Medicaid Nursing Home Rates by State

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Idaho

Medicaid nursing facility payment · Hybrid · researched October 2026

Idaho’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Hybrid

Case-mix level

Facility average

Classification

PDPM

Rate updates

Quarterly

Managed care (LTC)

Yes

Quality program

NF Quality Payment Program (NFQPP)

Paid outside the rate

Large

Bed hold

Leave only

Published rates

Rates only

Assisted living

Covered

Personal needs allowance

$40 / month

Overview

• Idaho pays each home a prospective per diem built from its own audited costs, capped at a statewide price.
• Since 7/1/2021 (Idaho Code 56-116) the direct care and indirect care prices are a percentage of the bed-weighted median cost: direct 108.15% for freestanding and urban hospital-based homes, 130.96% for rural hospital-based homes and 135.59% for behavioral care units; indirect 103.865% and 124.101%.
• A home below the price gets its cost plus a capped 'margin' (the direct care margin cap depends on its quality tier; the indirect cap is 5%).
• On top come a property rental rate (a formula, not actual cost), pass-through property taxes, insurance and utilities, then a legislature-set budget adjustment factor (BAF).
• Rates are rebased every July 1 and the direct line is re-weighted each quarter by the home's average Medicaid case mix.
• The 10/1/2026 rate file lists 73 homes (64 freestanding, 9 hospital-based).
• For the 68 non-state homes the median is $222.65/day (range $174.94-$278.95; freestanding $222.28, hospital-based $233.15).
• The 5 state-owned homes (4 veterans homes plus Syringa Chalet) are paid cost-based rates of $534.99-$1,060.54.

What matters in Idaho

• About 20-30% of base comes outside the per diem, as an annual quality-scored supplemental lump sum (last stated about $59M/yr).
• Posted rates fell a median 7.1% on 7/1/2026, about 14% below April 2025, following a 4% cut on 9/1/2025.
• Quality tier sets both the home's share of the annual lump sum (90-100%) and its direct care margin cap.
• Case mix is per home, reset quarterly; the 2026 rule bases the Medicaid acuity index on PDPM instead of RUG-III.
• Property taxes and insurance are spread over at least 80% occupancy, while average Idaho occupancy is about 68%.
• Hospital bed holds are not paid; home-visit leave pays 75% of the rate only when occupancy tests are met.

Frequently asked

Does an Idaho home's quality score change its daily rate or only a year-end payment?

Both. The quality tier sets the home's share of the annual lump sum (90% to 100%) and also its direct care margin cap.

How does occupancy affect Idaho's reimbursement of property taxes and insurance?

These costs are spread over at least 80% occupancy, while average Idaho occupancy is about 68%. Homes below the floor therefore recover less per day.

What Medicaid rate does a newly built Idaho nursing home receive?

A home built on or after 7/1/2023 is paid the class median rate minus 10% for its first 4 full years.

How much is paid outside the posted rate in Idaho?

Large, about 20-30% of base, mainly the annual quality-scored supplemental lump sum; the current pool size is unpublished.

What does Idaho Medicaid pay on Medicare coinsurance days?

Medicaid pays its allowed amount minus Medicare's payment, so homes usually receive $0 of the coinsurance.

Does Idaho require a minimum share of spending on care?

No; homes below the price keep only a capped margin, so under-spending lowers the next year's rate.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Idaho uniform cost report (state format, accrual basis, separate report per facility; chains may not file consolidated reports), audited by the Department and its contractor Myers and Stauffer. Hospital-based homes also use Medicare cost report data.

Base year and rebasing

Rebased every year. Each July 1 rate uses audited cost reports that ended in the calendar year two years earlier (CY2024 reports for 7/1/2026 rates), inflated from the cost report midpoint to the rate-year midpoint. Reports shorter than 184 days are not used. Property costs are not inflated.

