Medicaid expansion ruled legal

BOISE (AP) — The Idaho Supreme Court ruled Tuesday that a voter-approved initiative expanding Medicaid in Idaho is legal.

A majority of the five-member panel rejected arguments by the Idaho Freedom Foundation and its board chairman, Brent Regan, that the measure was unconstitutional because it delegated authority to the federal government and the state Department of Health and Welfare.

“Regan’s arguments are without merit,” Chief Justice Roger Burdick wrote for the majority of the justices in dismissing the lawsuit a week after hearing oral arguments.

While not unexpected, Reclaim Idaho co-founder Luke Mayville said the moment of learning of the court’s decision was one of pure joy.

“Overall, we weren’t surprised because we always knew the court case was meritless but nonetheless it was still a thrill.”

Mayville said Monday’s rally only reinforced the support the measure had among voters, with hundreds attending the rally at the capitol. In addition, 42 meetings were set up between legislators and residents with people travelling from as far north as Bonners Ferry and from Driggs in the east.

With the law now affirmed by the Idaho Supreme Court, the only thing remaining is for legislators to fund the new law, Mayville said.

The $10.8 million needed to fund the first phase is already in Idaho’s Millennium Fund, the state’s tobacco settlement endowment, Mayville said. Gov. Brad Little has already earmarked the money in his proposed budget and the fund’s board has agreed the money is available for Medicaid expansion.

It’s now time for legislators to follow the will of the people and fund the law.

“The money is there, the people have spoken, and Medicaid expansiion has been upheld by the highest court in the land,” he added. “It’s now time for the legislators to fund Medicaid expansion as the voters approved and without restriction.”

Voters authorized Medicaid expansion in November after years of inaction by the Idaho Legislature. The Idaho Freedom Foundation and Regan challenged the law shortly after it passed with 61 percent of the vote and asked the court to order Idaho Secretary of State Lawerence Denney to remove the voter-approved law.

“The primary concern with Proposition 2 was that it unconstitutionally delegated legislative authority to the federal government,” Regan said in an email statement. “The court found that Prop 2 is constitutional, not because the delegation of legislative authority is constitutional but because Prop 2 adopts the federal guidelines at the time of adoption … and therefore does not delegate future authority.”

Prior to his lawsuit, Regan said if the federal government had changed the matching payment from 90 percent to something lower then the Idaho department of Health and Welfare would have simply complied with the change.

“Now, the 90 percent matching payment, the 133 percent threshold and all other provisions at the time of adoption are locked in and cannot be changed without positive action by the Legislature,” he said. “These are the very ‘sideboards’ contemplated by some legislators.”

Regan said it was worth taking the case to the Idaho Supreme Court to ensure protection against federal overreach. “Absolutely (it was worth it),” he said. “Idaho’s sovereignty has been protected as a result.”

The law directs the state to expand Medicaid eligibility rules to include anyone earning less than 133 percent of the federal poverty level. That will provide access to preventative health care services for about 62,000 low-income Idaho residents. The federal government will pay for 90 percent of the estimated $400 million cost.

Lawmakers are working on plans to pay the state’s share.

“We applaud today’s decision by the court and look forward to seeing Medicaid expansion implemented in Idaho the way the voters chose,” said Emily Strizich of Reclaim Idaho, the group that led the signature drive to get the initiative on the November ballot.

“From the beginning, we felt the state had a strong argument to make,” Idaho Attorney General Lawrence Wasden said in a statement. “My office was honored to defend the will of Idaho’s citizens.”

A key part of Regan’s argument was that the federal government could change the percentage it paid or how eligibility was measured for Medicaid, making the expansion unconstitutional because Idaho would be stuck with something voters didn’t approve.

The majority of justices rejected that argument, noting that if the federal government upped the poverty level and increased the number of residents eligible for the Medicaid expansion, it wouldn’t mean Idaho had to cover them.

“Rather,” Burdick wrote, “because Medicaid is a cooperative federal-state program, if Idaho wanted to continue offering expanded Medicaid services, the Idaho Legislature would have to decide to pass new legislation conforming with the amendment.”

A majority of the justices also rejected Regan’s argument that the federal government could reduce its 90 percent share of what it pays, also leaving Idaho with something voters didn’t approve.

But the justices said the Idaho Legislature controls how much the state pays through its annual appropriation of funds.

“Accordingly, Regan’s contention that the federal government can control Idaho’s expenditure of funds is unpersuasive,” Burdick wrote.

The majority also rejected Regan’s argument that the expansion was unconstitutional because it was linked to federal law and therefore gave the federal government authority over Idaho. The justices noted many of Idaho’s laws and programs are linked to federal benchmarks, and that the Medicaid statute itself without the expansion used federal law to determine eligibility.

“If we were to accept Regan’s argument that any reference to a federal statute delegates lawmaking authority to the federal government, then many of Idaho’s statutes would be unconstitutional, and in fact, the option of any cooperative federal-state program would be curtailed,” Burdick wrote.

Regan also argued that the expansion gave the Idaho Department of Health and Welfare “unguided discretionary power that exceeds constitutional limits.”

But the majority of justices said the expansion didn’t give the department the option to determine Medicaid eligibility.

“Thus, Regan’s argument that the statute delegates uncontrolled power to the department is unpersuasive,” Burdick wrote.

Justices also ruled that the case rose to the level of urgency requiring the state’s highest court to act.

Burdick, writing for the majority, said that an approaching 90-day deadline for when the state must submit its Medicaid expansion plan to the federal government and the Legislature’s need to consider funding caused the case to rise to the level of urgency requiring the court to rule.