Idaho's catastrophic health care program faces dilemma

(Spokane, Wash.) Spokesman-ReviewJanuary 20, 2014 

Costs to the state and counties for Idaho’s unique catastrophic medical care program more than doubled from 2002 to 2013, and they’re expected to continue to mount if the program stays as-is.

Next year, the state’s portion of the bill is expected to jump 10.6 percent to $38.5 million, state lawmakers learned Thursday; the rest of the cost for the program is directly picked up by county property taxpayers.

“This is the nature of our program,” Roger Christensen, a Bonneville County commissioner and chairman of the state Catastrophic Care Program board, told legislative budget writers. “It doesn’t allow for preventive care, so we deal with the results after it becomes catastrophic, which is much more expensive, and it’s paid for dollar for dollar.” No federal matching funds are available.

The program covers catastrophic medical costs for patients who can’t pay the bills off in five years; liens are placed on patients’ property, but little is generally recovered. State general funds and local property taxes cover the full cost of the program.

Combined state and county costs were $52.7 million in 2013, down slightly from the prior year due to a temporary federal program that picked up some costs, but is now expiring. “We anticipate that trend will reverse in the future,” Christensen said.

In 2002, the combined state and county costs were $25.3 million.

Alternatives include expanding Idaho’s Medicaid program, which now is limited to children, very poor parents, and the disabled, to provide coverage for patients who otherwise would turn to the CAT program. Federal funds would cover most of the cost, and the existing program could be repealed.

Other options include sending some of the patients to the new health insurance exchange, through which roughly 40 percent likely would qualify for subsidized insurance; or cutting back the program to cover only emergencies.

Currently, the program’s highest costs are for heart disease and related conditions, followed by cancer, and then diabetes. The average claim paid has risen from $24,127 in 2010 to $26,602 in the first six months of this year.

“One area that’s a real concern to our counties is the issues of mental health,” Christensen told legislative budget writers. “We’re seeing quite an increase.”

He said, “This is an area where prevention pays dividends. When we deal with it, it’s usually after an episode. It’s unfortunate, because people are being treated in our jails. … We just want to point that out as an area of major concern and pressure on program costs that we may have in the future.”

Costs would be reduced if the patients who turn to the CAT fund instead were covered under health insurance, he noted.

Rep. Maxine Bell, R-Jerome, co-chair of the Idaho Legislature’s joint budget committee, told Christensen, “We appreciate having you as a partner. We probably don’t like the situation any better than you do, and we’ll continue to struggle to find a better way to do things.”

Rep. Steven Miller, R-Fairfield, asked why county costs for the program are so varied. “It’s difficult to predict … it’s kind of like the lottery,” Christensen responded. “You could have one huge case in your county” that would cost $1 million. “It doesn’t depend on the size of the population.”

Gov. Butch Otter had initially recommended a 3.4 percent increase in CAT fund state spending next year, but that was before the latest projections came in higher.

The Joint Finance-Appropriations Committee took its morning break after Christensen’s presentation, and the senators and representatives on the panel joined in animated discussions in the meeting room and outside in the Capitol’s hallways and rotunda. All focused on the dilemma Idaho faces with the program and the possible alternatives, from the Arkansas model – taking federal Medicaid expansion money and using it to buy private insurance for uninsured residents – to other options.

Gov. Butch Otter announced in his State of the State message this year that he’s not ready to accept federal Medicaid expansion funds without more study and reforms to Idaho’s Medicaid program.

“Some are coming to the realization we’re spending those dollars already on the indigent program,” said JFAC Co-Chair Dean Cameron, R-Rupert. “None of us are happy about having to spend those dollars.”

Sen. Dan Schmidt, D-Moscow, a physician and a CAT fund board member, said, “We have done as many things as we can to control those costs. We’ve put in medical reviews. We only pay at the Medicaid rate. We have a good contract with the counties for oversight. In essence, we’ve done what we can on paying a bill after we get it, to control the costs. The premise of this sort of payment is the question. It, in my opinion, needs to be addressed as a policy decision. We need to have that discussion.”

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