Components

Component	Method	Notes
direct care	Price = bed-weighted median of inflated, case-mix-neutral direct cost per day x class percentage: 108.15% freestanding/urban hospital-based, 130.96% rural hospital-based, 135.59% freestanding BCU (2021 values). Home gets the lesser of the price or its case-mix-neutral cost plus margin. Margin = lesser of (price - cost) or the margin cap (price x a cap % set by quality tier; tier 1 gets the highest). The result, less raw food and Medicaid ancillaries, is multiplied by the home's latest quarterly Medicaid CMI, then food and ancillaries are added back.	Direct care = RN/LPN/CNA/unit clerk wages, nursing admin, routine nursing supplies, direct portion of Medicaid-related ancillaries, social services, raw food, related benefits, medical waste. The tier margin-cap percentages are not published in the state plan. The class percentages are 'reviewed periodically'; current values not found.
indirect care	Price = bed-weighted median inflated indirect cost per day x 103.865% (freestanding/urban hospital-based) or 124.101% (rural hospital-based). Home gets the lesser of the price or cost + margin; margin cap = 5% of price for all types. Not case-mix adjusted.	Administration, activities, dietary (non-food), housekeeping, laundry, plant operations (excluding utilities), medical records, central services, related benefits.
property (freestanding)	Property rental rate formula (Idaho Code 56-108), not actual cost; see capital.	Grandfathered rates for pre-1985 assets/leases can apply.
costs exempt from limits	Pass-through per diem: property taxes, property insurance (capped at 2 standard deviations above the class mean per bed), utilities, NATCEP costs, and costs of new legal mandates over $0.50/day.	Taxes and insurance are spread over at least 80% occupancy.
hospital-based property	Actual property and utility costs per patient day from the rate-setting cost report (Idaho Code 56-120).
budget adjustment factor	Positive or negative factor applied to all computed prospective rates so total spending matches the legislature's NF budget.	Not applied to the customary-charge cap or to cost-settled homes.

Inflation

IHS Markit/S&P Global Table 6.7, CMS Nursing Home without Capital Market Basket (Idaho-specific if available), applied from the cost report midpoint to the rate-year midpoint for all components except property.

Verified October 11, 2026

Case mix

System

PDPM

Applied at

Facility average

How it works

Each quarter the home's direct care line is multiplied by the average CMI of its Medicaid residents on the picture date, so every Medicaid resident in the home gets the same posted rate (4.19-D II.01; Additional Terms A-4.1).

Classification

Likely PDPM-based since 7/1/2026: the 2026 rule text (IDAPA 16.03.26, dated 7-1-26) defines the Medicaid CMI as the average weight 'based on their PDPM classification', and in Dec 2023 the Department said Idaho would use the PDPM nursing component. Before that: RUG-III via the Optional State Assessment. The 2025 rule still said RUG, and the Department deferred commenters' request to switch it to PDPM for 7/1/2025. No approved PDPM methodology SPA was found.

Applies to

Direct care only (excluding raw food and Medicaid-related ancillaries). Indirect, property and pass-through costs are not case-mix adjusted.

Acuity measured from

Payment uses Medicaid residents only, from the most recent assessment of each Medicaid resident on the picture date, which is the first day of the first month of the prior quarter (e.g. April 1 sets July 1 rates). Cost neutralization uses the facility-wide CMI (all residents), the average of four quarterly picture dates covering the cost report year.

Updated

quarterly (Jan 1, Apr 1, Jul 1, Oct 1)

Move to PDPM

Planned for 7/1/2024 (Dec 2023 NF meeting notes) using the PDPM nursing component; it slipped. CMS stopped supporting the OSA after 9/30/2025. The 2026 rulemaking draft uses PDPM classification effective 7/1/2026. SFY2027 posted rates (7/1/2026) fell a median 7.1% from the 4/1/2026 quarter, which may partly reflect re-weighting, but no transition notice or budget-neutrality statement was found. (likely)

Verified October 11, 2026

Low-acuity residents

None found. Idaho has no reduced or flat rate for low case-mix residents. Low acuity only lowers the home's quarterly average CMI. Residents must meet nursing facility level of care (in rule, a qualifying RUG-III/PDPM classification from the standard assessment) to be covered at all. Residents with incomplete or inconsistent MDS data get a default classification, and MDS reviews exclude those from retroactive correction. Checked: 4.19-D (ID-21-0012), IDAPA 16.03.26.481-495 (2025) and the 2026 draft, Additional Terms - Nursing Facilities (Sept 2026), and IDAPA 16.03.10.225/265 (repealed).

