Committee hears health‑care related OPE study requests on Medicaid billing and plan selection

Committee members heard two health‑focused study requests from Representative Jordan Redmond and received a Department of Health and Welfare response.

Redmond described a proposal to have OPE analyze hospital billing patterns in Medicaid since Idaho’s switch to diagnosis‑based payment in 2021, citing concerns about upcoding in hospital stays and the potential for billing trends to affect premiums and actuary rate‑setting. He asked OPE to examine whether the Department of Health and Welfare is detecting inflated billing codes, to assess whether billing patterns have changed, and to recommend how rates for managed care should account for any changes.

Sasha O’Connell, the state Medicaid administrator and deputy director for the Department of Health and Welfare, said the department has requested additional resources in its budget to analyze DRGs and hospital billing and that OPE’s review would be helpful to inform next steps. O’Connell said the department will pursue additional program‑integrity resources but welcomed OPE’s technical review to 'get us in the right direction.'

Redmond also presented a constituent‑driven request for an OPE study on Your Health Idaho plan selection, asking OPE to analyze the number of uninsured Idahoans, reasons for noncoverage, and the taxpayer cost of providing care to uninsured residents. OPE staff said both studies are feasible; Medicaid hospital billing was described as a larger project and the Your Health Idaho study as medium sized.

The committee asked OPE to report feasibility and scope so members can weigh which projects to take on alongside other priorities.