Reporting and Fact-Checking Medicaid Claims

A legislator says Medicaid costs the state $5.5 billion. A candidate says enrollment is falling. An advocate says tens of thousands will lose coverage. A department says most people already comply. Each statement can be accurate and still mislead, because Medicaid reporting rests on counts that change by month, by definition and by funding source. This lesson is a field guide for reporters, candidates, advocates and residents who want to check a claim before repeating it. It builds on the programs described in Lesson 3, the budget material in Lesson 5 and the work requirement numbers in Lesson 6. For general skills, the course on Data and Statistics for journalists is a companion: see Numbers That Matter and Honest Charts.

Five labels for every number

Ask the same five questions each time

1. What is counted? People enrolled on one day, people enrolled at any time in a year, people eligible, or people who applied.
2. For what period? A single month, a fiscal year (Idaho's runs July 1 to June 30), a calendar year or a cumulative total since a start date.
3. In whose dollars? Total funds, state general fund, or federal funds. Idaho's regular federal match (the FMAP) is 67.31% in federal fiscal year 2027 per KFF, and expansion adults draw 90% federal.
4. Per what? Per enrollee, per member per month, per claim, or a program total.
5. Who said it, and what do they want? The department, a sponsor, an advocacy group, a researcher with a model, or a reporter quoting any of them.

When any of the five labels is missing, ask. If the speaker cannot supply it, report the number with the gap named: "The department did not say whether the count is people enrolled on a single day or people enrolled at any time during the year."

Where the numbers live

Most Idaho Medicaid data sits in a handful of places. Learn them in this order, from the closest to the program to the most analytic.

Source	What it gives you	Watch for
DHW reports and statistics	Medicaid Expansion Enrollment (PDF with cumulative enrollment by county, DocView id 14388); Medicaid Expansion Usage Table (id 15112); Monthly Budget Transparency Reports from the Divisions of Medicaid and Self-Reliance (Browse id 30519); Tableau dashboards for substance use disorder services and Core Set quality measures	"Cumulative" counts that include people who left; each file has its own date
Medicaid.gov enrollment data and data.medicaid.gov	Monthly application, eligibility and enrollment reports and quarterly enrollment reports that states file with CMS	States report with lags and revisions; read the notes on each file
KFF Medicaid and CHIP Monthly Enrollment	A state-by-state series. For Idaho the latest month on the page I read was June 2026: 287,984 in Medicaid, 19,076 in CHIP, 307,060 combined	Counts Medicaid and CHIP together or apart; does not match DHW's own expansion counts
MACPAC MACStats	National tables on enrollment, spending and managed care by state	Fiscal-year data with a lag of a year or more
Legislative Services Office budget and policy analysis and the Division of Financial Management (dfm.idaho.gov)	Budget books, the Legislative Budget Book, executive budget documents, performance reports	Totals by fund source; read the footnotes for one-time versus ongoing money
JFAC and committee minutes and attachments on legislature.idaho.gov	For example, the Division of Medicaid Base Review is attached to the January 22, 2026 JFAC minutes (260122_jfac_0800AM-Minutes_Attachment_1.pdf)	Presentations are the agency's own numbers
Office of Performance Evaluations	Independent legislative evaluations of state programs	Evaluations cover a specific period and question

One habit to build: save a copy of any page or PDF you rely on, with the date you downloaded it. Agencies replace files in place and a link that showed 85,000 in July may show a different number in October.

Nine patterns that make a number misleading

Per person versus total, and total funds versus general fund

The first two patterns are the most common and the easiest to fix. A large total is only a statement about size. The Idaho Joint Finance-Appropriations Committee set the fiscal year 2027 Medicaid budget at about $5.54 billion in total funds, per the Capital Sun on March 6, 2026. That figure includes federal dollars. The state general fund, the part that competes with schools, roads and prisons, is a smaller number, and Gov. Brad Little's recommended Medicaid reduction for the year was about $45 million of general fund, per the Capital Sun on Jan. 12, 2026.

Per-person numbers have a separate hazard. Dividing $5.54 billion by the 287,984 people KFF lists for June 2026 gives about $19,237 per enrollee a year. That figure mixes children, who are cheap to cover, with people with disabilities and nursing facility residents, who are expensive, and some budget lines do not tie to enrollment at all. Use per-person math only to compare like groups, and say it is an average.