Verified October 11, 2026

Capital

Freestanding homes get a 'property rental rate' under Idaho Code 56-108 instead of depreciation, interest and lease costs. Formula: $9.24 property base x change in building costs (Marshall & Swift class D western-region index since 1985; for freestanding SNFs, 1.145 in 1991, then the greater of that index or the CPI renters' cost) x (40 - age)/40. Age is capped at 30 years, so the floor is 25% of the indexed base. A frozen 'revised age' has applied since 1991, and age is reduced for documented renovations (gains capped at 3/4 of the gap). Homes with pre-1985 assets or pre-3/30/1981 leases can keep a higher 'grandfathered rate', which in most cases passes to a buyer. The rental rate covers major movable equipment. Property taxes and reasonable property insurance are paid on top as cost (exempt from price limits). Hospital-based homes get actual property plus utility cost per patient day. State-owned homes are paid on property cost.

Verified October 11, 2026

Budget adjustment factor

Yes, built in. Every July 1 the legislature's NF budget is compared with the modeled rates, and a single BAF (positive or negative) scales all prospective rates. It is not applied to the customary-charge cap or to cost-settled homes (4.19-D I.01; IDAPA 16.03.26.047; Additional Terms A-4.8). Annual BAF values are not published. Separately, an across-the-board 4% cut to all Medicaid provider rates took effect 9/1/2025 (MA25-17/MA25-19), with state-owned NFs exempt. It shows in the rate files as exactly 0.96 x the 7/1/2025 rate for 66 of 73 homes. Historical: SFY2010 cuts removed the indirect efficiency add-on and inflation and applied a 2.7% reduction (replaced by the UPL program).

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

large

Estimate

About 20-30% of base, derived. The NFQPP/UPL lump sum (last stated at about $59M/yr, before the 2023 switch to a PDPM-based UPL) is compared with a base of about $225-235M: roughly 925K Medicaid days on CY2024 Idaho SNF cost reports (our cost_report_summary, CCN prefix 13) x about $243/day median posted rate. The current pool size is not published, so the level is uncertain. The assessment that private homes pay to fund it is not netted out here.

Components

NFQPP/UPL supplemental payment, about $59M/yr (date uncertain), paid annually through FFS plus MCO pass-through; distressed-facility rates (rare, size unknown).

Source

https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

The UPL/NFQPP gap is computed and paid separately by ownership class: private, non-state government (county and hospital-district homes such as Bear Lake, Boundary, Franklin, Oneida and Power County), and state-owned (4 veterans homes, eligible since 2018). Each home draws on its own class's gap. Public homes are exempt from the assessment and fund their share by IGT, so their net gain differs from private homes, which pay the bed tax. State-owned homes are also paid cost-based rates outside the price system and were exempt from the 9/1/2025 4% cut. The size of the gap by class was not found.

Funding

IGT from the county/hospital-district owner or the state veterans division. No lease or management arrangements for private operators were found.

Source

https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id…

Verified October 11, 2026

Quality program

Program

Nursing Facility Quality Payment Program (NFQPP). It converted the old UPL supplemental payment into a quality-scored payment from SFY2021 (Idaho Code 56-1511(6)); shadow scoring ran in SFY2019-2020. Quality tier also sets each home's direct care margin cap inside the per diem.

Funding

Provider tax and IGT, not new state money. Private homes pay the nursing facility assessment, which is sized to the state share of the private-class payment plus admin. County/hospital-district homes and the state veterans homes put up the state share by IGT. The federal match comes through the Medicare upper payment limit (UPL) gap. From 10/1/2023 (SPA ID-23-0020) the UPL gap is measured against Medicare PDPM rates.

Size

UPL gap per ownership class (private, non-state government, state-owned), computed on FFS plus Idaho managed care Medicaid days. The guide cites 'approximately $59 million' a year in the pre-quality UPL program. The current annual total was not found.

Paid as

Lump sum once a year (notice letters targeted for August). Idaho pays FFS days directly and sends each MCO a lump sum with the amount it must pay each home.

Measures

Measure	Source	Weight	How points are earned
Long-stay antipsychotic medication use	MDS QM (CMS Care Compare)	20-100 points (of 900)	CMS Five-Star style cut points fixed at the 2017 base year; BCU/vent homes get the higher of own score or statewide median
Long-stay urinary tract infections	MDS QM	20-100 points	2017 base-year cut points
Long-stay pressure ulcers (high-risk)	MDS QM	20-100 points	2017 base-year cut points; measure frozen by CMS 10/1/2023, latest data used
Long-stay indwelling catheter	MDS QM	20-100 points	2017 base-year cut points
Decline in late-loss ADLs	MDS QM	20-100 points	frozen by CMS 10/1/2023; BCU/vent homes get the higher of own score or statewide median
Decline in mobility	MDS QM	20-100 points	frozen by CMS 10/1/2023
Physical restraints	MDS QM	20-100 points	2017 base-year cut points
Falls with major injury	MDS QM	20-100 points	2017 base-year cut points
Long-stay hospitalization rate (PointRight Pro Long Stay)	MDS-based, AHCA/PointRight	20-100 points	fixed cut points (guide Appendix C)

