Ms. Williamson — Confirmed that both vendors are currently being paid.
Ms. Williamson — Explained that contract inflation refers to preset year-over-year increases built into multi-year contracts to account for inflation and market changes.
Ms. Williamson — Finished explaining contract inflation and then responded to a question about the discrepancy in population forecast adjustments.
Ms. Williamson — Agreed to jump ahead to the population forecast adjustment discussion.
Ms. Williamson — Explained that the agency request included the ongoing impact of the 4% provider rate cut and referenced page 2-55 of the budget book.
Ms. Williamson — Explained that the governor split out the cuts to show the true ask and added a second line with the 4% provider rate cut and additional recommended cuts.
Ms. Williamson — Said the net ask is about $235.3 million, which is close to the agency request of $234.9 million.
Ms. Williamson — Returned to the ongoing enhancements and introduced the hospital assessment fund alignment item on page 2-54.
Ms. Williamson — Explained that the hospital assessment fund alignment must continue in perpetuity to stay aligned with House Bill 345 and involves $349.7 million moving from federal to dedicated appropriation.
Ms. Williamson — Added context that population forecasts and supplementals are best estimates and can result in reversions or supplemental requests depending on whether the estimate is too high or too low.
Ms. Williamson — Introduced the estate recovery system item on page 2-52 and explained it is related to the Division of Medicaid.
Ms. Williamson — Explained Medicaid estate recovery and said the ongoing request is $2,496,600 split evenly between dedicated and federal funds.
Ms. Williamson — Reported that the Idaho Medicaid estate recovery program has recovered an average of $20.4 million annually since 2021, offsetting general fund need.
Ms. Williamson — Said the department has a backlog of about 20,000 estate recovery cases and needs staff and a case management system replacement.
Ms. Williamson — Said the request would replace the case management system and add vendor support for the backlog of cases.
Ms. Williamson — Was asked to explain the backlog and case timing, but the question was deferred to the department.
Ms. Williamson — Resumed her presentation and introduced the Medicaid program integrity contract item.
Ms. Williamson — Concluded her remarks on the budget presentation.
Ms. Williamson — Ms. Williamson is repeatedly cited as someone who likely has a strong slide deck and can help explain the UPL and Medicaid-rate issue further, serving as a resource for clarification on the topic.
Mark Harris — Was directly addressed as one of the newer members being given an explanation of how ongoing enhancements become part of the base budget.
Mark Harris — Asks about the match rate between federal and state dollars.
Chris Bruce — Was directly addressed as one of the newer members being given an explanation of how ongoing enhancements become part of the base budget.
Chris Bruce — Representative Bruce asks how population forecast adjustments are calculated, whether they reflect actual growth, and whether there is a formula behind them. Ms. Williamson responds that the term was changed from 'nondiscretionary adjustments' because the old wording implied the committee had no ability to act, and explains that the adjustments are largely driven by statute. She also offers to share a spreadsheet with him for more detail.
Chris Bruce — Representative Chris Bruce questions the director about Medicaid expansion enrollees, first asking what share are able-bodied adults without dependents and then following up on how many expansion enrollees have reported income above the eligibility threshold within the last 12 months but remain enrolled. The director responds that they would likely meet the able-bodied definition.
Mr. Williamson — The presenter is referred to while explaining the supplemental request tables and taking questions.
Mr. Williamson — Said he would need to defer to the department on where the software price came from.
Elaine Price — Representative Price asks whether the supplemental requests are ongoing or one-time.
Elaine Price — Addressed by Ms. Williamson as Representative Price.
Elaine Price — Representative Price is invited to hear a more detailed explanation of UPL, with the speaker offering to spend more time walking through it for him and anyone else who wants to understand it.
Brooke Green — Representative Green asked follow-up questions about the 4% reduction and how it is affecting services and access to care, including disability, behavioral health, pharmacy, dental, hospital services, and physical therapy. He requested examples and more information on how communities are being impacted, and the exchange concluded with a commitment to coordinate with the department and provide additional details.
Brooke Green — Representative Green followed up on the estate-recovery backlog, asking how long cases remain open and how far back the backlog extends for families. He expressed concern that some families may have been waiting one, two, or even three years for final estate decisions because of the backlog.
Brooke Green — Asked where Meals on Wheels program services appear in the budget.
Brooke Green — Representative Green follows up on crisis response teams and asks about cuts raised by law enforcement.
Heather Scott — Asked when the committee moved away from the previous vendor and referenced the budget.
Jim Guthrie — Senator Cook questioned whether the proposed software and contract would realistically increase case output enough to address the backlog, expressing concern that the expected performance did not measure up. He then asked whether there were any guarantees or promises tied to the proposal and requested written performance reporting and quarterly updates to ensure accountability for the $2.5 million request.
Jim Guthrie — The speaker addresses Senator Hart and responds to his question about wellness and reducing service needs.
Jim Guthrie — A senator identified as 'Burkey' is called on; the name is uncertain and may be a transcription error.
Deputy Director O’Connell — Was invited to respond on behalf of the department.
Sasha O’Connell — Sasha O’Connell, the Deputy Director at the Department of Health and Welfare and state Medicaid administrator, explained that the budget line item covers software and contractor support for estate recovery. She said the department relies on the vendor’s software because its own system is outdated and could create compliance risks with CMS standards.
Deputy Director — Responded that contractor payment is tied to recoveries.
Edward Hill — Asked for an estimate of the monthly return on investment if the new system and contractors expand case processing.
Edward Hill — The chair directed questions back to Ms. Williamson and then resumed her presentation.
Edward Hill — Identified by the chair as the next speaker; then raised a question about Medicaid FTE growth from fiscal year 25 to 305.5.
Edward Hill — Edward Hill is repeatedly addressed as "Mr. Chairman"/"Chairman" during a brief procedural exchange, including a transition in the discussion and a question exchange involving Representative Harris about estate recovery. The mentions all refer to the chair in the same uninterrupted segment.
Deputy Director / witness — Said the department expects the request to more than cover costs and that state recovery aims to more than double the number of cases worked.
Director — The Director explained that Medicaid estate recovery is a federally required program, with exceptions for certain family members who still live in the home. The Director also described how Idaho Medicaid supports independence by helping people remain in their homes and communities through available services.
Ms. O'Connell — Referenced as having briefly mentioned the Medicaid program integrity contract earlier.
Carrie Semmelroth — Senator Ward-Engelking noted that dental services had been restored after significant work and urged careful review of the proposal to avoid shifting costs elsewhere or making reductions that could undermine those services.
Carrie Semmelroth — Senator Winterall is recognized and thanks the chair and deputy director, then makes a substantive comment opposing revenue cuts and urging restoration of revenue to avoid service reductions.
Glenneda Zuiderveld — Senator Bjurkey raised concerns about budget cuts, noting that he had received over a thousand constituent emails about the issue and expressing worry about the overall budget size and increase. That earlier concern was later referenced again in a request for a general fund versus federal fund breakdown, tying the discussion to how the budget is structured and funded.