Release of Medicaid waivers coming soon

Aug. 10--A controversial waiver authorizing Medicaid expansion work requirements should be released for public comment within the next week or two.

Lori Wolff, deputy director of the Idaho Department of Health and Welfare, updated lawmakers regarding the status of the work requirements and other waiver requests during an interim committee hearing Friday.

The Legislature's Republican majority approved the waivers earlier this year. They essentially add "sideboards," or restrictions, on the straight Medicaid expansion proposal that Idaho voters approved last fall.

Four of the proposed waivers need federal approval before they can be implemented.

The first would give individuals earning 100 percent to 138 percent of the federal poverty level the option of receiving federal tax credits to buy subsidized private insurance through the state health exchange.

Under current federal law, Wolff said, people who are eligible for Medicaid are ineligible for the tax credits. This waiver request would set aside that prohibition for people who would rather buy private insurance than enroll in a federal program.

That waiver was submitted in July, she said. Federal officials have until the end of August to decide if the application is complete or to ask the state for more information. Once the application is accepted, it will trigger a federal public comment period; however, there's no deadline for a final decision, so it could be months before the state learns if the waiver is approved.

The work requirement waiver will go through a similar process, with public hearings at the state and federal level. It proposes a 20-hour-per-week work requirement for all Medicaid expansion enrollees. That can be satisfied through a combination of work, volunteer service and participation in a job training program. It provides multiple exemptions, including people younger than the age of 19 and older than age 59, pregnant women, those who are physically or intellectually unable to work, parents with children younger than the age of 18, students attending school at least half time and those who are caring for someone with a serious medical condition or disability.

"We expect to release that for public comment by the end of next week or the following week," Wolff said. "The comment period is 30 days, after which we'll submit it (to the Centers for Medicare and Medicaid Services)."

A third waiver would prohibit traditional and expanded Medicaid participants from receiving family planning services or supplies from outside providers, without a referral from their "medical home" or primary medical provider.

Wolff said that waiver will likely be proposed as an amendment to the work requirements waiver.

The last waiver would allow private mental health facilities to receive Medicaid payments when providing substance abuse and mental health services to Medicaid-eligible patients.

"There's a lot of work that goes into that one," Wolff said. "Our plan is to release it for public comment in early September."

In response to a question from one lawmaker, Wolff also noted that the Trump administration's recent decision regarding Utah's Medicaid expansion plan should have no effect on Idaho.

Utah wanted to do a partial Medicaid expansion up to 100 percent of the federal poverty level, she said, with the federal government picking up 90 percent of the cost. The Trump administration rejected the proposal, saying the plan would only qualify for the same 70-30 match as traditional Medicaid.

"In Idaho, we're fully expanding Medicaid (up to 138 percent of the federal poverty level), so we qualify for the full 90-10 match," Wolff said.

Even though Idaho is requesting a coverage waiver for those in the 100 percent to 138 percent income category, it won't affect the overall matching rate, she said. "We will receive the full (90-10) match."

Updates regarding the status of Idaho's various Medicaid expansion waivers can be found online at www.medicaidexpansion.idaho.gov.

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

___

(c)2019 the Lewiston Tribune (Lewiston, Idaho)

Visit the Lewiston Tribune (Lewiston, Idaho) at www.lmtribune.com

Distributed by Tribune Content Agency, LLC.