State Politics

Idaho Republicans consider restrictions to Medicaid expansion that could delay launch

Idaho Supreme Court hears arguments regarding the legality of Medicaid expansion

The Idaho Supreme Court hears arguments Jan. 29, 2019, regarding the legality of Medicaid expansion, an initiative that passed on the November 2018 ballot with 61 percent of the vote.
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The Idaho Supreme Court hears arguments Jan. 29, 2019, regarding the legality of Medicaid expansion, an initiative that passed on the November 2018 ballot with 61 percent of the vote.

Three months after Idaho voters approved a Medicaid expansion ballot initiative, House lawmakers are still discussing what conditions or restrictions should be placed on the move.

No bills have been introduced yet, but a group of about 15 Republicans met this week to coordinate their proposal. They’re looking at nearly a dozen waiver options, including work restrictions, co-pay requirements and lifetime limits.

“This is just a starting point. I suspect (the final bill draft) will have a lighter touch,” said Rep. John VanderWoude, R-Nampa. “If we do nothing, then we’re left with full-blown Medicaid expansion.”

Perhaps their most controversial request is that the federal Centers for Medicare and Medicaid Services (CMS) take action on all of the waivers — before Idaho moves ahead with expansion.

“That doesn’t mean they all have to be approved,” VanderWoude said. “It just means we want an answer. Don’t leave us hanging.”

Given the number of conditions they’re proposing, though, this would conceivably delay implementation beyond the expected Jan. 1, 2020, starting date.

VanderWoude agreed, but said that isn’t the intent. Rather, the idea is to “put pressure on CMS” and get an answer as soon as possible. Nevertheless, postponing expansion until CMS responds to the waivers arguably reins in the will of the voters.

“Yes, but that’s what all these sideboards are,” he said.

More than 60 percent of Idaho voters supported the ballot measure, which expands the state’s Medicaid eligibility rules to include anyone earning less than 133 percent of the federal poverty level. (The Affordable Care Act includes a 5 percent “disregard” when calculating income limits, so the effective income cap is 138 percent of poverty.)

The Department of Health and Welfare expects to submit an amended state plan to CMS within the next few weeks, seeking federal approval of the new income limit. Any additional restrictions or limitations would require a separate waiver request. The Legislature would first have to adopt the waiver, which would then be subject to federal approval.

Although voters authorized a straightforward, “full-blown” version of Medicaid expansion, many Republicans feel some kind of “sideboards” or limitations are needed to rein in costs and encourage positive behavior.

“The purpose of Medicaid is to help people advance their situation,” said Rep. Brian Zollinger, R-Idaho Falls, who also is working on the waiver bill. “We think these requirements will help incentivize people to improve their lives.”

The whole discussion of waivers, though, could be rendered moot by the Idaho Supreme Court. The court heard arguments this week in an Idaho Freedom Foundation lawsuit that seeks to block implementation of the ballot initiative. Zollinger said he’d prefer to wait for a ruling in the case before introducing a waiver bill.

“We can shop the draft bill around and maybe introduce it in three weeks,” he said.

Whenever the legislation is introduced, VanderWoude said it likely will be packaged as a single measure, rather than parceled out into separate bills for each waiver. He thinks other lawmakers may introduce competing proposals that only include one or two sideboards.

Medicaid waivers are a topic of interest in the Senate as well, although Senate President Pro Tem Brent Hill, R-Rexburg, said it “doesn’t feel as urgent on this side as it is in the House.”

Overall, Hill thinks his caucus is willing to consider sideboards, so long as they’re reasonable.

“They need to improve the accountability of the system and not be designed to deny access to those who need services,” he said. “I can’t speak for the whole caucus, but if they help create a springboard to get people off (public assistance), those are the type of things we want to consider.”

Reclaim Idaho, the grassroots organization that launched the Medicaid ballot initiative, will hold a rally Monday at the Statehouse to advocate for a “clean” expansion program. More than 100 volunteers from around the state will talk with lawmakers. Several others — including Rep. Bill Goesling, R-Moscow — will speak from the Statehouse steps.

“My thoughts are we need to fund Medicaid expansion and then look at who’s in the program, why they’re in it and how we get them out of it,” Goesling said. “That’s how I’ll look at any sideboard proposal. I see (expansion) as an investment in people; if there are bad actors, we can address that later.”

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