What’s next for Medicaid in Idaho? This bill is in Gov. Brad Little’s hands

Idaho senators on Tuesday evening passed a bill to curtail the state’s spending on its Medicaid expansion program, sending the bill on to Gov. Brad Little’s desk to be signed into law.

It was a sudden resolution to a monthslong effort by Republican lawmakers, who sponsored multiple bills this legislative session to slash the program’s funding or even cut it entirely.

The bill that won the day, House Bill 345, was an attempt to compromise on previous proposals. It includes removing a “trigger” in a prior bill that would repeal the state’s Medicaid expansion if it couldn’t clear certain hurdles that critics called virtually insurmountable, the Idaho Statesman previously reported.

The new bill also eliminates a cap on the number of people who can be enrolled in the program, and a limit on the number of months they can be enrolled over their lifetimes. A prior version sought to restrict it to three years.

This bill ”is what I believe to be our balance,” said Sen. Carl Bjerke, R-Coeur d’Alene. “It’s more than a balance. I think this is a great way for us to act.”

Looking for other ways to save costs, bill cosponsor Jordan Redman, R-Coeur d’Alene, added new components to the bill, including “managed care,” which provides a network of medical providers and oversight of health care providers to reduce costs. He also added a requirement for Medicaid expansion recipients to report their hours worked.

Opponents of the bill raised concerns that those new components would add red tape, complexity and cost to the Medicaid expansion program. They said the work reporting requirement would be costly to administer, perhaps canceling out other savings the bill could offer.

“I am opposed to this bill because I do think it’s going to increase costs,” Sen. Melissa Wintrow, D-Boise, said Tuesday.

During a previous public hearing for the bill, opponents highlighted its similarity to a law passed in other states, which proved expensive and, in some ways, ineffective.

“When Arkansas implemented their (work requirement), it cost them $26 million before the court said stop,” Rep. Ben Fuhriman, R-Shelley, said during the hearing. “When Georgia implemented theirs, they’ve already spent $80 million.”

Redman’s proposed work requirement is very similar to that of Arkansas, said Hillarie Hagen, a health policy associate at Idaho Voices for Children, in her testimony against the bill. And in Arkansas, she warned, one in four people subject to the work requirement lost Medicaid expansion coverage — even though 95% of those recipients met program requirements or qualified for an exemption.

Bjerke said he believes Idaho can “avoid some of the pitfalls” Arkansas and Georgia experienced.

Gov. Little concerned about cuts to popular Medicaid expansion

The Affordable Care Act, passed in 2010, required states to expand Medicaid coverage to continue receiving federal funding. But the U.S. Supreme Court struck down that requirement in 2012, leaving it to states to decide whether to broaden the list of qualified recipients.

The Republican-dominated Idaho Legislature chose not to expand offerings to lower-income residents in the so-called coverage gap — those who earned too much to qualify for standard Medicaid but not enough for private insurance discounts. About 90,000 Idaho residents fall into that gap, according to the Idaho Department of Health and Welfare.

Idaho residents brought forward a successful ballot measure to close that gap in 2018, and Medicaid expansion has been in place in Idaho since then, the Statesman previously reported.

But the cost of the program is “not sustainable,” Rep. Wendy Horman, R-Idaho Falls, said on the House floor last month. Rep. John Vander Woude, R-Nampa, said in a January hearing that the state program’s expected costs went way beyond what lawmakers expected: from $32 million in projected costs in 2018 to $110 million in fiscal year 2026.

Redman has focused on a need to cut the state’s spending on the program’s “skyrocketing” costs, he said at a public hearing.

The federal government pays 90% of the costs of Idaho’s Medicaid expansion. But GOP lawmakers in the state raised concerns that the Trump administration might lower the payment threshold as it targets federal spending, and Idaho taxpayers could be left holding the bag.

Little in February expressed reservations about cuts to the Medicaid expansion program. The two-term Republican governor said he was “all about cost control,” but also said it was important to remember that Medicaid expansion “was passed overwhelmingly by the public” just over six years ago.

‘We’ve seen this play out’: New bill to curtail Idaho’s Medicaid expansion moves forward

Gov. Little shares ‘concerns’ over Republican-led push to end Idaho’s Medicaid expansion

‘One accident away from bankruptcy’: Idaho House passes bill to gut Medicaid expansion

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