Idaho House votes to kill $4.7 billion Medicaid budget

BOISE — The Idaho House of Representatives voted Monday to kill the Idaho Department of Health and Welfare’s Medicaid budget, placing a potential barrier in the way of wrapping up the 2023 legislative session this week. 

House Bill 334 failed on a 34-36 vote after several Republicans complained about the overall cost of the Medicaid budget, which totals $4.7 billion from all state, federal and dedicated funding sources.

The fiscal year 2024 Medicaid budget included funding for five programs, including expanded Medicaid, which applies to adults who fall under 138% of the federal poverty level. 

In 2018, 60.6% of Idaho voters voted to expand Medicaid coverage to adults whose income is too low for private health insurance. 

Rep. Britt Raybould, the Rexburg Republican who sponsored the Medicaid budget, told legislators that the budget is based on legal obligations and funding matches the state is required to pay.

“Cutting the dollars is not going to change what the end result is,” Raybould said in her floor debate.

However, several other Republicans have been signaling since before the 2023 session began that they would push for cutting or reversing the state’s expanded Medicaid program. 

Their opportunity came Monday.

“This is the largest bill the state has ever seen,” Rep. Josh Tanner, R-Eagle, said. 

House Health and Welfare Committee Chairman John Vander Woude, R-Nampa, opposed the Medicaid budget Monday after recommending the Idaho Legislature keep Medicaid expansion in place and review it again in 2025. 

Vander Woude said he has been focusing on reducing Medicaid spending.

“It’s kind of like Medicaid expansion that was sold to us as a $400 million budget for 2024 and it’s now a billion,” Vander Woude said in Monday’s floor debate. “We can’t keep doing that, folks, we can’t keep increasing that and expect the federal government and the Idaho taxpayers to pay this.”

“I can’t get my arms around this budget nor can I get control of it at this point …  I don’t necessarily want you to kill it, but I definitely will vote no,” Vander Woude added.

Even with the recommendation to keep Medicaid expansion in place, earlier this session Vander Woude introduced a bill to reverse Medicaid expansion, which he said was just for discussion purposes. 

Before the House voted to kill the Medicaid budget Monday, Rep. Rod Furniss, R-Rigby, pointed out that legislators could kill the Medicaid budget and rewrite it with a smaller bottom line, but the state will still wind up paying the bills on the back end. 

“We could cut this down to 75,000 or whatever the number that you want to cut it down to, but the problem is we’ve just got to come back with a supplemental next year, which throws it out of the true budget,” Furniss said in his floor debate. “I’d rather take this thing on head on, right now, than have it come back and have it not be in the budget next year, in the true budget that we need.”

Raybould agreed with Furniss.

“So if this body is serious about wanting to cut down on the number of supplementals that we have and passing budgets that reflect the realities of the obligations that we have under law, then you support this budget,” Raybould told legislators. “We could go back and we could cut it in (Joint Finance-Appropriations Committee), and if that would make the body feel better? I guess if you want to feel better more than have the right-sized budget, I don’t necessarily have a better answer for you.”

In the end, the budget failed by two votes, which kicks it back to JFAC to be rewritten. 

What happens next to Idaho’s Medicaid budget

Republican legislative leaders have been targeting Friday as the day to adjourn for the year — or at least the day to wrap up their business for the year before going into recess to await any potential gubernatorial vetoes — since before the session began Jan. 9.

The Idaho Legislature is required to set a balanced budget for the upcoming 2024 fiscal year, which begins July 1, before it can adjourn the session for the year. Killing the bill on the House floor Monday means the Joint Finance-Appropriations Committee will need to rewrite the Medicaid budget. The rewritten budget will need to pass out of JFAC, pass both the Idaho House and Idaho Senate with at least a simple majority of votes and avoid Gov. Brad Little’s veto.

Usually, it takes about two weeks for budget bills to complete the legislative process. However, legislators have the ability to suspend rules and fast-track bills during the closing days of a session to speed the process up.