Scoring period

Four-quarter QM average for the prior calendar year; Medicaid days from cost reports two years back. Example: the SFY2025 payment used QMs ending 12/31/2023 and rates/days from SFY2024. Payment comes about 7-8 months after the measurement year ends.

Payment formula

Total score (max 900) sets the tier: Tier 1 720-900, Tier 2 620-700, Tier 3 180-600 (2017 base). Each home's own share of its class pool = its Medicaid days / class Medicaid days x class UPL gap. It is paid a percentage of that share by tier and by change from last year: Tier 1 always 100%; Tier 2 100% unless the score fell 40+ points (95%); Tier 3 100% if improved 40+, 95% if flat, 90% if down 40+. Withheld money is redistributed within the ownership class by days. In practice homes receive 90-100% of their pool share.

Eligibility

All Medicaid nursing homes except cost-settled state/county homes. State veterans homes take part via IGT since 2018. Missing measures are imputed at the statewide median. There is a dispute process with a 4-member review committee.

Cadence

Scored and paid annually (state fiscal year). Quarterly score reports go to homes, and a Quality Standing report comes in Q2.

Scores published

No public per-facility scores or payments found. Reports go to each home privately. Program guide and workgroup notes: https://publicdocuments.dhw.idaho.gov/WebLink/Browse.aspx?id=…

Notes

The tiers were fixed on 2017 data through SFY2025 payments, with a rebase due for SFY2026 payments (QMs ending 12/31/2024); the outcome was not found. A 40-point COVID credit was added in SFY2022-2023. Quality tier also sets the direct care margin cap in the per diem (4.19-D II.04.c), so quality moves both the lump sum and the base rate.

Verified October 11, 2026

Provider tax

Charged

per non-Medicare day

Standard amount

Uniform per-resident-day rate set each fiscal year (notice by Aug 30), excluding Medicare Part A and MA/SNP days. The total may not exceed the federal maximum % of prior-year net patient service revenue. The current amount was not found.

Tiers

Who	Test	Amount
state-owned and county-owned facilities (incl. state veterans homes)	public	exempt; they fund their state share by IGT instead

Lower for high-Medicaid homes

no

Returned in the rate

Not in the per diem. Returned through the annual UPL/NFQPP supplemental lump sum to private homes. The assessment fund may also 'reimburse the Medicaid share of the assessment' (Idaho Code 56-1504(3)(b)), but no per diem add-on for it was found in the rate method.

Source

https://legislature.idaho.gov/wp-content/uploads/statutesrule…

Verified October 11, 2026

Provider tax notes

Nursing facility assessment (Idaho Skilled Nursing Facility Assessment Act, Idaho Code 56-1501 et seq.). It is a uniform amount per resident day excluding Medicare Part A and Medicare Advantage/SNP days, collected once a year. The total is capped at the federal maximum % of net patient revenue and in practice set to fund the state share of the private-home UPL/quality payment plus up to 1% admin. State and county-owned homes are exempt. It comes back as the annual supplemental payment, not in the per diem. The current per-day amount was not found.

Verified October 11, 2026

Supplemental payments

(1) Annual UPL supplemental payment, quality-scored as the NFQPP since SFY2021 (4.19-D p.26-27, SPA ID-23-0020, eff. 10/1/2023, Medicare comparison at PDPM rates). It is computed separately for private homes and for state/county-owned homes, from the gap between Medicare-equivalent and Medicaid payment on FFS + managed care days, and paid as a lump sum once a year (through the MCOs for their days). Funded by the provider assessment (private homes) and IGT (county/hospital-district homes and state veterans homes). The last stated size is about $59M/yr. (2) Distressed-facility rates: a negotiated, re-requested-yearly rate above the caps (up to UPL) for homes in under-served areas (IDAPA 16.03.26.486). No MCO directed payment other than the NFQPP pass-through was found.

