Lawmakers unlikely to bridge Medicaid gap this year

BOISE - A key lawmaker says there's little chance legislation will move forward this session to address Idaho's Medicaid gap population.

House Health and Welfare Chairman Fred Wood, R-Burley, introduced a $10 million proposal two weeks ago to provide limited primary care services to adult Idahoans who earn less than 100 percent of the federal poverty level and who don't qualify for Medicaid or for subsidized health insurance premiums.

However, during a meeting of the Joint Millennium Fund Committee on Monday, Wood said the measure doesn't have enough votes to move out of committee, much less pass the House.

"I don't think there will be any legislation coming forward this year regarding the gap population," he said. His bill "is languishing in House Health and Welfare, but there's not enough votes to get it out."

In a radical departure from past practice, Wood also recommended that the Millennium Fund Committee not solicit any grant applications next year. That would provide a funding source for a possible "gap bill" next session and allow the committee to step back and re-evaluate how Millennium Fund revenues are being spent.

"We're spending a lot of money and I don't know what we're accomplishing," Wood said. "I think we need a different paradigm going forward. It's more of a patronage system right now. I worry that we're supporting organizations, rather than supporting programs."

The Millennium Fund Committee makes recommendations on how to allocate funding related to a 1998 tobacco lawsuit settlement. It typically receives more than two dozen applications each year, primarily for health-related programs and tobacco prevention-cessation projects.

The committee approved its fiscal 2018 funding recommendation Monday, although the actual appropriation won't be set by the joint budget committee until next week.

The recommended projects include $90,600 for a Nez Perce Tribe substance-abuse education program, $187,100 for the Idaho State Police tobacco sales compliance checks, $750,000 for public health district tobacco cessation programs, $2.7 million for Project Filter and $300,000 for eight statewide substance-abuse recovery centers - including $25,000 for the Moscow center and $50,000 for the Lewiston center.

Wood's proposal to not solicit applications for fiscal 2019 would give groups about 15 months notice that they can't count on any additional funding. The motion excluded Project Filter and the public health districts, whose funding would be ongoing.

The proposal failed on a 5-5 tie, but that was because some members want more time to consider the idea. The committee plans to meet again in a week or two to discuss the issue further.

Sen. Janie Ward-Engeling, D-Boise, wants the Legislature to address the needs of the Medicaid gap population, but she opposed using Millennium Fund dollars to do so.

"It's taking money away from people and programs that need it desperately and using it to help other needy folks," she said. "I don't think that's the right approach."

An estimated 78,000 Idahoans are in the gap population. Most are working adults who earn too much to qualify for Medicaid and too little to qualify for health insurance premium subsidies. Consequently, they often can't afford preventative medical treatment and wait until their condition becomes more serious.

Sen. Grant Burgoyne, D-Boise, said Idaho's opportunity to help the gap population has come and gone.

"I believe we missed the train for taking care of them," he said. "There's only one place our gap population can look to now for a remedy, and that's Washington, D.C. This state can't do that on its own; we can't afford it. With a different Congress and different president, a federal solution may be more acceptable in Idaho than it has been the last eight years."

In other action Monday, the joint budget committee approved a $531.9 million general fund budget for the Department of Health and Welfare's Division of Medicaid.

That's a $12.3 million, 2.4 percent increase over the current year. The total amount is expected to increase by about $1.2 million, however, as a related bill dealing with children's mental health services moves through the Senate.

The total fiscal 2018 Medicaid budget, including dedicated and federal funds, is $2.28 billion, a $51.5 million, 2.3 percent increase over 2017.

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Spence may be contacted at bspence@lmtribune.com or (208) 791-9168.