Latah County objects to proposed Medicaid work rules

Sep. 12--MOSCOW -- The Latah County commissioners plan to submit written comments opposing Idaho's efforts to impose work requirements on expanded Medicaid recipients.

The commissioners discussed the issue during a work session Wednesday morning.

"Work requirements are not only more expensive (for taxpayers), but they result in more people not being covered," Commissioner Tom Lamar said. "That means the county indigent fund will continue to be needed. It's just extremely inefficient."

The state is accepting public comments on the proposed waiver through Sept. 22.

The waiver, which is subject to federal approval, would impose a 20-hour-per-week work requirement on the expanded Medicaid program. Exceptions are made for various individuals, including pregnant women, people who are physically or intellectually unable to work, parents with children younger than the age of 18, those older than the age of 59, students who are attending school at least half time and those who are caring for someone with a serious medical condition or disability.

When the Legislature agreed to the requirement earlier this year, Republican lawmakers characterized it as a reasonable condition for people accepting public assistance. Opponents, however, suggested that thousands of low-income adults will end up losing eligibility for Medicaid services -- not because they aren't working, but simply because they can't or won't keep up with the necessary paperwork.

"What we've seen in other states that implemented work requirements is thousands of people dropping off Medicaid," Lamar said.

Commissioner Kathie LaFortune suggested that the complex, monthly reporting requirement is a bureaucratic time-drag for state employees, as well as a burden for Medicaid enrollees.

"This isn't so much a work requirement as a document reporting requirement," she said.

The work waiver is one of several sideboards or conditions the Legislature decided to implement after voters approved the expanded Medicaid initiative last year.

The state's first waiver, which would allow people earning 100 to 138 percent of the federal poverty level to purchase subsidized private insurance through the state exchange, was recently rejected.

The Centers for Medicare and Medicaid Services said more information is needed to properly evaluate the proposal. Moreover, even if additional information is forthcoming, the waiver likely "would not be approvable" because it isn't deficit neutral.

Like Lamar and LaFortune, Commissioner Dave McGraw thinks Idaho should wait to see how straight Medicaid expansion works before adding more conditions or requirements.

"When I signed the petition for Prop 2 (the Medicaid expansion initiative), I didn't have restrictions in mind," he said. "The idea was to help people. This whole thing of the Legislature trying to change what people voted for -- to me, it's not right."

The Idaho Department of Health and Welfare plans to submit the work requirement waiver to federal officials after the public comment period closes Sept. 22.

More information on the various Medicaid expansion waivers can be found onlne, at https://medicaidexpansion.idaho.gov/. Comments regarding the proposed work requirements 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

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

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