Verified October 11, 2026

Other add-ons

(1) Special rates (Idaho Code 56-117; IDAPA 16.03.26.491): per-resident add-ons, approved case by case for needs lasting 30+ days. Ventilator-dependent and tracheostomy residents get a fixed add-on for equipment, supplies and extra RN/CNA hours, updated yearly (supplies by inflation, staff by the annual WAHR wage survey); amounts not found. Equipment and non-therapy supplies outside the per diem are paid at DMEPOS rates as an add-on. Homes that were 100% special care units on 7/1/2000 have no direct care cap. (2) Behavioral Care Units: no add-on, but a higher direct care price (135.59% of median vs 108.15%) for homes with 30%+ BCU days. (3) Distressed-facility negotiated rate. (4) Interim increases for new state/federal mandates costing more than $0.50/day, settled at audit. (5) NATCEP costs are paid as an exempt cost.

Verified October 11, 2026

Units paid separately

(1) State-owned homes (4 Idaho State Veterans Homes plus DHW's Syringa Chalet) are outside the price system. They were cost-settled; SPA ID-26-0003 moves them to a prospective cost-based rate from 7/1/2026, with no case mix and no price limits. 10/1/2026 rates are $534.99-$1,060.54. They are exempt from the 9/1/2025 4% cut. (2) Hospital-based homes: same price method with separate, higher rural hospital-based prices, plus actual property and utility cost. (3) BCU homes: higher direct care price class. (4) Vent/trach: per-resident add-on, not a separate unit rate. (5) New facilities: the class median rate (new homes built on or after 7/1/2023: median minus 10%) for the first 4 full years. New beds added after 7/1/1999: rate limited to a bed-weighted blend of the home's rate and the class median minus 10% for 3 years. (6) Change of ownership: the buyer keeps the seller's rate, inflated, until it has a qualifying cost report; in the third year, the higher of that or the class median. (7) Out-of-state placements: paid the host state's per diem.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

yes

Detail

Duals only. IMPlus (mandatory for full duals in 34 counties; Molina and UnitedHealthcare, which replaced Blue Cross of Idaho on 6/1/2025) and MMCP (voluntary integrated plan) pay nursing home days for enrolled duals with no day limit. Medicaid-only residents stay fee-for-service. Statewide comprehensive managed care is scheduled for 1/1/2030 (H345).

Verified October 11, 2026

Who pays

mixed: fee-for-service (Gainwell) for Medicaid-only residents and for duals outside the mandatory counties. Full duals (Medicare + Medicaid) in 34 named counties must enroll in Idaho Medicaid Plus (IMPlus: Molina or UnitedHealthcare, Medicaid benefits only) unless they pick the voluntary Medicare-Medicaid Coordinated Plan (MMCP: Molina, and UnitedHealthcare from 1/1/2026). Both plans cover all Medicaid enhanced plan benefits, including nursing facility care. Comprehensive Medicaid managed care for everyone (H345, 2025) is delayed to 1/1/2030, with the RFP expected in 2027.

Verified October 11, 2026

Managed care rate floor

Not found. No IMPlus/MMCP contract language seen that requires plans to pay at least the state per diem. The quality supplemental payment (NFQPP) computes the managed care share and sends it to each plan as a lump sum with the amount each home must receive, i.e. a pass-through. Sources: https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id… ; https://healthandwelfare.idaho.gov/services-programs/medicaid…

Verified October 11, 2026

Included in the daily rate

Included (IDAPA 16.03.10.225 / 16.03.26.473): room and board, linens, nursing, personal services, special diets, OTC 'medicine chest' drugs, dressings, all routine medical supplies (incontinence, syringes, gloves, etc.), administration of injections/IV/oxygen, activities, and reusable DME such as wheelchairs, walkers, canes, bed rails and traction. The direct care cost pool includes the 'direct portion of Medicaid-related ancillary services', so routine therapy and ancillaries are largely in the rate (likely). Paid separately: prescription drugs (pharmacy claims; drug costs and pharmacist salaries are unallowable on the cost report); equipment and non-therapy supplies not listed in the coverage rule (DMEPOS add-on via special rate); physician and hospital services.

Verified October 11, 2026

Bed hold

Hospital stays

Not paid. The rule covers only therapeutic home visits.

