State Politics

House committee to hold Medicaid expansion sideboards hearing Wednesday after Senate vote

Idaho’s health insurance coverage gap

A legislative working group convened in 2016 for a day-long meeting on Idaho's "Medicaid gap" - people who do not qualify for Medicaid, but also do not make enough money for assistance through the state health insurance exchange.
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A legislative working group convened in 2016 for a day-long meeting on Idaho's "Medicaid gap" - people who do not qualify for Medicaid, but also do not make enough money for assistance through the state health insurance exchange.

The Idaho Senate on Tuesday voted to advance a bill that would place several special rules and programs on Medicaid expansion.

The bill includes a controversial work requirement, which says people getting health insurance coverage on expanded Medicaid must prove they’re working or are exempt from having to work. The bill also includes a special carve-out that may allow some Idahoans who qualify for expanded Medicaid to instead get private insurance.

The legislation passed by a 20-15 vote. It heads to the House next. The House Health and Welfare Committee will hold a hearing on the bill at 9 a.m. Wednesday at the Statehouse. 

Democrats and several Republicans debated against the bill. They said the work requirements are unnecessary, expensive to administer and may drag Idaho into a costly lawsuit. They also said the add-ons defy the will of Idaho voters, who passed a straight Medicaid expansion by 61 percent last fall.

But other Republican senators, such as Caldwell’s Jim Rice, argued that a work requirement is a path out of poverty and gives people “skin in the game.” They said the penalty for non-compliance with work rules was less punitive than the rules in Arkansas and Kentucky that a federal court last week deemed illegal.

Here are more details on the bill, which the Senate cobbled together this week with a series of amendments:

  • Idaho would seek a waiver to let some people get private insurance, paid for by the federal government. Under this proposal, people who qualify for expanded Medicaid but have incomes slightly above poverty level would have the option of obtaining insurance through the state’s exchange, Your Health Idaho. This amendment was proposed by Sen. Fred Martin, R-Boise.

    Read more: What’s the difference between private insurance and Medicaid? A lot.
  • Low-income adults who qualify for Medicaid expansion would have to work, volunteer or go to school. Unlike the work requirements that have been discussed in Idaho and other states, failure to comply wouldn’t mean losing Medicaid. People still would have coverage. They would just have a co-pay imposed on them — such as $5 to $30 for a doctor’s appointment — until they complied. Some people would be exempt, such as parents, caregivers and those filing for disability. This amendment came from Sen. Steven Thayn, R-Emmett.

    Read more: The fate of Idaho Medicaid expansion comes down to 2 words: work requirements
  • There would be a trigger clause to keep Idaho from losing out on federal funds. If the federal government grants a waiver associated with Medicaid expansion, but on the condition that it drops the federal share for expansion costs below 90 percent, the state wouldn’t be authorized to carry out that waiver. This amendment was introduced by Sen. Brent Hill, R-Rexburg.
  • People on expanded Medicaid would have their health care provided and managed by a “medical home,” such as a primary care clinic. Specifically, the amendment introduced by Sen. Mary Souza, R-Coeur d’Alene, would require a referral to get family planning services outside of the medical home.
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