State versus federal share

The federal government pays a share of Medicaid called the Federal Medical Assistance Percentage (FMAP). KFF lists Idaho at 67.59% for federal fiscal year 2025, 66.91% for 2026 and 67.31% for 2027. For expansion adults the federal share is 90% under section 1905(y) of the Social Security Act. A claim that a program "costs Idaho taxpayers $100 million" is incomplete without the fund source. The sponsors' fiscal note for House Bill 345 shows how the shares can be checked. It projected $27.2 million in total savings in fiscal year 2027 with $9.0 million from the general fund, a state share of 9.0 divided by 27.2, or 33.1%. The state's share under the regular match is 1 minus 0.6731, or 32.7%. The figures are close, which fits a savings estimate on the regular population. For fiscal year 2026 the note shows $15.9 million total and $5.3 million general fund, 33.3%, against 33.1% from the 2026 match. Those two checks do not prove the savings will happen. They show that the note was built with the usual split, which is a modest comfort about its arithmetic and no comfort about its assumptions.

Enrolled, eligible and ever enrolled; point in time versus cumulative

Medicaid agencies count people many ways. A point-in-time count is people enrolled on a specific date or in a specific month. A cumulative count includes everyone who was ever enrolled during a longer window. An eligible count is people who could qualify, whether or not they applied. DHW's expansion enrollment file is described as cumulative enrollment by county, which can run higher than a single-month count because it includes people who left. A statement about "enrollment" without one of those labels is incomplete.

A case study: seven counts of expansion enrollment

Idaho voters approved expansion in 2018 and coverage began January 1, 2020. Different Idaho sources have reported different expansion enrollment numbers over the past 19 months.

Date	Figure	Reported by	What it likely reflects
March 2025	89,400	Idaho Capital Sun	Expansion enrollment in the March 2025 article; the same article gave about 262,000 total
June 2025	About 92,000	Idaho Capital Sun	Shortly after the pandemic-era unwinding; definition not stated
March 31, 2026	Nearly 79,000	Idaho Capital Sun	Reporting on House Bill 913
April 9, 2026	79,000 to 80,000	Idaho Capital Sun	Session wrap-up reporting
July 2026	About 83,000	DHW initial review, via Capital Sun	People covered when DHW ran its first check of work requirement status
July 24, 2026	About 85,000	State figure, via Capital Sun	The article gives both figures without explaining the gap
October 2026	85,000 to 90,000	DHW managed care page	DHW's estimate of members affected by the work requirement, not an enrollment count; no date attached

What the chart supports and what it does not

Take two numbers from the table and compute the headline a careless writer would produce. From the June 2025 figure of about 92,000 to the March 2026 figure of nearly 79,000 is a drop of 13,000, which is 14.1% of 92,000. From March 2026 to the July 24, 2026 figure of about 85,000 is a rise of 6,000, which is 7.6%. "Expansion enrollment fell 14% and rebounded 8%" would make a tidy story. It would also be unsupported, because the counts come from different articles, different sources and perhaps different definitions, and the gap between the DHW review figure of about 83,000 and the state figure of about 85,000 appears in the same July article without explanation. The accurate sentence is narrower: "Reported expansion enrollment ranged from nearly 79,000 to about 92,000 over 19 months in figures from different sources; DHW did not publish a single series with consistent definitions in the materials reviewed." If you need a trend, ask DHW for the monthly point-in-time count of people enrolled in the expansion group on the first day of each month since January 2025, with the definition, and plot that.

The same caution applies to total Medicaid. The Capital Sun reported about 260,000 to 262,000 people enrolled in 2025. KFF's monthly series lists 287,984 in Medicaid and 19,076 in CHIP for Idaho in June 2026, 307,060 combined. The numbers differ because one counts Medicaid alone as reported at one date, one adds CHIP, and the underlying data come from different reports. A table of your own with date, source, definition and link lets a reader see exactly why.

Expansion versus traditional growth, and the word "able-bodied"

Officials in 2025 attributed most cost growth in Medicaid to the traditional Medicaid population, as distinct from the expansion adults. DHW asked for a $60 million supplemental appropriation for fiscal year 2026, citing in part about $22 million of general fund meant for fiscal year 2025 that was released in fiscal year 2026 instead because of a Luma business-system error. If a story attributes budget growth to expansion, ask for the split by eligibility group. The Division of Medicaid Base Review attached to the January 22, 2026 JFAC minutes is a place to start.

"Able-bodied" has no single legal definition in the federal community engagement law. A December 2025 DHW report found about 48% of "able-bodied" adults on Medicaid were working, per the Capital Sun on April 9, 2026. A fact-checker's first questions are: which adults were counted, what rule excluded the others, and for which month. KFF has reported that about 92% of working-age adult Medicaid enrollees who are not on SSI, SSDI or Medicare already work or have a reason they cannot. Those two statements can both be accurate if the denominators differ, so write both with their definitions. Lesson 6 lists the exclusions and exemptions in the federal law, and the Idaho materials from DHW list the same categories.

