NOTICE OF INTENT TO SUBMIT STATE PLAN 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 State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) to update cost sharing requirements for Medicaid members. These updates are consistent with Idaho Code § 56-2203 Legislative Approval – Medicaid Cost-Sharing (created by Idaho House Bill H0345 Medicaid (2025)). Members, at the time of their enrollment and reenrollment after a redetermination of eligibility, and when premiums, cost sharing charges, or aggregate limits are revised, are notified of their cost sharing obligations. This occurs in Notice of Decision materials that reference the state’s current public schedule or premiums and cost sharing, and the notice to beneficiaries of aggregate limits, as posted on the State Medicaid Agency’s website (https://healthandwelfare.idaho.gov/services-programs/medicaid- health). American Indian / Alaska Native (AI/AN) members are federally exempt from cost sharing. This amendment: • Increases Medicaid member copays from three dollars and sixty-five cents ($3.65) to four dollars ($4.00) on benefits already subject to a copay for applicable members, and adds benefits that will be subject to a copay. Services that will be subject to a copay would include: - Accessing Emergency Transportation Services For Non-Emergency Medical Condition. - Accessing Hospital Emergency Dept Services For Non-Emergency Medical Condition. - Ambulatory Surgical Center Services. - Chemotherapy and Radiation Therapy Services. - Chiropractic Services. - Dental Services. - Diagnostic X-Ray Services. - Durable Medical Equipment. - Federally Qualified Health Center (FQHC) Services. - Home Health Services. - Inpatient Hospital Services. - Laboratory Services. - Occupational Therapy Services. - Optometric Services. - Outpatient Hospital Services. - Physical Therapy Services. - Physician Office Visits. - Podiatry Services. - Rural Health Clinic (RHC) Services. - Speech Therapy Services. - Urgent Care Center Services. • Adds copays on preferred and non-preferred drugs. Preferred drugs will have a four dollar ($4.00) co-pay, and non-preferred drugs will have an eight dollar ($8.00) copay. The Department intends to submit this amendment to CMS on or before July 1, 2026, with a requested effective date to be determined in consultation with CMS. ESTIMATE OF EXPECTED CHANGE IN ANNUAL AGGREGATE EXPENDITURES There is an expected decrease in annual aggregate expenditures. PUBLIC REVIEW When available, copies of the draft SPA and waiver pages will be posted on the IDHW website at https://healthandwelfare.idaho. gov/about-dhw/policies-procedures-and-waivers (under “Medicaid policies”, PUBLIC-DOCUMENTS > About DHW > Policies & Standards > Medicaid > Draft State Plan Amendments). 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 Custer County Owyhee County OF PROPOSED STATE PLAN Eastern Idaho Public Health, 1050 N. Southwest District Health, 132 E. AMENDMENT Clinic Road, Suite A, Challis, ID 83226 Idaho, Homedale, ID 83628 Ada County DHW Region 4, 1720 Westgate Drive, Elmore County Payette County Boise, ID 83704 DHW Region 4, 2420 American Legion DHW Region 3, 515 N. 16th Street, Central District Health Department, Blvd., Mountain Home, ID 83647 Payette, ID 83661 707 North Armstrong Place, Boise, Central District Health Department, Southwest District Health, 1155 Third ID 83704 520 E. 8th Street N, Mountain Home, Avenue North, Payette, ID 83661 ID 83647 Adams County Power County Adams County Clerk’s Office, 201 Franklin County Southeastern Idaho Public Health, 590 Industrial Avenue, Council, ID 83612 DHW Region 6, 223 North State, 1/2 Gifford, American Falls, ID 83211 Preston, ID 83263 Bannock County Southeastern Idaho Public Health, 50 Shoshone County DHW Region 6, 1070 Hiline, Pocatello, West 1 St. South, Preston, ID 83263 DHW Region 1, 35 Wildcat Way, Suite ID 83201 B, Kellogg, ID 83837 Southeastern Idaho Public Health, Fremont County Panhandle Health District, 114 1901 Alvin Ricken Drive, Pocatello, Eastern Idaho Public Health, 45 South Riverside Avenue W, Kellogg, ID ID 83201 2nd West, St. Anthony, ID 83445 83837 Bear Lake County Gem County Teton County Southeastern Idaho Public Health, Southwest District Health, 1008 East Eastern Idaho Public Health, 820 455 Washington, Suite #2, Montpelier, Locust, Emmett, ID 83617 Valley Centre