State Politics

A new bill in the Idaho Legislature would add work requirements to Medicaid expansion

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.

An Idaho House panel on Monday voted to hold a public hearing on legislation that would place limits on Idaho’s Medicaid expansion.

The bill would:

  • add a work requirement to the health insurance program, with an exemption for parents.
  • nullify Medicaid expansion if the federal government’s share of Medicaid expansion costs falls below 90 percent.
  • move toward seeking approval for Medicaid to pay for inpatient psychiatric treatment, which it’s not allowed to do under current law.
  • allow people whose income is just above poverty level to instead get insured through the state’s health insurance exchange.

The changes could result in fewer Idahoans getting health care through Medicaid expansion, which 61 percent of voters approved in November — with no wording about work requirements or other limitations.

One of the changes would save Idaho money by shifting potentially thousands of Idahoans onto private health insurance instead of Medicaid. That could limit their access to services Medicaid covers but private insurance does not, such as home health care and medical transportation.

The House Health and Welfare Committee voted 9-3 to print the bill. The bill must then come back before the committee for a full public hearing.

The draft legislation introduced by Republican Rep. John Vander Woude, of Nampa, would require people in the Medicaid program to either work or undergo pre-employment training — requirements similar to those on the federally funded food-stamp program, called the Supplemental Nutrition Assistance Program, or SNAP.

What is straight-vanilla Medicaid expansion?

Idaho Medicaid expansion, as approved by voters in November, opens up Medicaid coverage to childless and low-income adults who make less than 138 percent of federal poverty level, or about $17,200 a year for a single Idahoan.

The law provides access to preventive health care services for about 91,000 low-income Idaho residents, according to a risk management company hired by the state. The federal government would cover 90 percent of the estimated $400 million cost.

The voter-approved law doesn’t include work or training requirements. It also doesn’t have a provision to move people onto private insurance if they make 100 percent to 138 percent of the federal poverty level.

Lawmakers taking sides

Many Republican lawmakers in the GOP-dominated Legislature still oppose Medicaid expansion. Among their concerns are potential costs and what they claim could be an incentive for people not to work.

“I believe there’s always a benefit if we can help people move off of a government program and be self-sustaining,” Vander Woude told lawmakers Monday.

Representatives, senators and the officials with governor’s office have been meeting for weeks to determine what kind of legislation could be approved by both chambers and Gov. Brad Little, a Republican.

The legislation introduced Monday is designed to do that, and Republican Rep. Fred Wood, chairman of the committee and a retired medical doctor, believes that the bill might have the right mix to become law.

“I do, yeah, but we’ll see,” he said after the meeting. “In my discussions with people, I think a lot of people are supportive of it.”

Idaho would not be the first state where added recipient requirements have been considered. Utah passed sweeping changes to a voter-approved Medicaid expansion last month, cutting the number of people covered nearly in half and adding work requirements that the Trump administration is expected to approve.

Arkansas has implemented a fairly complex work requirement that has resulted in thousands of Arkansans being removed from Medicaid. Some who lost Medicaid coverage described running into paperwork and bureaucratic problems as they tried to comply with the work rules.

Democrats on Monday took issue with the accuracy of the estimated cost of Vander Woude’s legislation, saying the numbers could be low-balling the actual cost. The legislation estimates the state will pay about $1.8 million annually to administer requirements spelled out in the legislation, with Idaho picking up about $1.5 million and the federal government the rest.

“I am extremely disappointed that the committee voted to introduce a bill that would significantly restrict Medicaid expansion,” Democratic Rep. Ilana Rubel said in a statement after the meeting.

The required fiscal note estimating costs associated with the legislation did not say how much counties might end up paying for health care for patients who would not qualify for Medicaid under the proposed law. Idaho’s counties pay health care costs for indigent residents.

The proposed legislation also does not appear to differentiate between the expansion and those already on Medicaid. The federal funding share of 90 percent applies only to Idahoans who join expanded Medicaid. The federal government pays a lower share for those already on Medicaid.

On related issues, the Legislature’s budget committee on Wednesday approved a budget for Medicaid that includes the expansion. But it still has to pass the House and Senate.

Last month, the House Health and Welfare Committee killed two pieces of legislation intended to repeal Medicaid expansion.

And a Senate panel last month voted to hold a hearing to drop Medicaid expansion if the federal government reduces the percentage it pays for the program. That hearing has not yet been held.

Also last month, the state Supreme Court upheld the voter-approved initiative for Medicaid expansion following a challenge from a conservative group that argued it was unconstitutional.

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Watchdog reporter Audrey Dutton joined the Statesman in 2011. Before that, she covered finance policy in Washington, D.C., during the financial crisis. She also worked as a reporter in Maryland, Minneapolis and New York. Audrey hails from Twin Falls.