification
shall
occur
between
periods
of
formal
redetermination
for
7
individuals.
8
(c)
No
applicable
individual
shall
remain
enrolled
in
medicaid
in
any
9
month
unless
the
individual
has
demonstrated
compliance
with
the
work
10
requirements.
1
1
(3)
An
applicable
individual
seeking
an
exemption
from
work
require
-
12
ments
shall
provide
documentation
for
the
exemption
sought.
The
department
13
shall
verify
all
exemptions
and
shall
not
accept
self
-
attestation
from
indi
-
14
viduals
seeking
exemptions.
15
(a)
The
department
shall
not
seek
or
implement
any
additional
optional
16
exemptions
under
42
U.S.C.
1396a(xx)(3)(B)
or
any
other
optional
exemp
-
17
tion
without
obtaining
approval
from
the
legislature.
Such
approval
18
shall
be
provided
in
statute.
19
(b)
The
department
shall
not
accept
exemption
designations,
approvals,
20
or
determinations
by
a
managed
care
organization.
21
(c)
The
department
shall
only
approve
an
exemption
for
an
individual
22
who
is
medically
frail
or
otherwise
an
individual
with
special
needs
23
if
the
individual
has
been
medically
certified
by
a
statement
from
a
24
physician,
physician's
assistant,
nurse,
nurse
practitioner,
desig
-
25
nated
representative
of
a
physician's
office,
a
licensed
or
certified
26
psychologist,
or
a
social
worker
as
having
a
disabling
mental
disorder,
27
having
a
physical,
intellectual,
or
mental
disability
that
signif
-
28
icantly
impairs
the
ability
to
perform
activities
of
daily
living,
29
including
eating,
dressing,
bathing,
grooming,
getting
in
and
out
of
30
beds
and
chairs,
walking,
going
outdoors,
or
using
the
toilet,
or
is
31
in
treatment
for
chronic
substance
use
disorder.
In
no
case
may
the
32
department
expand
the
definition
of
"medically
frail
or
otherwise
an
33
individual
with
special
needs"
beyond
the
scope
of
the
definition
es
-
34
tablished
under
42
CFR
440.315(f).
35
(4)
The
department
shall
disenroll
any
applicable
individual
who
fails
36
to
comply
with
the
work
requirements.
37
(5)
The
department
shall
submit
quarterly
reports
to
the
legislature
38
and
the
governor
on
compliance
rates,
the
number
and
type
of
exemptions
39
granted,
and
the
impact
on
medicaid
enrollment,
consistent
with
the
report
-
40
ing
requirements
of
section
71119,
P.L.
119
-
21.
41
(6)
The
requirements
of
this
section
shall
be
implemented
no
later
than
42
December
31,
2026,
or
such
earlier
date
as
permitted
by
federal
law
and
ap
-
43
proved
by
the
centers
for
medicare
and
medicaid
services.
44
SECTION
2.
That
Chapter
2,
Title
56,
Idaho
Code,
be,
and
the
same
is
45
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
46
ignated
as
Section
56
-
277,
Idaho
Code,
and
to
read
as
follows:
47
56
-
277.
MEDICAID
ELIGIBILITY
VERIFICATION.
(1)
Except
as
required
un
-
48
der
federal
law,
the
department
of
health
and
welfare
shall
not
accept
self
-
49
3
attestation
of
any
of
the
following
in
the
administration
of
the
medicaid
1
program
without
verification
before
enrollment:
2
(a)
Income;
3
(b)
Residency;
4
(c)
Identity;
5
(d)
Household
composition;
or
6
(e)
Citizenship
or
immigration
status.
7
(2)
On
at
least
a
monthly
basis,
the
department
of
health
and
welfare
8
shall
receive
and
review
information
concerning
medicaid
recipients
that
9
indicates
a
change
in
circumstances
that
may
affect
medicaid
eligibility
10
from:
1
1
(a)
The
state
tax
commission;
12
(b)
The
United
States
social
security
administration,
including
13
earned
income
information,
death
register
information,
incarcera
-
14
tion
records,
supplemental
security
income
information,
beneficiary
15
records,
earnings
information,
and
pension
information;
16
(c)
The
United
States
department
of
health
and
human
services,
includ
-
17
ing
income
and
employment
information
maintained
in
the
national
direc
-
18
tory
of
new
hires
database
and
child
support
enforcement
data;
19
(d)
The
United
States
department
of
housing
and
urban
development,
in
-
20
cluding
payment
and
earnings
information;
and
21
(e)
The
federal
bureau
of
investigation,
including
national
fleeing
22
felon
information.
