Let's talk about expanding Medicaid

Greetings from Boise! This past Monday, I introduced a bill offering six elements of protection and enhancement to the new Medicaid Expansion law in Idaho. My intent, and that of the others who worked with me on the bill, is to get the conversation about the expansion out into the public so folks all over Idaho can talk about the options, so here they are:

Senate Bill 1100 includes:

1. An optional workforce training program for those in the expansion.

2. A Federal waiver request to keep those above the “gap” on the insurance exchange.

3. A Federal waiver request to help counties pay for people with mental health disabilities.

4. An escape clause so if the Federal funding for the expansion drops, the program will stop unless the Legislature takes action to continue.

5. A review clause stating in January of 2023 the Legislature will review and report the impacts of the expansion in Idaho.

6. An emergency clause to put this bill into action as soon as it is signed into law.

Here’s a quick explanation of each of these points:

1. This free, optional, workforce training will help folks in the expansion get a better job. It is estimated to cost the state $177,000 but will provide them an opportunity to get career-level skills and certifications.

2. The “gap” means people who make below 100 percent of Federal Poverty Level (FPL). But Medicaid expansion doesn’t just include the gap, it extends up to 138 percent of FPL and pulls those people onto Medicaid also, whether they want to or not. My original effort was to keep these folks on the insurance exchange, where they are currently, by applying for a Federal waiver. Now new information has come out showing it is not feasible, so this section of the bill will be removed.

3. The mental disabilities funding waiver (IMD) has been granted to almost every state that has applied, and over half the states have done so. This money will go to our counties because, in order to pay for Medicaid expansion, Idaho will have to take back funding from the counties’ current indigent fund and catastrophic fund.

4. The escape clause offers budget protection (think education, teacher pay, transportation) in case the Feds change the 90/10 funding ratio for our Medicaid expansion. The current state cost of the expansion in Idaho is an estimated $42 million per year, not including the Federal portion. If at any time in the future the Feds change the funding to, for example, 70/30, which is the ratio we pay for regular Medicaid for the disabled in Idaho, then the cost to the state for the expansion will triple. The predicted $42 million would increase to $126 million per year, which would certainly cut into many other budgets in the state.

Voters passed Medicaid expansion through the initiative process last November, which I have honored, and Gov. Otter signed it into law. Now it is time for the Legislature to do our job, which is to fund it while still maintaining the integrity of our budget. We must make sure the people of Idaho have a strong economy with quality job growth, continued improvement in education, safety and security in our communities and on our roads, and preservation of our natural resources. With Idaho’s constitutional requirement to balance the budget, our job this year is especially challenging. Please know we are working hard for everyone in Coeur d’Alene, Kootenai County, and all across Idaho.

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Sen. Mary Souza is a Republican representing District 4, Coeur d’Alene.