Drive, Driggs, ID 83422 ID 83254 Gooding County Twin Falls County Benewah County South Central Public Health, 255 North DHW Region 5, 601 Pole Line Road, Panhandle Health District, 137 N 8th Canyon Drive, Gooding, ID 83330 Twin Falls, ID 83301 Street, St Maries, ID 83861 South Central Public Health, 1020 Idaho County Washington Street North, Twin Falls, Bingham County DHW Region 2, Camas Resource ID 83301 DHW Region 6, 701 East Alice, Center, 216 South C Street, Blackfoot, ID 83221 Grangeville, ID 83530 Valley County Southeastern Idaho Public Health, 145 North Central Health District, 903 W Central District Health Department, W Idaho Street, Blackfoot, ID 83221 Main, Grangeville, ID 83530 703 1st Street, McCall, ID 83638 Blaine County Jefferson County Washington County South Central Public Health, 117 East Eastern Idaho Public Health, 380 Southwest District Health, 46 West Ash Street, Bellevue, ID 83313 Community Lane, Rigby, ID 83442 Court, Weiser, ID 83672 Boise County Jerome County PUBLIC COMMENT Boise County Clerk’s Office, 420 Main South Central Public Health, 951 East The Department is accepting written Street, Idaho City, ID 83631 Avenue H, Jerome, ID 83338 and recorded comments regarding the proposed changes for a period Bonner County Kootenai County of at least thirty (30) calendar days. DHW Region 1, 207 Larkspur Street, DHW Region 1, 1120 Ironwood Drive, Any persons wishing to provide input Ponderay, ID 83852 Coeur d’Alene, ID 83814 may submit comments and should Panhandle Health District, 2101 W. Panhandle Health District, 8500 N. be aware that personally identifiable Pine Street, Sandpoint, ID 83864 Atlas Road, Hayden, ID 83835 information (PII) may be subject to public disclosure. Commentors should Bonneville County Latah County refrain from submitting Protected DHW Region 7, 150 Shoup Avenue, DHW Region 2, 1350 Troy Highway, Health Information (PHI). Idaho Falls, ID 83402 Moscow, ID 83843 Eastern Idaho Public Health, 1250 North Central Health District, 333 Comments must be received by the Hollipark Drive, Idaho Falls, ID 83401 E Palouse River Drive, Moscow, ID Department within thirty (30) days of 83843 the posting of this notice, and must Boundary County be sent using one of the following Panhandle Health District, 7402 Lemhi County methods: Caribou Street, Bonners Ferry, ID DHW Region 7, 111 Lillian Street, Suite 83805 104, Salmon, ID 83467 • Send Email Comments To: Eastern Idaho Public Health, 801 MCPT@dhw.idaho.gov Butte County Monroe, Salmon, ID 83467 • Call and Leave Recorded Comments Southeastern Idaho Public Health, 178 At: (208)-364-1887 Sunset Drive, Arco, ID 83213 Lewis County • Send Fax Comments To: North Central Health District, 132 N Hill 1-208-287-1170 Camas County Street, Kamiah, ID 83536 • Mail Comments To: Camas County Clerk’s Office, 501 Division of Medicaid Soldier Road, Fairfield, ID 83327 Lincoln County PO Box 83720, Boise, ID 83720-0009 South Central Public Health, Lincoln Attn: Policy Team Canyon County County Community Center, 201 South DHW Region 3, 3402 Franklin Road, Beverly St., Shoshone, ID 83352 Hand Deliver Comments During Caldwell, ID 83605 Regular Business Hours (M-F from Southwest District Health, 13307 Madison County 8AM to 5PM, except holidays) To: Miami Lane, Caldwell, ID 83607 DHW Region 7, 333 Walker Drive, Division of Medicaid Rexburg, ID 83440 450 West State Street, 6th Floor, Caribou County Eastern Idaho Public Health, 314 North Boise, ID 83720 Southeastern Idaho Public Health, 3rd East, Rexburg, ID 83440 Attn: Policy Team 55 East 1st South, Soda Springs, ID 83276 Minidoka County The Department will review all South Central Public Health, 485 22nd comments received prior to submitting Cassia County Street, Heyburn, ID 83336 the amendments to CMS. DHW Region 5, 2241 Overland Avenue, Burley, ID 83318 Nez Perce County PUBLIC HEARING DHW Region 2, 1118 F Street, No public hearings have been Clark County Lewiston, ID 83501 scheduled at this time. Eastern Idaho Public Health, 332 West North Central Health District, 215 10th Main, Dubois, ID 83423 Street, Lewiston, ID 83501 QUESTIONS For technical questions or to review Clearwater County Oneida County the changes, e-mail the request to North Central Health District, 105 115th Southeastern Idaho Public Health, 175 MCPT@dhw.idaho.gov. Street, Orofino, ID 83544 South 300 East, Malad, ID 83252