23
(3)
On
at
least
a
quarterly
basis,
the
department
of
health
and
welfare
24
shall
receive
and
review
information
from
the
department
of
labor
concerning
25
medicaid
recipients
that
indicates
a
change
in
circumstances
that
may
affect
26
medicaid
eligibility,
including
changes
to
employment
or
wages.
27
(4)
On
at
least
an
annual
basis,
the
department
of
health
and
welfare
28
shall
receive
and
review
information
concerning
medicaid
recipients
that
29
indicates
a
change
in
circumstances
that
may
affect
medicaid
eligibility
30
from:
31
(a)
The
state
tax
commission,
including
adjusted
gross
income
and
fam
-
32
ily
composition;
and
33
(b)
The
internal
revenue
service,
including
tax
filing
data,
adjusted
34
gross
income,
and
family
composition.
35
(5)
The
department
of
health
and
welfare
shall
enter
into
any
36
data
-
sharing
agreements
with
the
agencies,
departments,
and
bureaus
de
-
37
scribed
in
this
section
as
necessary
to
effectuate
the
requirements
of
this
38
section.
39
(6)
The
department
of
health
and
welfare
may
contract
with
an
indepen
-
40
dent
third
party
for
database
searches
that
may
contain
information
that
in
-
41
dicates
a
change
in
circumstances
that
may
affect
medicaid
applicant
or
re
-
42
cipient
eligibility.
43
(7)
Upon
receiving
information
concerning
a
medicaid
recipient
that
44
indicates
a
change
in
circumstances
that
may
affect
medicaid
eligibility,
45
the
department
of
health
and
welfare
shall
promptly
conduct
an
eligibility
46
redetermination
for
the
recipient.
47
(8)
Unless
prohibited
under
federal
law,
the
department
of
health
and
48
welfare
shall
conduct
eligibility
redeterminations
for
all
nonelderly
adult
49
medicaid
recipients
whose
eligibility
is
determined
based
on
the
appli
-
50
4
cation
of
modified
adjusted
gross
income
standards
under
42
CFR
435.603,
1
including
adults
eligible
under
42
U.S.C.
1396a(a)(10)(A)(i)(VIII)
and
42
2
U.S.C.
1396u
-
1
at
least
once
every
six
(6)
months.
3
(9)
The
department
of
health
and
welfare
shall
conduct
eligibility
re
-
4
determinations
for
all
medicaid
recipients
not
described
in
subsection
(8)
5
of
this
section
at
least
once
every
twelve
(12)
months.
6
SECTION
3.
That
Chapter
2,
Title
56,
Idaho
Code,
be,
and
the
same
is
7
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
8
ignated
as
Section
56
-
278,
Idaho
Code,
and
to
read
as
follows:
9
56
-
278.
INELIGIBLE
ALIENS.
(1)
The
department
of
health
and
welfare
10
shall
not
provide
medical
assistance
to
an
individual
in
Idaho
unless
the
in
-
1
1
dividual
is:
12
(a)
A
resident
of
the
United
States;
and
13
(b)
At
least
one
(1)
of
the
following:
14
(i)
A
citizen
or
national
of
the
United
States;
15
(ii)
An
alien
lawfully
admitted
for
permanent
residence
as
an
im
-
16
migrant,
as
defined
in
8
U.S.C.
1101(a)(15)
and
(20),
excluding
17
alien
visitors,
tourists,
diplomats,
students,
or
other
individ
-
18
uals
admitted
temporarily
without
intent
to
abandon
their
resi
-
19
dence
in
a
foreign
country;
20
(iii)
An
alien
who
has
been
granted
the
status
of
Cuban
or
Haitian
21
entrant,
as
defined
in
section
501(e),
P.L.
96
-
422;
or
22
(iv)
An
individual
lawfully
residing
in
the
United
States
in
ac
-
23
cordance
with
a
compact
of
free
association
pursuant
to
8
U.S.C.
24
1612(b)(2)(G).
25
(2)
The
department
of
health
and
welfare
shall
require
that
all
income
26
of
ineligible
household
members
be
included
when
calculating
financial
eli
-
27
gibility
for
medicaid.
28
(3)
The
department
of
health
and
welfare
shall
include
an
immigration
29
status
on
all
presumptive
eligibility
applications
submitted
to
the
depart
-
30
ment.
