June 4, 2025  – Idaho is preparing to transition its Medicaid program to a fully managed care model by 2029, according to state health officials. The shift, authorized by legislation passed earlier this year, will move all Medicaid benefits under the management of private health insurance companies. This is a structure already used in most other states.

Although some components of Idaho’s Medicaid program are already operated by managed care organizations, much of the system remains under state control. The current model is a hybrid, with some services are administered directly by the Idaho Department of Health and Welfare, others by private insurers, and some through provider networks. The new legislation calls for a more uniform approach.

Juliet Charron, deputy director of Idaho Medicaid, briefed lawmakers on the plan during a May 22 meeting of the Legislature’s Medicaid Review Panel. She explained that while initial discussions explored launching managed care contracts as early as 2027, officials ultimately determined that such a timeline posed significant risks.

“We have been evaluating all of the different scenarios and timelines,” Charron said. “And have determined that going much earlier is risky… you’re going to start to have pieces overlapping throughout this. And that will be particularly challenging for our provider communities.”

Charron told lawmakers that 2029 offers a more feasible starting point for a comprehensive managed care rollout, allowing the department adequate time to conduct contract negotiations, stakeholder engagement, and system redesign.

House Bill 345, the legislation prompting the change, was passed by the Idaho Legislature in 2025 as part of a broader effort to control rising Medicaid costs. Supporters say managed care models create opportunities for cost savings, improve care coordination, and increase accountability through performance metrics.

Medicaid in Idaho serves approximately 260,000 residents, including individuals with disabilities, low-income families, pregnant women, and older adults. Of those, nearly 92,000 are enrolled through Medicaid expansion, which is a policy approved by Idaho voters to increase income eligibility thresholds.

Under managed care, private insurance companies receive a set payment per enrollee to provide all necessary services. They are responsible for ensuring timely access to care, managing provider networks, and meeting quality benchmarks. States that have moved to full managed care typically report more predictable spending, though the outcomes vary based on oversight and contract structure.

The upcoming transition will be Idaho’s most significant Medicaid overhaul in decades. State officials emphasize the importance of balancing cost control with continuity of care for beneficiaries. As Charron put it, “If we don’t get the planning right, we risk disruptions in services. That’s something we want to avoid at all costs.”

The Department of Health and Welfare will spend the next several years laying the groundwork for the shift, including developing the request for proposals, engaging with providers, and setting contract standards. Lawmakers are expected to receive regular updates on progress and implementation milestones.

If the current timeline holds, Idaho Medicaid recipients can expect to see major changes to how they receive care by 2029—marking a new chapter in the state’s approach to healthcare delivery for its most vulnerable populations.