NOTICE OF INTENT TO SUBMIT WAIVER AMENDMENT AND SOLICITATION OF PUBLIC INPUT Pursuant to 42 C.F.R. § 430.25 Waivers of State plan requirements, 42 C.F.R. § 440.345 EPSDT and other required benefits, 42 C.F.R. § 440.386 Public notice, 42 C.F.R. §441.304 Duration, extension, and amendment of a waiver, 42 C.F.R. § 447.203 Documentation of access to care and service payment rates, 42 C.F.R. § 447.204 Medicaid provider participation and public process to inform access to care, 42 C.F.R. § 447.205 Public notice of changes in Statewide methods and standards for setting payment rates, and 42 C.F.R. § 457.65 Effective date and duration of State plans and plan amendments, the Idaho Department of Health and Welfare Division of Medicaid (Department) provides public notice of its intent to submit a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS). PROPOSED CHANGES Idaho Medicaid intends to submit a 1915(c) Aged and Disabled (A&D) Waiver amendment to the Centers for Medicare and Medicaid Services (CMS). Updates to the A&D waiver include: • Service rate changes and addition of a Case Management service approved during the 2024 and 2025 Legislative sessions. • Removing the option for Legally Responsible Individuals (spouses) as caregivers for Attendant Care services in alignment with changes in the State’s 1115 Demonstration Waiver amendment that discontinues Family Personal Care Services (FPCS) effective July 2025. CMS approved this amendment on May 15, 2025. • Geographic service areas and managed care organizations offering the Idaho Medicaid Plus and MMCP dual plans and reference updates related to Idaho Code or Statute changes approved during the 2025 Legislative session. These changes are consistent with Idaho Code 56-2201 Legislative Approval Required, Idaho Senate Bill S1108 Appropriations – Health And Human Services (2025), and Idaho Senate Bill S1201 Appropriations – Health And Welfare – Medicaid (2025). The Department intends to submit this amendment to CMS with a requested effective date of January 1, 2026. The Department attests that Medicaid payment rates in the aggregate (including base and supplemental payments) following the proposed reduction or restructuring for each benefit category affected by the proposed reduction or restructuring would be at or above eighty percent (80%) of the most recently published Medicare payment rates for the same or a comparable set of Medicare-covered services. The Department attests that the proposed reduction or restructuring, including the cumulative effect of all reductions or restructurings taken throughout the current State fiscal year, would be likely to result in no more than a four percent (4%) reduction in aggregate fee- for-service Medicaid expenditures for each benefit category affected by proposed reduction or restructuring within a State fiscal year. ESTIMATE OF EXPECTED CHANGE IN ANNUAL AGGREGATE EXPENDITURES There is no expected increase or decrease in annual aggregate expenditures. PUBLIC REVIEW When available, copies of the draft pages will be posted on the IDHW website at https://healthandwelfare.idaho.gov/about-dhw/ rules-policies-procedures-and-waivers under “Medicaid policies” (PUBLIC-DOCUMENTS > About DHW > Policies & Standards > Medicaid > Medicaid Public Notices). Unless otherwise specified, copies are also available upon request for public review during regular business hours at any Regional Medicaid Services office of the Idaho Department of Health and Welfare. LOCATIONS FOR PUBLIC REVIEW OF Custer County Oneida County PROPOSED STATE PLAN AMENDMENT Eastern Idaho Public Health, 1050 N. Southeastern Idaho Public Health, 175 Ada County Clinic Road, Suite A, Challis, ID 83226 South 300 East, Malad, ID 83252 DHW Region 4, 1720 Westgate Drive, Elmore County Owyhee County Boise, ID 83704 DHW Region 4, 2420 American Legion Southwest District Health, 132 E. Idaho, Central District Health Department, 707 Blvd., Mountain Home, ID 83647 Homedale, ID 83628 North Armstrong Place, Boise, ID 83704 Central District Health Department, 520 Payette County Adams County E. 8th Street N, Mountain Home, ID DHW Region 3, 515 N. 16th Street, Adams County Clerk’s Office, 201 83647 Payette, ID 83661 Industrial Avenue, Council, ID 83612 Franklin County Southwest District Health, 1155 Third Bannock County DHW Region 6, 223 North State, Avenue North, Payette, ID 83661 DHW Region 6, 1070 Hiline, Pocatello, Preston, ID 83263 Power County ID 83201 Southeastern Idaho Public Health, 50 Southeastern Idaho Public Health, 590 Southeastern Idaho Public Health, 1901 West 1 St. South, Preston, ID 83263 1/2 