Feds reject Idaho’s bid for Medicaid waiver

Aug. 30--An effort to give low-income Idahoans a choice between public Medicaid coverage and private health insurance ran into a federal roadblock Thursday.

The Centers for Medicare and Medicaid Services rejected Idaho's request for a private insurance waiver, saying the application lacked all the information needed to properly evaluate the proposal.

Moreover, even if additional information is forthcoming, the agency said, the waiver likely "would not be approvable" because it isn't deficit neutral.

The move does not affect any proposed Medicaid work restrictions, which will be addressed in a separate waiver application.

Nevertheless, Thursday's decision was a setback for Republican lawmakers, who earlier this year imposed a series of restrictions and conditions on the Medicaid expansion initiative that voters approved last fall.

Besides the work restrictions, lawmakers wanted people earning 100 percent to 138 percent of the federal poverty level to have the option to buy subsidized private health insurance, rather than automatically be enrolled in Medicaid. They directed state officials to apply for a waiver allowing individuals in that income category to qualify for federal tax credits, which would lower the cost of their monthly premiums.

However, in the letter to Idaho Department of Insurance Director Dean Cameron, federal officials said the state failed to provide an apples-to-apples comparison of the "with waiver" and "without waiver" scenarios.

Specifically, they said the application incorrectly assumed that, if the waiver wasn't granted, people in the 100 percent to 138 percent category would not be eligible for Medicaid. The waiver also failed to demonstrate that the insurance premium tax credits were a cheaper option than just enrolling people in Medicaid.

"Any ... waiver application that would increase the federal deficit cannot be approved by the federal government," the letter stated.

In a joint news release, Gov. Brad Little, House Speaker Scott Bedke and Senate President Pro Tem Brent Hill accused federal officials of "pulling the rug out from under us."

"We are disappointed and surprised by the assessment from CMS about our waiver application, after the amount of work and coordination Idaho spent (on the application)," they said. "Simply put, CMS pulled the rug out from under us. For months, state agencies worked closely with federal agencies on the purpose and goals of the waiver application. We shared multiple strategies and considerations about how Idaho would approach the cost neutrality portion of the application. At no time during those conversations did the federal government indicate Idaho's approach to the budget neutrality guardrail would be insufficient for consideration."

The news release said the 100-138 waiver "remains a high priority for Idaho."

"It's important to give Idahoans the choice to stay on private coverage rather than forcing them onto public assistance," it said. "The state is already taking steps to submit the additional information required by CMS, so that our application can be fully considered on its merits."

Lawmakers knew the 100-138 proposal was a long shot to begin with, since no waiver of that type has previously been approved. Still, their objections to Medicaid and other public entitlement programs is such that they felt the effort had to be made.

A separate effort to impose a 20-hour-per-week work requirement on the expanded Medicaid program has yet to be presented to the federal government for approval.

The Department of Health and Welfare recently opened a 30-day public comment period on the proposed work requirements. That comment period ends Sept. 22, after which the waiver application will be forwarded to the Centers for Medicare and Medicaid Services for review.

Public hearings on the proposed work requirements will take place in Boise next week, on Tuesday and Friday. People can participate in the hearings by calling 1-877-820-7831 and entering code 301388. Both meetings run from noon to 2 p.m. PDT.

More information on the various Medicaid expansion waivers can be found at medicaidexpansion.idaho.gov/.

Spence may be contacted at bspence@lmtribune.com or (208) 791-9168.

How to participate

Comments can be emailed to 1115.comments@dhw.idaho.gov, or mailed to:

Attention: Cindy Brock

Medicaid Program Policy Analyst

Division of Medicaid

P.O. Box 83720

Boise, ID 83720-0009

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