Leave days

Paid for home visits in a physician-ordered plan: up to 3 days per visit and 15 days per calendar year, at the lesser of 75% of audited allowable cost or the home's private-pay bed-hold charge. Only if the home charges private payers for reserved beds. The posted rate files show a leave rate (rev code 183) of exactly 75% of the daily rate.

Occupancy rule

Homes under 100 licensed beds: not paid if 5 or more beds are empty. Homes with 100+ beds: paid only at 95%+ occupancy (measured the day before the leave).

Source

https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id…

Verified October 11, 2026

Personal needs allowance

Per month

40

Effective

2024-07-01 (current rule date)

Notes

IDAPA 16.03.05: $40 personal needs deduction; for veterans/surviving spouses the first $90 of VA pension substitutes for the $40. Employed/sheltered-workshop residents: lower of $200 or gross earnings, total PNA capped at $230 ($200 with protected VA pension). Personal Needs Supplement tops gross income up to $40. Not COLA-indexed.

Confidence

confirmed

Source

https://adminrules.idaho.gov/rules/current/16/160305.pdf

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

For skilled nursing facilities, 'Medicaid will pay the Medicaid allowed amount minus Medicare's Part A payment without regard to Medicare's co-insurance, co-pay, or deductible' (Supplement 1 to 4.19-B, p.3, TN 15-0009), i.e. capped at the home's Medicaid per diem. Medicare Advantage: no FFS rule found. Most full duals are in IMPlus/MMCP, where the plan handles Medicaid cost sharing; the MMCP integrates both.

Effect

Medicare's PDPM payment on days 21-100 is well above the Idaho Medicaid rate (about $223/day median), so the home usually gets $0 of the coinsurance from FFS Medicaid.

Source

https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id…

Verified October 11, 2026

Required care spending

Applies

no

Rule

No nursing-facility spending floor. The closest feature is cost-based pricing: a home whose cost is below the price keeps only a capped margin (direct care cap set by quality tier; indirect 5%), so under-spending lowers the next year's rate. Idaho Code 56-265(2) does impose a direct-care-worker spending requirement, but only on cost-surveyed HCBS services (residential habilitation, personal care, DDA, supported employment, service coordination), not on NFs.

Source

https://legislature.idaho.gov/statutesrules/idstat/Title56/T5…

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

(1) Property costs other than the property rental rate (i.e. property taxes and insurance, and actual property for hospital-based homes) are spread over at least 80% of capacity. Below 80%, the shortfall share is disallowed. New homes and added beds are exempt for 6 months. (2) Bed-hold payments only at 95% occupancy (100+ beds) or fewer than 5 empty beds (under 100 beds). Average Idaho SNF occupancy on CY2024 cost reports is about 68% (our DB), so the 80% rule bites for many homes.

Source

https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id…

Verified October 11, 2026

MDS accuracy penalties

After each picture date the home gets a resident roster (classification, CMI, Medicaid status) to sign or correct. If a later Department MDS review finds errors that change the CMI, the rate is retroactively adjusted for every quarter containing the incorrect assessment and the difference is recouped (IDAPA 16.03.10.265 / 16.03.26.487; 4.19-D XII). Residents with incomplete or inconsistent MDS data are given a default classification and are excluded from that retroactive correction. SPA ID-24-0014 (requested 7/1/2024) added provisions on 'failure to timely submit minimum data sets'; detail not found. Separately, a late cost report brings a 10% rate cut from the first of the next month, then payment suspension.

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

quarterly

When

July 1 annual rebase (new prices, cost report, BAF); Oct 1, Jan 1 and Apr 1 case-mix updates to the direct care line from the prior quarter's picture date. Ad hoc changes such as the 9/1/2025 4% cut.

Verified October 11, 2026

When rates change

State fiscal year starting July 1; quarterly case-mix updates on 10/1, 1/1, 4/1. The SFY2026 Q1 file was split 7/1-8/31/2025 and 9/1-9/30/2025 for the 4% cut.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://publicdocuments.dhw.idaho.gov/WebLink/Browse.aspx?id=… (Fee Schedules > Nursing Facilities > Quarterly Per Diem Rates; archive https://publicdocuments.dhw.idaho.gov/WebLink/Browse.aspx?id=…)

Format

pdf (text-extractable table)

Cadence

quarterly

History

SFY2023 Q1 (7/1/2022) through SFY2027 Q2 (10/1/2026) online; earlier files not found.

