House passes Medicaid budget, heads to governor

BOISE — The Idaho House approved the Medicaid budget on Wednesday, marking the approval of the state’s largest budget. The appropriation goes to the governor for consideration.

The total budget for the program, including federal and state money, is $5.2 billion. The budget approved Wednesday was just the “enhancement” budget, largely accounting for funds the state was obligated to pay through contracts or federal laws.

The “maintenance budget” that had previously been approved with ongoing funds allocated from the prior year totaled around $4.6 billion. The enhancement budget that passed Wednesday totaled $674 million in mostly federal money. The state’s general fund portion of the budget totaled around $70 million.

“This is as close to a maintenance budget as we could actually get in the department of Medicaid,” said bill sponsor Rep. Rod Furniss, R-Rigby.

The budgeted items include funding to do surveys required by the federal government, for a contract for actuaries to forecast costs, the population adjustment, and costs related to the passage of House Bill 345 — which among many reforms, required the move of the entire program to a contract with a third-party managed care organization.

Multiple representatives stood Wednesday to oppose how large the budget was and the amount of federal dollars used in the program.

Rep. David Leavitt, R-Twin Falls, cited the federal debt, which sits at $35.46 trillion, according to the U.S. Treasury.

“I would challenge anybody in this room to count from one to 37 trillion. I don’t think it’s possible. It’ll take us decades, if not centuries,” Leavitt said.

Rep. Josh Tanner, R-Eagle, who sits on the budget-writing committee, debated against the budget, largely because he thought there could have been more reductions, including cutting provider reimbursement rates.

When health care providers see and treat patients who are on Medicaid, they are paid, at least in part, for that service through the provider reimbursement rate.

Tanner said that the provider rate increases approved last year could have been re-evaluated. He advocated for voting down the budget and returning it to the Joint Finance and Appropriations Committee (JFAC) to re-work.

JFAC Vice Chair Rep. Steve Miller, R-Fairfield, highlighted that the budget included bills that the state had to pay.

Rep. Clay Handy, R-Burley, said that the costs of health care have been rising, and that was reflected in the budget.

“All of these people in health and welfare, all these people in need, some unemployed and some of the working poor, these funds are just the fact that’s what we owe, it’s what it cost them to remain healthy,” Handy said.

He also underscored the human aspect of it, saying he appreciated that the Senate debate on the budget “brought it back to the fact that we’re dealing with people and people’s lives.”

“It’s not just money,” he said.

The budget passed in a 40-30 vote. The Senate on Monday advanced the bill in a 22-13 vote; it now goes to the governor’s desk for consideration.

Lawmakers are obligated to pass a balanced budget before they may adjourn for the year — the targeted date for the end of the session was March 21. There are still a number of outstanding budgets for lawmakers to consider, including budgets that failed on the floor and had to be re-written by JFAC such as the Liquor Division and The Office of Energy and Mineral Resources.