Idaho Measure Limiting Medicaid Eligibility Lands Hearing

People earning more than 100 percent of the federal poverty level would not be eligible for expanded Medicaid under a new sideboard bill introduced Monday.

The income cap is substantially less than the 138 percent of poverty that voters approved last fall. The House Health and Welfare Committee, which introduced the measure on a party line voice vote, will hold a public hearing on it Wednesday.

The bill is similar to legislation that was held in committee after a lengthy hearing two weeks ago. The biggest change is the reduced income limit.

The earlier bill proposed that people earning between 100 and 138 percent of the federal poverty level would have the option to buy private, subsidized health insurance through the state insurance exchange, rather than automatically move to Medicaid. The new version doesn't give people a choice. It directs the Department of Health and Welfare to seek a federal waiver that limits eligibility to those who earn less than 100 percent of poverty.

Anyone in the 100 to 138 percent income bracket would either continue to buy subsidized private insurance, or go uninsured. However, if that waiver isn't approved by Jan. 1 -- when the state expects to implement Medicaid expansion -- then people in the 100-138 percent category would be eligible for Medicaid.

Rep. John Vander Woude, R-Nampa, suggested patients and the economy would be better off under this proposal.

"How many doctors are taking new Medicaid patients?" Vander Woude asked.

The Department of Health and Welfare estimates about 91,000 Idahoans would qualify for expanded Medicaid. That includes about 30,000 in the 100-138 percent income range. If all of them suddenly shift to Medicaid, Vander Woude said, it could overwhelm the health care system -- particularly if medical practices limit the number of Medicaid patients they accept because of lower reimbursement rates.

"I think they might be better off (staying with private insurance)," he said.

Rep. Mike Kingsley, R-Lewiston, supported the motion to introduce the bill. Rep. Ilana Rubel, D-Boise, opposed the motion.

"This flies in the face of what voters approved and underscores why they needed a ballot initiative in the first place, because the Legislature doesn't always listen," Rubel said.

Compared to the measure that was held two weeks ago, the new version scales back mandatory work requirements from 30 hours per week to 20 hours. It also clarifies that the requirements won't apply to anyone younger than 19 or older than 59; to parents with children 18 and younger; to pregnant women or the disabled; to people in a substance abuse treatment program; to students attending college at least half-time; or to anyone who's getting unemployment benefits, so long as they comply with the work requirements of that program.

If Medicaid expansion really serves the working poor, Vander Woude said, "then there shouldn't be anyone who has a problem meeting these requirements."

He wasn't sure if the new version of the bill has any more support than the initial proposal.

"I have no idea, but for this (Medicaid expansion) to move forward, we have to start having votes," he said. "The committee may send this bill to the floor without a recommendation, but we can't keep guessing (what type of sideboards lawmakers will support)."

Without some sideboards, Vander Woude said, he doubts the Medicaid expansion funding bill will pass the House.

Other restrictions and conditions in the legislation include:

A waiver limiting retroactive Medicaid eligibility to 30 days, down from 90 days for traditional Medicaid;

A potential waiver allowing private mental health facilities to be reimbursed by Medicaid for treating Medicaid-eligible patients;

Language directing that all Medicaid expansion patients be placed in a "medical home" managed care program, to help coordinate their medical care;

A new waiver prohibiting any Medicaid participant from receiving family planning services or supplies from an outside provider without a referral from their medical home;

Language directing the Department of Health and Welfare to collect information from participants about potential substance abuse issues or addictions, so they can be referred to other agencies for treatment;

Language nullifying Medicaid expansion in Idaho if Congress amends the Affordable Care Act or a federal court declares it unconstitutional;

Language nullifying Medicaid expansion if the federal government reduces its 90 percent funding rate, unless the Legislature decides otherwise;

Language requiring the House and Senate health and welfare committees to review "all fiscal, health and other impacts of Medicaid (expansion) eligibility" and recommend whether expansion should remain in effect.

Spence may be contacted at [email protected] or (208) 791-9168.

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