Home identifier

NPI plus legal business name and DBA. Also revenue code (100 = daily rate; 183 = leave-of-absence rate at exactly 75% of the daily rate), effective date, and type (FS freestanding / HB hospital-based). No CCN or Medicaid provider number.

Verified October 11, 2026

Rate build-ups

Published

No

Where

None found. Only final per diems are posted; prices, medians, margin caps, BAF and facility CMIs are not published. The method is in the state plan (4.19-D) and the Medicaid Provider Agreement 'Additional Terms - Nursing Facilities'.

What they show

n/a. The rate file shows only the total daily rate and the 75% leave rate per facility.

Format

n/a

Example file

https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

Aged and Disabled (A&D) 1915(c) waiver (ID.1076): 'Adult Residential Care' in Residential Assisted Living Facilities (RALFs), plus state plan personal care services delivered in a RALF.

What is paid

Services only. The resident pays room and board (often from SSI plus the state AABD cash supplement).

Rate

Waiver S5140 Adult Residential Care - RALF: a daily rate 'as authorized per participant' (individually set from the assessment). State plan T1019 personal care in a RALF $5.12 per 15 min, and T1019 HE milieu management $62.40/day (fee schedule effective 9/1/2025, reviewed 1/1/2026).

Limits

No waitlist or regional limit found. Duals in IMPlus/MMCP get these through their plan.

Source

https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id…

Verified October 11, 2026

Sources

1. Idaho Medicaid SNF quarterly per diem rates, SFY2027 Q2 (eff. 10/1/2026) · rate file
2. Quarterly Per Diem Rates archive (SFY2023-SFY2026) · rate file
3. MA26-18 Update to Additional Terms - Nursing Facility Provider Agreement (eff. 9/7/2026) · agency page
4. Idaho Medicaid State Plan Attachment 4 (4.19-D NF, TN ID-21-0012; supplemental payments TN ID-23-0020; crossover Supp. 1 to 4.19-B) · state plan
5. IDAPA 16.03.26 Medicaid Plan Benefits (temporary rule text, eff. 7/1/2025) · regulation
6. IDAPA 16.03.26 2027 official text - negotiated rulemaking draft (July 2026; PDPM definitions) · regulation
7. 16.03.26 public comment and response (June 2025 hearings; PDPM request deferred) · agency page
8. IDAPA 16.03.26.047 Long-term care facility payment (Cornell LII) · regulation
9. IDAPA 16.03.10.270 Special rates and related NF sections .225/.263/.265/.292 (repealed 2025; Cornell LII) · regulation
10. Idaho Code Title 56 Ch. 1 (56-101, 56-108 property rental rate, 56-117 special rates, 56-120 hospital-based property) · statute
11. Idaho Code 56-116 Nursing facility payment methodology (2020) · statute
12. Idaho Code 56-265 Provider payment · statute
13. Idaho Skilled Nursing Facility Assessment Act, Idaho Code 56-1501 to 56-1511 · statute
14. Nursing Facility Quality Payment Program Guide (June 14, 2024) · agency page
15. NF meeting notes 12/6/2023 (frozen measures, PDPM UPL, planned PDPM methodology) · agency page
16. MA25-17 Medicaid Provider Rate Adjustment (4% cut, 8/22/2025) · agency page
17. MA25-19 Medicaid Provider Rate Adjustment - Amended (exemptions incl. state-owned NFs) · agency page
18. MA25-03 Medicare and Medicaid Dual Eligible Program Updates · agency page
19. SPA ID-24-0014 Nursing Facility Reimbursement - tribal notice · agency page
20. SPA ID-23-0020 NF PDPM UPL - tribal notice · agency page
21. SPA ID-26-0003 Reimbursement State-Owned Nursing Facilities - public notice · agency page
22. DHW - The Future of Idaho Medicaid is Managed Care (H345; delayed to 1/1/2030) · agency page
23. DHW - Medicare Medicaid Members (MMCP and IMPlus) · agency page
24. Residential Assisted Living Facility (RALF) fee schedule · rate file
25. Aged & Disabled Waiver Services fee schedule (eff. 7/1/2026) · rate file
26. S1433 (2026) Statement of Purpose - FY2027 Medicaid appropriation · statute
27. Personal needs allowance · regulation
28. Internal: tic_unified cost_report_summary, Idaho SNFs (CCN prefix 13), FY2021-2025 Medicaid/total days · secondary

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