Idaho agency preps for Medicaid expansion

The 'Healthy Idaho Plan' aims to curb abuse and educate new recipients, just in case.


Idaho has so far balked at expanding Medicaid coverage for more low-income residents, part of President Barack Obama’s insurance overhaul left optional for states by the U.S. Supreme Court.

But the Idaho Department of Health and Welfare doesn’t want to get caught flat-footed if lawmakers and Gov. Butch Otter decide otherwise.

So for just more than a month, Health and Welfare has been asking private insurance companies for details about how they’d go about providing expanded Medicaid coverage for roughly 104,000 adults who earn less than 138 percent of the federal poverty line.

“Basically, we want to be ready, if and when Idaho decides to expand,” Denise Chuckovich, Health and Welfare’s deputy director in charge of Medicaid, said Monday.

During the 2013 Legislature, her agency helped determine that expanding Medicaid could save county property taxpayers some $478 million through 2024, because the state could replace its existing system of providing medical treatment for indigent residents with one that, at least initially, is 100 percent funded by the federal government.

But lawmakers and Otter balked at tackling Medicaid expansion during a session that had already seen bitter debate over adopting a state-based insurance exchange that numerous Republicans railed against as an acceptance of the Affordable Care Act — or worse, a step toward socialized medicine.

Before any expansion, Otter has said that he wants to revamp Idaho’s Medicaid program, to ensure that any new recipients take more responsibility and make good health care choices.

To that end, Health and Welfare has been developing its “Healthy Idaho Plan,” which would require newly eligible Medicaid recipients to make co-pays to discourage abuse of services, punish those who don’t adhere to rules, and offer incentives for healthy living, including for quitting smoking.

By asking companies for their feedback now, Health and Welfare aims to determine the feasibility of, among other things, utilizing private insurers that are also offering coverage via Idaho’s insurance exchange to tailor policies for the expanded Medicaid population, too. Under such a system, Idaho would pay private insurers from Medicaid funds, with insurers managing that money to pay doctors for services they provide.

“We’re trying to get information from the plans about how this would work and what barriers they see,” Chuckovich said.

She said a system using private insurers could simplify the state’s new insurance landscape, since many in the Medicaid-eligible population are expected to “churn” between Medicaid and federally subsidized policies offered via Idaho’s insurance exchange.

“What we’ve tried to do is structure a benefit plan that could fit pretty much what people would get if they moved from Medicaid into the exchange,” she said.

Regardless of what Health and Welfare learns from companies — only one had responded through Monday evening, Chuckovich said — Republican lawmakers said Monday that it will take nothing less than Otter’s full endorsement for any Medicaid expansion proposal to pass muster in the 2014 Legislature.

In an election-year session just ahead of the May primary, GOP lawmakers facing a stiff challenge could be even more reluctant to be perceived as supporting Obama’s overhaul than they were during the exchange battle this year.

“First and foremost, it has to have the strong support” of Otter, said Sen. Dean Cameron, R-Rupert. “I still think it’s more of a 2015 issue than it is a 2014 issue. We’ll see how the stars align.”

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