Time to stop another bad Medicaid expansion restriction

Idaho’s Republican legislators who want to put restrictions on the voter-approved Medicaid expansion are striking out with their sideboards.

Work reporting requirements are a bureaucratic waste of time and money and have been shot down in the courts in other states.

The Centers for Medicare and Medicaid Services this summer told Idaho that it would reject the part of the plan that allows newly Medicaid-eligible Idahoans to buy private insurance instead, using federal tax credits.

We think the state is headed for its third strike, this time with a rule that would require patients to get a referral from a primary care physician before they can get family planning services such as birth control, abortions or pregnancy care.

State officials say the referral requirement would apply to all Medicaid recipients in the state and lead to better patient outcomes.

But critics say the waiver is an attempt to prevent women from seeking medical help by putting unnecessary obstacles in their way.

For example, if a woman wanted a prescription for birth control pills, she would have to go through her primary health care provider first. She could see an outside gynecologist only with a referral — she couldn’t just pick a women’s health clinic and go there without her primary doctor’s approval.

Why would the state government tell a citizen what’s the best way to handle their own health care? This goes against all tenets of Idaho’s conservative values of staying out of an individual’s personal decision.

Further, just like the work requirements, this plan might run afoul of federal law.

Medicaid has special rules for family planning services and requires state Medicaid programs to cover them, forbidding states from making them hard to access.

According to a federal manual for state Medicaid programs, a Medicaid HMO program cannot require a referral for a patient to get family planning services or supplies outside the HMO. Instead, patients are allowed to choose “any qualified provider,” it says.

“The right to freely choose to receive family planning services from any qualified participating Medicaid provider is an essential protection designed to ensure that Medicaid beneficiaries have ready access to the health services they need when they need them, and from a provider they trust,” according to a memo from the National Family Planning and Reproductive Health Association. “Federal law guarantees that Medicaid beneficiaries can receive family planning services from any qualified Medicaid provider ... this principle is referred to as ‘freedom of choice.’ ”

The Kaiser Family Foundation wrote in a comprehensive 2017 report on how changes like those approved by the Idaho Legislature affect family planning: “Medicaid enrollees may not be charged cost-sharing for family planning services and are given freedom of choice of provider when it comes to family planning.”

The Idaho Department of Health and Welfare is still taking comments through Oct. 12, which is Saturday.

You can email comments to 1115_FamPlan@dhw.idaho.gov or mail comments to:

Attention: Clay Lord, Medicaid Program Policy Analyst, Division of Medicaid; P.O. Box 83720; Boise, Idaho 83720-0009.

Meanwhile, enrollment for people eligible for Medicaid expansion begins Nov. 1, with coverage starting Jan. 1. State officials have said those dates are valid whether the waivers are approved or not.

Statesman editorials are the unsigned opinion expressing the consensus of the Idaho Statesman’s editorial board.
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