Bill Analyses and Ratings
Bill Information: H0928E1 – Merit-Based Health Care Act (HB 928)
Bill Summary
House Bill 928, known as the Merit-Based Health Care Act, creates a new chapter in Idaho Code (Chapter 25, Title 56) that establishes restrictions on diversity, equity, and inclusion (DEI) practices for health care providers participating in Idaho’s Medicaid program. The bill defines ‘prohibited DEI conduct’ broadly to include race- or sex-based hiring preferences, mandatory implicit bias training, equity goals or quotas, and required attestations endorsing DEI principles. Health care providers receiving Medicaid reimbursements are prohibited from engaging in discriminatory hiring, implementing internal DEI policies or trainings, or using state funds for public-facing communications that promote DEI conduct.
The bill establishes compliance with these provisions as a material condition of Medicaid provider agreements and grants the Attorney General authority to investigate complaints and seek civil penalties ranging from $5,000 to $100,000 depending on provider size and number of violations. A limited private right of action is created for health care professionals who face retaliation for refusing to participate in prohibited DEI conduct, with available remedies including reinstatement, injunctive relief, compensatory damages, and attorney’s fees. The bill includes carve-outs for compliance with federal civil rights laws, clinical data collection, patient-specific medical discussions, and federally required training or disparity-reduction programs. The act is declared an emergency measure effective July 1, 2026.
Overall Assessment
This bill is primarily evaluated under the American Family metric, where it received a score of 1, reflecting its intent to eliminate what the legislature characterizes as ideologically driven employment practices in Medicaid-funded health care settings. The bill’s findings assert that merit-based employment decisions promote patient trust and high-quality care, and its prohibitions on DEI-related hiring preferences and mandatory ideological training align with policy positions that emphasize individual merit over group-based considerations in publicly funded institutions. The connection to family values is indirect but present, as the bill seeks to ensure that health care delivery funded by public dollars is governed by clinical competency rather than ideological frameworks.
All other metrics received scores of zero because the bill’s scope is narrowly focused on Medicaid provider employment and contracting practices, with no substantive provisions touching on education, agriculture, water, natural resources, energy, elections, religious liberty, law enforcement, national defense, or other policy areas covered by the remaining metrics. While the bill has enforcement mechanisms involving the Attorney General, these are ancillary to its primary health care employment focus and do not rise to the level of significant impact on law and order or government accountability metrics.
Rating Breakdown
ARTICLE I. Responsibility in Government (0)
The bill's legislative findings reference the 'efficient use of public funds' (§56-2502(1)(c)) and frame Medicaid participation as subject to conditions imposed by the state as a steward of public resources. However, the bill creates no changes to appropriations, budget structures, or government spending levels, and its fiscal accountability language is aspirational rather than operative.
ARTICLE II. Citizen Involvement in Government (0)
The bill regulates employment and contracting practices of Medicaid health care providers. It contains no provisions related to elections, voting access, citizen participation in government processes, or civic engagement mechanisms.
ARTICLE III. Education (0)
Although the bill's definition of DEI (§56-2503(2)) overlaps conceptually with concerns about critical race theory in schools, the bill's prohibitions apply exclusively to Medicaid health care providers and their employment and training practices. It does not regulate public schools, universities, curriculum, or any institution within Idaho's education system.
ARTICLE IV. Agriculture (0)
The bill addresses Medicaid provider employment and contracting practices and has no provisions touching farming, ranching, agricultural markets, water for irrigation, or any other agricultural concern.
ARTICLE V. Water (0)
The bill has no connection to water rights, water allocation, irrigation districts, or any aspect of Idaho water policy.
ARTICLE VI. Natural Resources and Environment (0)
The bill governs Medicaid provider employment practices and contains no provisions related to natural resource management, environmental regulation, or land use policy.
ARTICLE VII. Energy (0)
The bill has no provisions related to energy production, energy independence, utility regulation, or any other energy policy matter.
ARTICLE VIII. Idaho National Laboratories (0)
The bill governs Medicaid health care providers and has no connection to the Idaho National Laboratory, nuclear research, or federal energy research facilities.
ARTICLE IX. Private Property Rights (0)
The bill imposes conditions on voluntary Medicaid participation but does not address property ownership, eminent domain, regulatory takings, or any other private property rights issue.
ARTICLE X. State and Federal Lands (0)
The bill addresses Medicaid provider employment practices and contains no provisions related to the ownership, management, or transfer of state or federal lands.
ARTICLE XI. Wildlife Management (0)
The bill has no connection to wildlife management, hunting and fishing rights, predator control, or any related natural resource topic.
ARTICLE XII. Economy (0)
The bill creates new compliance obligations for Medicaid-participating health care providers, which adds regulatory burden particularly for smaller organizations. While it targets a specific subset of private employers rather than the broader economy, it neither reduces existing regulations nor expands market competition, leaving its net economic effect negligible at the macro level.
ARTICLE XIII. Health and Welfare (0)
The bill directly targets the Medicaid health care delivery system, requiring that employment and contracting decisions funded by Medicaid be based on 'individual merit, qualifications, and clinical competency' (§56-2502(2)(a)) rather than DEI criteria. By prohibiting the use of Medicaid reimbursements for DEI training, equity benchmarks, or ideological pledges (§56-2504(1)(c)), the bill redirects public health care dollars toward what the legislature characterizes as patient-focused, competency-driven care.
ARTICLE XIV. American Family (1)
The bill's DEI definition includes a prohibition on compelling belief that individuals can change their sex or gender (§56-2503(2)(j)), which touches on gender identity issues. However, this provision applies narrowly to Medicaid provider employment and training contexts, not to family law, parental rights, education, or the broader policy questions concerning children and gender that this metric addresses.
ARTICLE XV. Older Americans (0)
While older Idahoans are significant users of Medicaid services, the bill regulates provider employment and contracting practices rather than benefit levels, eligibility, or services directed at older Americans. No provisions specifically address the needs or protections of elderly populations.
ARTICLE XVI. Law and Order with Justice (0)
The bill establishes civil penalties and a private right of action in the health care regulatory context (§§56-2506, 56-2507), but it does not address criminal justice, gun rights, drug policy, incarceration, or any of the law enforcement and judicial topics this metric covers.
ARTICLE XVII. National Defense - Securing the Border (0)
The bill addresses Medicaid provider employment practices and has no provisions related to military readiness, veterans' services, border security, or immigration enforcement.
ARTICLE XVIII. Election of Judges and Idaho Supreme Court Justices (0)
The bill has no provisions related to judicial selection, judicial elections, or the interpretation of Idaho's constitution by state courts.
ARTICLE XIX. Religious Liberty (0)
The bill prohibits employers from requiring 'statements, pledges, attestations, or affirmations endorsing diversity, equity, and inclusion principles or related ideological frameworks as a condition of employment or contracting' (§56-2503(4)(d)), which could incidentally protect employees whose religious convictions conflict with DEI mandates. However, the bill frames this protection in terms of ideological compulsion rather than religious liberty specifically, and contains no provisions directly addressing religious exercise, accommodation, or conscience rights.