The
department
shall
require
hospitals,
clinics,
and
other
qualified
31
entities
conducting
presumptive
eligibility
determinations
to
collect
and
32
transmit
such
attestations
to
the
department.
No
presumptive
eligibility
33
application
shall
be
approved
unless
the
applicant
certifies
that
the
appli
-
34
cant
is
a
qualified
citizen.
35
(4)
The
department
of
health
and
welfare
shall
verify
citizen
-
36
ship
or
immigration
status
prior
to
enrollment
and
shall
conduct
regular
37
cross
-
checks
of
applicant
and
recipient
information
against
federal
38
databases,
including
the
systematic
alien
verification
for
entitlements
39
program.
A
match
through
any
electronic
or
data
verification
system
shall
40
not,
by
itself,
be
accepted
as
proof
of
identity.
Each
applicant
shall
be
41
required
to
provide
documentary
proof
of
United
States
citizenship,
United
42
States
national
status,
or
alien
status
eligible
for
medical
assistance.
43
The
department
shall
promptly
refer
any
applicant
identified
as
an
individ
-
44
ual
who
is
not
a
citizen
or
national
of
the
United
States
and
does
not
have
45
lawful
immigration
status
as
defined
under
federal
law
to
the
United
States
46
immigration
and
customs
enforcement
or
other
appropriate
federal
authori
-
47
ties
for
further
investigation
and
enforcement.
48
5
(5)
This
section
shall
not
affect
coverage
for
emergency
medical
1
services
provided
to
all
individuals
as
required
pursuant
to
42
U.S.C.
2
1396b(v).
3
(6)
The
requirements
set
forth
in
this
section
shall
be
implemented
no
4
later
than
October
1,
2026.
5
SECTION
4.
That
Chapter
2,
Title
56,
Idaho
Code,
be,
and
the
same
is
6
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
7
ignated
as
Section
56
-
279,
Idaho
Code,
and
to
read
as
follows:
8
56
-
279.
MULTISTATE
ENROLLMENT.
(1)
The
department
of
health
and
wel
-
9
fare
shall
receive
and
review
address
change
information
from
returned
mail
10
by
the
United
States
postal
service,
the
national
change
of
address
data
-
1
1
base,
and
medicaid
managed
care
companies
operating
in
Utah.
The
department
12
shall
conduct
cross
-
checks
of
such
address
change
information
against
state
13
medicaid
enrollment
at
least
monthly
to
identify
enrollees
who
have
moved
14
out
of
state.
The
requirements
of
this
subsection
shall
be
implemented
no
15
later
than
January
1,
2027.
16
(2)
The
department
of
health
and
welfare
shall
receive
and
review
in
-
17
formation
regarding
out
-
of
-
state
electronic
benefit
transactions
and
con
-
18
duct
cross
-
checks
of
such
information
against
state
medicaid
enrollment
at
19
least
monthly
to
identify
enrollees
who
have
moved
out
of
state.
The
re
-
20
quirements
of
this
subsection
shall
be
implemented
no
later
than
January
1,
21
2027.
22
(3)
Upon
receiving
information
concerning
a
medicaid
enrollee
that
in
-
23
dicates
a
change
in
circumstances
that
may
affect
medicaid
eligibility,
in
-
24
cluding
a
change
in
residency,
the
department
of
health
and
welfare
shall
25
promptly
conduct
an
eligibility
redetermination
for
the
enrollee.
26
(4)
The
department
of
health
and
welfare
shall
submit
enrollment
infor
-
27
mation
to
the
centers
for
medicare
and
medicaid
services
national
medicaid
28
enrollment
database
every
month
to
identify
individuals
enrolled
in
medic
-
29
aid
in
multiple
states
at
the
same
time.
The
requirements
of
this
subsection
30
shall
be
implemented
no
later
than
October
1,
2029.
31
(5)
No
later
than
August
31
of
each
year,
the
department
of
health
and
32
welfare
shall
submit
an
annual
report
to
the
legislature
detailing
the
im
-
33
plementation
of
the
requirements
established
in
this
section.
The
annual
34
report
shall
be
made
publicly
available
on
the
department
of
health
and
wel
-
35
fare
website
and
shall
include:
36
(a)
The
number
of
enrollees
flagged
through
address
change
information
37
and
out
-
of
-
state
electronic
benefit
transactions;
38
(b)
The
number
of
enrollees
removed
from
medicaid
due
to
enrollment
in
39
multiple
states;
and
40
(c)
The
estimated
fiscal
impact
to
the
state
due
to
implementing
the
re
-
41
quirements
of
this
section.
