Idaho will spend $78 million more if Medicaid expansion ends, state official tells legislature

If voters had not agreed to expand Idaho Medicaid to low-income adults, Idaho residents would have spent tens of millions of dollars on health care for these patients.

If the state rolls back Medicaid coverage, Idaho will spend nearly $78 million more due to the loss of federal funding, a state official told lawmakers Monday.

Idaho Medicaid is a state-run health insurance program. For decades, it was only offered to adults with disabilities, low-income children, and, in some cases, their parents. When Idahoans needed medical care, the federal budget paid most of the bill — about 70% to 75% of it, depending on the year. Idaho’s Medicaid budget paid the rest.

What about other low-income adults in Idaho, who couldn’t afford health insurance and didn’t qualify for Medicaid? When they needed medical attention, the resulting medical bills often went unpaid—or when they did, the money came from a patchwork of Idaho taxpayer-funded accounts.

When Idaho approved the expansion by a vote of 60.6% in the 2018 election, it opened up Medicaid to those previously uninsured. Because of provisions in the Affordable Care Act, the federal government has promised to pay 90% of the medical bills for these newly insured patients.

Idaho lawmakers for years chose not to expand Medicaid. However, federal law requires Idaho residents to pay the federal budget for expansion.

The 2018 ballot measure opened the program to more people and changed how health care is paid for in Idaho.

Now, about 145,000 Idaho residents have coverage through the Medicaid expansion.

“We know that it relieves the burden on the state and counties to support destitute populations, allows the state to remove[the catastrophic medical bill fund]and we are now able to claim federal matching behavioral health services that were previously provided through state public funds,” said Juliette Charron, director of Idaho Medicaid. , during her presentation before the Idaho House and Senate Health and Welfare Committees, he also supports a healthier workforce and supports lower health care costs and increased productivity.

As more people are insured by the program, and because of their medical needs and the cost of Medicare, the Medicaid budget has grown exponentially.

But, as Sharon explained Monday to members of the Idaho legislature, Idaho taxpayers actually pay less for Medicare for Idahoans. These patients are still likely to go to the hospital or need surgery or cancer treatment without Medicaid; But now, as she points out, 90% of their bills are covered by federal funding, instead of being paid only by Idaho taxes or not paid at all.

Idaho Rep. Megan Blanksma, R. Hammett, asks a question during an overview of Medicaid expansion.  She has brown hair and wears glasses and a gray jacket, holding her hand and gesturing to confirm
Hammett, Idaho Rep. Megan Blanksma, asks a question about Juliet Sharon, Idaho’s director of Medicare during a joint meeting of the health and welfare committees of the Idaho legislature. (screenshot via Idaho In Session)

Charron said hospitals in Idaho have had to write off about $61 million less in unpaid bills since Medicaid expanded.

The committees met Monday for an overview of the first three years of the Idaho Medicaid expansion. The meeting was required by Idaho law, which orders lawmakers to “review all financial, health and other impacts” of the expansion and to “make a recommendation” to the full legislature about continuing the expansion.

Voters approved the expansion without side panels, but state lawmakers have ordered the Idaho Department of Health and Welfare to seek federal permission to add side panels and multiple conditions for Medicaid coverage. Almost all of these waiver requests, Sharon explained, failed to gain approval from the Trump and Biden administrations.

Dory Healy asks a question.  She is sitting and wearing blue
Rep. Dory Healy, R. Boyes, asks a question during an overview of Medicaid expansion Jan. 23. Healy, a registered nurse in advanced practice, asked about preventive care and whether Medicaid recipients go to the emergency room instead of being directed to primary care settings. (screenshot via Idaho In Session)

Members of the Health and Welfare Committee fed Charon questions about the costs of the expansion, how well it was doing in keeping Idaho residents healthy and whether it really gave Idaho residents more access to care. In her answers to several questions, Sharon said she would follow up with more information – as committees will continue to discuss enlargement during this legislative session.

Pharmacy was the largest group of Idaho Medicaid costs, and for the expansion group alone. This includes diabetes and psoriasis care, psychiatric and epilepsy medications, and cancer treatments. As Director of Health and Social Care Dave Jepsen explained to the Legislature’s Appropriations Committee last week, this is mainly due to higher-cost new drugs.

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