Expansion of Medicaid could be put into action as soon as 2020

Jan. 29--The funding sources, rollout and what Idaho's Medicaid expansion will look like will probably not be decided until the end of the legislative session, but the picture is starting to become a little more clear.

Idaho voters passed the Medicaid expansion initiative with 61 percent approval in November, but the initiative still needs to be funded by the Legislature.

Gov. Brad Little's budget anticipates the expansion to cost roughly $20 million in fiscal 2020, which starts July 1. He recommended taking $12.6 million from the Millenium Fund and about $9.3 million from savings in the Department of Correction and Department of Health and Welfare budgets to cover the expansion.

The Joint Millennium Fund Committee's recommendation to approve Recovery Idaho's application for $893,400 in Millennium Fund support in fiscal 2020 could lower Little's $12.6 million request to $11.7 million.

The Millennium Fund was established as an endowment fund to receive, invest and disburse funds the state receives as a result of a 1998 settlement agreement reached with tobacco companies.

"I don't think funding's a particularly big deal," Sen. David Nelson, D-Moscow, said. "I mean the amount of money we're talking about is so small in the context of a $4 billion state budget. It just doesn't make sense that that's a barrier."

Nelson said he expects Medicaid expansion to take effect Jan. 1 despite the fact the fiscal 2020 budget starts July 1 of this year.

Nelson said he would prefer that the initiate is funded through the General Fund rather than the Millennium Fund, but that doesn't appear to be the preference of Republicans.

Nelson said the potential six-month delay in implementation, which is recommended by the Department of Health and Welfare, would line up with the open enrollment period for the state health insurance exchange and allow the department to put Medicaid programs in place.

"We know we leave those people hanging for another six months, and we probably could get it started earlier, but there's clearly no will in the session to push it faster than that," Nelson said.

The first-term senator said he is "cautiously optimistic" that sideboards, or requirements, will not be placed on those who would get Medicaid via the expansion. He said requirements cost extra money and the federal government does not reimburse states for implementing those sideboards.

One of the requirements tossed around is those who qualify for the expansion would need to demonstrate that they are working.

"It's not a really productive thing to do a requirement like that," Nelson said. "It puts barriers to people getting served. It's expensive just to set up the bureaucracy to track that. It's not the Idaho way to set up a big bureaucracy, so I don't see why we'd do that."

Rep. Bill Goesling, R-Moscow, said the more requirements implemented, the more complex and expensive the process becomes.

"I think it's got to be as clean as possible," Goesling said.

Rep. Caroline Nilsson Troy, R-Genesee, said she wished a funding source was identified as part of Proposition 2. She pointed to Utah as an example of a state that planned ahead on how to fund its Medicaid expansion, which was approved by Utah residents in November.

According to The Salt Lake Tribune, Utah's sales tax on nonfood items will increase by 0.15 percentage points under the expansion initiative and generate roughly $90 million in new state revenue.

"The risk is if we don't have some funding source identified, we'll be cutting education," said Nilsson Troy, who noted a great percentage of the state budget is education. "I don't think anybody wants that."

One potential roadblock to Medicaid expansion implementation is the Idaho Freedom Foundation's lawsuit challenging the constitutionality of the voter-approved initiative. The Idaho Supreme Court scheduled oral arguments for the case today .

Nelson said the lawsuit appears to be on weak grounds and he expects it to be resolved fairly quickly.

"Once we get that behind us, I think we can move ahead," Goesling said.

Nelson said he does not expect the Legislature to vote on Medicaid expansion implementation until March.

Garrett Cabeza can be reached at (208) 883-4631, or by email to gcabeza@dnews.com.

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