Bill would put terms on keeping standard Medicaid

BOISE — A House committee introduced a bill Tuesday to repeal Medicaid expansion if a long list of conditions — which include capping enrollment far below its current level — aren’t met. The bill will return for a full hearing.

Rep. Jordan Redman, R-Coeur d’Alene, presented the bill, which he said was meant to provide “safeguards to the Medicaid program, ensuring its sustainability.”

“This safeguard approach will strengthen Idaho’s Medicaid program while maintaining flexibility,” Redman said.

The bill targets Medicaid expansion, which voters approved in 2018 to expand eligibility in the program to adults who earned too much to qualify for traditional Medicaid but could not afford private insurance through the state health exchange.

Redman introduced a nearly identical bill last year, which died in committee after overwhelmingly negative testimony, with many of the testifiers saying the conditions were impossible to meet.

The conditions include capping enrollment at 50,000 — currently there are around 90,000 people enrolled under Medicaid expansion, according to the Department of Health and Welfare — adding work and volunteer requirements, adding a 36-month lifetime limit of benefits, and presumptive Medicaid coverage in hospitals for pregnant women and children. There is a deadline to implement all these conditions by July 1, 2026, after which all people enrolled in the program would lose their coverage by Oct. 1, 2026.

To change how the state’s Medicaid program is administered, the Idaho Department of Health and Welfare must seek a waiver from the federal Centers for Medicare & Medicaid Services. Many of the conditions are waivers that the department has previously sought and either failed to obtain or were rejected.

Redman said Tuesday he felt confident the department would receive the waivers under the current presidential administration.

Juliet Charron, who heads the Idaho Medicaid division, told the Idaho Press last year that other states had attempted to implement enrollment caps on their programs and were denied under the previous Trump administration.

Idaho’s health department in 2019 applied for a waiver to add work requirements to the program, but the federal agency never acted on the waiver.

There is also a 2020 U.S. Court of Appeals decision, Gresham v. Azar, that determined Medicaid eligibility could not be tied to work requirements.

The House Health and Welfare Committee unanimously voted to introduce the bill, but several members had questions that they wanted addressed at a future hearing.

Rep. Josh Wheeler, R-Ammon, said he supported the “idea of guardrails,” but had concerns of the full repeal triggered by a denial or failure to receive the needed waivers.

“I’m concerned that that may not be our best way to govern, because I’m worried that we’re going to give up our power as an elected legislative body to D.C. bureaucrats,” Wheeler said.

He asked Redman if he would consider changing the full repeal to be subject to legislative review rather than automatically dissolve.

Redman said he would discuss that option after the meeting.

Rep. Ben Fuhriman, R-Shelley, said he wondered if Your Health Idaho, the state’s health insurance marketplace, would be ready to bring a large number of people into the private marketplace.

Rep. Lori McCann, R-Lewiston, said she had questions about determining who was able-bodied under the 36-month lifetime coverage cap, and if that would be re-determined if an incident were to occur and they needed coverage for longer.

House Minority Leader Ilana Rubel, D-Boise, said she did not agree with the bill’s fiscal note — which estimated the state would save up to $163 million — because it did not account for other costs that are saved due to fewer people being uninsured under Medicaid.

“My back-of-the-envelope is that it would cost us about $140 million,” Rubel said.

Rep. Megan Egbert, D-Boise, said she would vote to introduce so it could be heard for a full hearing, but would have questions about staffing needed to oversee the work requirements.

There was another bill introduced this session by Rep. John Vander Woude, R-Nampa, to repeal Medicaid expansion from state code.

Advocates gathered last week at the Capitol to urge lawmakers to protect the program amid calls to repeal it, the Idaho Press reported.

Guido covers Idaho politics for the Lewiston Tribune, Moscow-Pullman Daily News and Idaho Press of Nampa. She may be contacted at lguido@idahopress.com and can be found on Twitter @EyeOnBoiseGuido.