Bill could repeal Idaho Medicaid expansion

BOISE — An Idaho legislator on Monday introduced a bill that would create a number of requirements for Idaho Medicaid, that, if not met, would result in the permanent repeal of Medicaid expansion.

These requirements would include applying for a federal waiver to allow work requirements for Medicaid eligibility and capping the expansion population.

Bill sponsor Rep. Jordan Redman, R-Coeur d’Alene, said the legislation was “crafted to create checks and balances” for the state’s Medicaid program.

“I think we are all very well aware that our Medicaid budget last year was the largest budget that the state has ever passed,” Redman told the House Health and Welfare Committee on Monday. “This bill is geared to offer more oversight, accountability and curb broad waste and abuse within our Medicaid system.”

Last year, the Legislature passed a Medicaid budget that totaled around $4.5 billion, which included around $726 million from state general funds, $558 million from dedicated funds and $3.2 billion from federal money.

Enrollment cap

One of the requirements would be to implement an enrollment cap of 50,000 people in the Medicaid expansion population.

Medicaid expansion was approved by voters in 2018 and opened up eligibility of the program to those who couldn’t afford health care under the Affordable Health Care Act but didn’t quite qualify for traditional Medicaid coverage.

The department said around 100,000 people are currently enrolled through the program.

Rep. Josh Wheeler, R-Ammon, asked Redman what would happen if more than 50,000 people who were equally qualified for the benefit applied.

“What’s the tiebreak and do we need to address that in the language?” Wheeler asked.

Redman responded that there’s no tiebreak associated with the legislation so he would assume it would be “first in, first to serve,” but added that he would be open to discussing that part of it more.

The proposed legislation has some advocates concerned about access to health care.

Randy Johnson, government relations director at American Cancer Society Action Network — which is the lobbying arm of the American Cancer Society — said there could be dramatic consequences for those who might lose coverage as a result of the cap.

“Expansion was meant to cover that gap; now we’re creating a donut hole within a donut hole of coverage in the state,” Johnson said.

He also expressed skepticism that the move would save money for the state.

Last year, the Division of Medicaid Administrator Juliet Charron told lawmakers that an analysis of Medicaid expansion estimated that the state saved approximately $10 million in 2022 by having the program in place. Without that coverage, Idaho would likely need to boost spending for behavioral health department’s crisis centers, local indigent patients, and hospitalizations and substance use disorder services within the Department of Correction, the analysis found.

The cost of Medicaid has been a frequent subject of debate and concern for many in the Idaho Statehouse. An interim task force was convened last year to look into cost-saving measures for Medicaid; the group met 10 times and recommended some more legislative oversight of the program and its contracts, the Idaho Press previously reported.

Work requirements

Johnson said his group also had concerns about the proposed work requirements in the bill.

Gov. Brad Little had said in his budget that he wanted the Idaho Department of Health and Welfare to look into work requirements in the program as well.

Idaho in 2019 applied for a waiver from the federal government to be able to implement these work requirements; this waiver is still listed as pending, according to info gathered by KFF.

Under the Trump administration, the federal government approved 13 waivers for work requirements, but the Biden administration later withdrew these approvals.

The bill would like the health department to seek work requirements for able-bodied adults enrolled in Medicaid, requiring them to work, volunteer or participate in a work program at least 20 or more hours per week. There would be exemptions for those who are younger than 19, older than 64, medically certified as physically or mentally unfit for employment, pregnant, a parent or caretaker for dependent children younger than 6, a parent or caretaker for a child with a serious medical condition or disability, receiving unemployment compensation and complying with requirements as part of that system, or participating in a drug addiction or alcoholic treatment and rehabilitation treatment program.

The department would need to evaluate these exemptions to determine if someone is eligible.

Johnson, with the American Cancer Society Action Network, argues that implementing these requirements sets up red tape across access to health care and would create a burden of added bureaucracy on the department.

“If you have cancer, and trying to work and getting chemo, that to us is just really burdensome,” Johnson said. “And not just for folks who have cancer but it’s for their caregivers. And really, we’re just opposed to anything that puts a block on access to quality care.”

Redman told the Idaho Press that the health department would not need to successfully obtain the waivers requested in the bill, and would only need to show lawmakers that it had applied for them.

“We know that it may be hard to get those waivers, however, we want to apply for them,” Redman said.

The agency would need to report to House and Senate Health and Welfare committees within 30 days of submission, approval, rejection or withdrawals of federal waivers.

If conditions under the bill are not met by July 1, 2025, then Medicaid expansion would be repealed.

Coverage of transgender treatment and surgeries

The bill stipulates that no funds from Medicaid be used for “any gender reassignment procedures, including treatments and surgery” for residents older than age 18.

The Legislature last session banned transgender treatments and surgery for minors younger than 18 with HB 71; a federal judge temporarily blocked the law from going into effect while it is being challenged in court, the Idaho Capital Sun reported.

On May 1, 2023, Little sent a letter to the health department directing it to implement a policy that excludes Medicaid funds from going toward any of these treatments for adults as well as children.

Idaho is being sued in federal court over this policy, with the plaintiffs arguing it is discriminatory.

In June, a judge denied the state’s motion to dismiss the case. Idaho Legal Aid attorney Howard Belodoff, who is representing the transgender woman who brought the lawsuit, said he is still awaiting a decision on the case.

The bill introduced Monday states that if a court were to require coverage of these types of surgery or treatments for Medicaid patients, that “it shall still be considered a violation of the conditions of the state plan.”

Redman told the Idaho Press that, in this case, the health department would have the discretion to provide coverage, but it would still not be allowed under the state legislation. If the department were to comply with the potential court mandate, and provided coverage for this type of surgery, then it could potentially trigger a repeal of Medicaid expansion under the legislation. He said this case would probably be litigated because the laws would be in opposition to each other.

There are a number of other requirements and suggested waivers for the department to apply for in the bill, HB 419. The committee voted to introduce the legislation, which will pave the way for a public hearing on it later.

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 X @EyeOnBoiseGuido.