Fiscal notes and savings claims

Every bill printed in the Idaho Legislature carries a Statement of Purpose and Fiscal Note. The cover page states the limit in plain words. On House Bill 913 it reads that the document is "prepared by a proponent of the bill" and is not an expression of legislative intent (Joint Rule 18). The fiscal note for HB 913 itself says "no new fiscal impact outside" the funds the department asked the Joint Finance-Appropriations Committee to appropriate. That statement points to a different document, the budget request, where the numbers live: DHW's fiscal year 2027 budget request included $1.87 million for work requirements, split between federal and state funds, and $1 million for twice-yearly eligibility checks ($900,000 federal and $100,000 general fund), as reported by the Capital Sun in September 2025. Read the fiscal note, then follow its pointer.

Filing a public records request with DHW

Many of the data requests in this lesson are answerable from public pages. The rest require a records request. DHW's public records page explains the route.

Choose the right route

• If you want information about yourself or another person's case, use DHW's Records Request Form and include written proof of your authority. DHW may require a notarized signature if it cannot verify the signature on file.
• If you want other records, such as contracts, reports, correspondence or spreadsheets, use the Online Public Records Request Form.
• Vital records (birth, death, marriage and divorce certificates) and child support case information go through separate offices and are not public records requests.

Where to send it and what to expect

Item	As DHW states it (page read October 2026)
Online	DHW's Public Records Request Form portal, English and Spanish
Email	publicrecordsrequest@dhw.idaho.gov
Mail	Idaho Department of Health and Welfare, Transparency Team, P.O. Box 83720, 450 W. State Street, 10th Floor, Boise, ID 83720-0036
Fax	208-639-5742
Phone questions	208-334-5564
Response for Idaho residents	Three working days, extended to ten working days if needed; DHW will notify you of an extension
Response for nonresidents	21 calendar days, extended to 35 calendar days if needed
Fees	Fees apply; Idaho residents must prepay if the request needs more than two hours of labor or more than 100 pages of copies; see the DHW fee schedule

The Idaho Public Records Act (Title 74, chapter 1) balances access against privacy, and exemptions apply to some health information. Aggregate counts without names generally raise fewer concerns than case files. A request for individual case records belongs on the route that requires proof of authority.

Claims you will hear and the questions that test them

The patterns above show up in predictable sentences. The table pairs common Idaho Medicaid claims with the first question to ask and the document most likely to answer it.

Claim you may hear	First question	Where to look
"Medicaid is eating the state budget."	Share of total funds or of general fund, and compared with what year?	LSO budget books, DFM budget documents
"Expansion is costing Idaho taxpayers."	What is the state share for the expansion group at 90% federal, and which fund sources pay it?	JFAC Division of Medicaid Base Review, DHW expansion usage table
"Most enrollees already work."	Which group, which month, and how did the state decide someone worked?	Capital Sun reporting (July 24, 2026)
"The work requirement will remove thousands."	Whose model, what assumptions, and how far out? Urban Institute and Robert Wood Johnson Foundation estimated 20,000 to 34,000 by 2028	The study itself, not a news summary
"Managed care will save money."	Who wrote the savings estimate and is the timing conditional?	Bill fiscal note, DHW managed care page
"This bill has no fiscal impact."	No impact beyond what budget request?	DHW budget request and JFAC action
"The cut is only 4%."	Four percent of what, and what are the other cuts on the same service?	Governor's budget highlights, bill statement of purpose

Questions to ask a quoted expert

• What data did you use, and what date does it end?
• Does your figure include people who left coverage during the period?
• What would change your estimate by half?
• Who funded the work, and did they review it before release?
• Can you send the table you used, so I can check the arithmetic?

Most experts answer these questions gladly. Those who cannot are telling you something about the quote.

Writing it up with the label attached

Three habits turn a checked number into a clear story. First, put the label in the sentence: "About 85,000 people were enrolled in the expansion group, according to a state figure reported July 24" is more useful than "85,000 people are on expansion." Second, show a baseline in charts. The bars in Figure 2 start at zero. If the axis started at 75,000, the 92,000 bar would look more than four times as tall as the 79,000 bar, though it is only 16% longer. Third, say what you could not find. "DHW did not respond by deadline to a request for monthly enrollment since January 2025" is a finding. For a longer treatment of charts and sources see Checking and Writing.

Next steps

Choose one Medicaid number you have seen this month and write its five labels on a sheet of paper. If any label is missing, email the source and ask. Then file one records request through DHW's online form for the monthly expansion count from January 2025, and calendar the three-working-day mark. When the file arrives, plot it from zero and compare it with the six figures in this lesson. Lesson 10 shows how to take a verified number to a committee and what to say once you are there.