Gifford, American Falls, ID 83211 Alvin Ricken Drive, Pocatello, ID 83201 Fremont County Shoshone County Bear Lake County Eastern Idaho Public Health, 45 South DHW Region 1, 35 Wildcat Way, Suite B, Southeastern Idaho Public Health, 455 2nd West, St. Anthony, ID 83445 Kellogg, ID 83837 Washington, Suite #2, Montpelier, ID Gem County Panhandle Health District, 114 Riverside 83254 Southwest District Health, 1008 East Avenue W, Kellogg, ID 83837 Benewah County Locust, Emmett, ID 83617 Teton County Panhandle Health District, 137 N 8th Gooding County Eastern Idaho Public Health, 820 Valley Street, St Maries, ID 83861 South Central Public Health, 255 North Centre Drive, Driggs, ID 83422 Bingham County Canyon Drive, Gooding, ID 83330 Twin Falls County DHW Region 6, 701 East Alice, Idaho County DHW Region 5, 601 Pole Line Road, Blackfoot, ID 83221 DHW Region 2, Camas Resource Twin Falls, ID 83301 Southeastern Idaho Public Health, 145 Center, 216 South C Street, Grangeville, South Central Public Health, 1020 W Idaho Street, Blackfoot, ID 83221 ID 83530 Washington Street North, Twin Falls, ID Blaine County North Central Health District, 903 W 83301 South Central Public Health, 117 East Main, Grangeville, ID 83530 Valley County Ash Street, Bellevue, ID 83313 Jefferson County Central District Health Department, 703 Boise County Eastern Idaho Public Health, 380 1st Street, McCall, ID 83638 Boise County Clerk’s Office, 420 Main Community Lane, Rigby, ID 83442 Washington County Street, Idaho City, ID 83631 Jerome County Southwest District Health, 46 West Bonner County South Central Public Health, 951 East Court, Weiser, ID 83672 DHW Region 1, 207 Larkspur Street, Avenue H, Jerome, ID 83338 PUBLIC COMMENT Ponderay, ID 83852 Kootenai County The Department is accepting written Panhandle Health District, 2101 W. Pine DHW Region 1, 1120 Ironwood Drive, and recorded comments regarding the Street, Sandpoint, ID 83864 Coeur d’Alene, ID 83814 proposed changes for a period of at least Bonneville County Panhandle Health District, 8500 N. Atlas thirty (30) calendar days. Any persons DHW Region 7, 150 Shoup Avenue, Road, Hayden, ID 83835 wishing to provide input may submit Idaho Falls, ID 83402 Latah County comments. Eastern Idaho Public Health, 1250 DHW Region 2, 1350 Troy Highway, Comments must be received by the Hollipark Drive, Idaho Falls, ID 83401 Moscow, ID 83843 Department within thirty (30) days of Boundary County North Central Health District, 333 E the posting of this notice, and must Panhandle Health District, 7402 Caribou Palouse River Drive, Moscow, ID 83843 be sent using one of the following Street, Bonners Ferry, ID 83805 Lemhi County methods:Send Email Comments To: Butte County DHW Region 7, 111 Lillian Street, Suite MCPT@dhw.idaho.gov Southeastern Idaho Public Health, 178 104, Salmon, ID 83467 Call and Leave Recorded Comments At: Sunset Drive, Arco, ID 83213 Eastern Idaho Public Health, 801 (208)-364-1887 Camas County Monroe, Salmon, ID 83467 Send Fax Comments To: 1-208-287- Camas County Clerk’s Office, 501 Lewis County 1170 Soldier Road, Fairfield, ID 83327 North Central Health District, 132 N Hill Mail Comments To: Division of Medicaid Canyon County Street, Kamiah, ID 83536 PO Box 83720, Boise, ID 83720-0009 DHW Region 3, 3402 Franklin Road, Lincoln County Attn: Policy Team Caldwell, ID 83605 South Central Public Health, Lincoln Hand Deliver Comments During Regular Southwest District Health, 13307 Miami County Community Center, 201 South Business Hours (M-F from 8AM to 5PM, Lane, Caldwell, ID 83607 Beverly St., Shoshone, ID 83352 except holidays) To: Division of Medicaid Caribou County Madison County 450 West State Street, 6th Floor, Boise, Southeastern Idaho Public Health, 55 DHW Region 7, 333 Walker Drive, ID 83720 East 1st South, Soda Springs, ID 83276 Rexburg, ID 83440 Attn: Policy Team Cassia County Eastern Idaho Public Health, 314 North The Department will review all comments DHW Region 5, 2241 Overland Avenue, 3rd East, Rexburg, ID 83440 received prior to submitting the Burley, ID 83318 Minidoka County amendment to CMS. Clark County South Central Public Health, 485 22nd PUBLIC HEARING Eastern Idaho Public Health, 332 West Street, Heyburn, ID 83336 No public hearings have been scheduled Main, Dubois, ID 83423 Nez Perce County at this time. Clearwater County DHW Region 2, 1118 F Street, Lewiston, QUESTIONSFor technical questions or North Central Health District, 105 115th ID 83501 to review the changes, e-mail the request Street, Orofino, ID 83544 North Central Health District, 215 10th to MCPT@dhw.idaho.gov. Street, Lewiston, ID 83501