42
SECTION
5.
That
Chapter
2,
Title
56,
Idaho
Code,
be,
and
the
same
is
43
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
44
ignated
as
Section
56
-
280,
Idaho
Code,
and
to
read
as
follows:
45
6
56
-
280.
DECEASED
ENROLLEES.
(1)
As
used
in
this
section,
"death
master
1
file"
means
the
database
maintained
by
the
United
States
social
security
ad
-
2
ministration
containing
reported
deaths.
3
(2)
The
department
of
health
and
welfare
shall
receive
and
review
in
-
4
formation
from
the
death
master
file
and
shall
conduct
cross
-
checks
of
such
5
information
against
state
medicaid
enrollment
at
least
monthly
to
identify
6
deceased
medicaid
enrollees.
7
(3)
The
department
of
health
and
welfare
shall
receive
and
review
data
8
regarding
birth
and
death
records
from
the
bureau
of
vital
records
and
health
9
statistics
and
shall
conduct
cross
-
checks
of
such
data
against
state
medic
-
10
aid
enrollment
at
least
monthly
to
identify
deceased
medicaid
enrollees.
1
1
(4)
The
department
of
health
and
welfare
shall
remove
any
deceased
en
-
12
rollee
from
the
medicaid
program
promptly
upon
confirmation
of
death.
13
(5)
The
department
of
health
and
welfare
shall
ensure
that
no
medicaid
14
payments
are
made
on
behalf
of
a
deceased
enrollee
for
services
rendered
af
-
15
ter
the
date
of
death.
16
(6)
The
department
of
health
and
welfare
shall
recoup
any
funds
ex
-
17
pended
on
deceased
enrollees
for
capitations
or
services
occurring
after
the
18
date
of
death.
19
(7)
The
requirements
of
this
section
shall
be
implemented
no
later
than
20
January
1,
2027.
21
SECTION
6.
That
Chapter
2,
Title
56,
Idaho
Code,
be,
and
the
same
is
22
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
23
ignated
as
Section
56
-
281,
Idaho
Code,
and
to
read
as
follows:
24
56
-
281.
RETROACTIVE
ELIGIBILITY.
(1)
As
used
in
this
section:
25
(a)
"Expansion
population"
means
individuals
who
are
eligible
for
26
medical
assistance
under
42
U.S.C.
1396a(a)(10)(A)(i)(VIII),
commonly
27
known
as
the
medicaid
expansion
population
under
the
affordable
care
28
act.
29
(b)
"Medicaid"
means
the
medical
assistance
program
established
under
30
title
XIX
of
the
social
security
act
and
administered
by
the
department
31
of
health
and
human
services.
32
(c)
"Non
-
expansion
population"
means
all
individuals
eligible
for
med
-
33
icaid
who
do
not
qualify
under
the
expansion
population
definition,
in
-
34
cluding
but
not
limited
to
pregnant
women,
children,
elderly
individu
-
35
als,
and
persons
with
disabilities.
36
(d)
"Retroactive
eligibility"
means
medicaid
coverage
for
services
37
provided
prior
to
the
month
of
application,
as
authorized
by
42
U.S.C.
38
1396a(a)(34).
39
(2)
The
department
of
health
and
welfare
shall
limit
retroactive
eligi
-
40
bility
for
medicaid
benefits
as
follows:
41
(a)
For
individuals
determined
to
be
eligible
as
part
of
the
expansion
42
population,
medicaid
coverage
may
be
made
retroactive
for
no
more
than
43
one
(1)
month
prior
to
the
month
in
which
the
individual
submits
a
com
-
44
pleted
medicaid
application.
45
(b)
For
individuals
eligible
as
part
of
the
non
-
expansion
population,
46
medicaid
coverage
may
be
made
retroactive
for
no
more
than
two
(2)
47
months
prior
to
the
month
in
which
the
individual
submits
a
completed
48
medicaid
application.
49
7
(3)
The
limitations
set
forth
in
subsection
(2)
of
this
section
apply
1
only
to
initial
applications
for
medicaid
and
do
not
affect
eligibility
for
2
continuous
or
ongoing
coverage.
3
SECTION
7.
An
emergency
existing
therefor,
which
emergency
is
hereby
4
declared
to
exist,
this
act
shall
be
in
full
force
and
effect
on
and
after
its
5
passage
and
approval.
6