Idaho Senate approves Medicaid budget

BOISE — The Idaho Senate on Monday approved the budget for Medicaid — the state's largest budget and a major hurdle to clear before lawmakers may adjourn for the year.

Senators debated at length in the afternoon, stopping mid-debate to go to lunch and returning later to resume discussion before voting 22-13 to approve the bill.

Idaho’s total Medicaid budget costs around $5.2 billion, with $3.4 billion of that coming from the federal government. The Legislature already passed a $4.5 billion “maintenance budget” for the program with no new spending. The “enhancement budget” approved Monday included $674 million of additional funds, of which, $70 million comes from state general funds. 

The enhancement was first approved by the Joint Finance Appropriations Committee on March 17.

The budget will largely be spent toward federally required contracts, population forecast adjustments over what was predicted the previous year versus what was actually spent and implementation funding for a Medicaid managed care reform bill passed earlier this year.

Sponsor Sen. Carl Bjerke, R-Coeur d’Alene, noted that the bill doesn't increase the number or level of services or reimbursement rates to providers, and the costs included are ones the state is legally obligated to pay.

“We wouldn't be in a good state if we didn’t pay our bills,” Bjerke said.

Bjerke highlighted that increases in costs were largely due to increased utilization of services and higher-cost services.

Co-chair of the budget-writing committee, Sen. Scott Grow, R-Eagle, also noted that the state was obligated to pay for the services under Medicaid — underscoring that if the Legislature opts to make big cuts now, it’s likely the agency will have to come back next session with a supplemental budget request to cover the costs anyway.

He also noted that the state relies on actuarial estimates, which will likely need to be adjusted.

Multiple senators opposed the budget, citing the federal government’s budget deficit and the fact that the program is largely funded by federal dollars.

Sen. Glenneda Zuiderveld, R-Twin Falls, lamented that the Legislature had a bill introduced this year that would have repealed Medicaid expansion — a program approved via voter initiative in 2018 to expand eligibility to those who fell in the gap between traditional Medicaid and qualifying for credits to purchase private insurance on the state health exchange. She would have rather voted on the expansion repeal because of increased costs. 

Sen. Josh Keyser, R-Meridian, quoted Nancy Reagan’s famous “just say no,” although he was referring to rejecting spending more money, rather than abstaining from drug use as was the focus of Reagan’s information campaign.

Sen. Todd Lakey, R-Nampa, said he wasn’t necessarily “excited” about everything in the bill, but it would pay the state’s contracts.

“I feel like I need to support this, because Idaho pays its bills,” Lakey said.

The bill will go to the House for another vote.