House committee now proposing Medicaid expansion repeal

BOISE — The chairperson of the House Health and Welfare Committee is now proposing to repeal Medicaid expansion in Idaho.

The legislation comes just over a week after the committee submitted its recommendation that the program stay. The committee voted to introduce the legislation, with only the three Democrats voting against it.

Rep. John Vander Woude, R-Nampa, introduced the legislation Friday morning to the health committee, saying he received new information since submitting the letter that led him to changing his mind.

“In conversations that I’ve had, I think we need to take a real good look at what this program is costing us and what benefits we’re getting out of it,” he told the committee.

Medicaid expansion, approved by Idaho voters in 2018, opened the program to adults without disabilities who make too much to qualify for traditional Medicaid health coverage, but not enough to qualify for subsidies on the state’s health care exchange set up by the Affordable Care Act. Per statute, the program is now up for its five-year review by the Legislature.

House Minority Leader Ilana Rubel, D-Boise, said she usually votes to introduce legislation so it can get a hearing, but said she felt she couldn’t support this proposal.

“This one I cannot,” Rubel said. “I just think the damage done and the anxiety caused to hundreds of thousands of Idahoans who rely on this coverage, and the undercutting of what I thought was the fairly clearly expressed will of this committee was that we not do this this year. … I think there’s a lot of things on the table right now and I just can’t get behind introducing this into the discussion right now.”

Vander Woude said he made the recommendation that the program stay under the assumption that its costs would go down significantly once the public health emergency order was lifted and the Department of Health and Welfare could remove people from the program who became ineligible but couldn’t be removed during the emergency order per federal law.

Idaho Division of Medicaid Administrator Juliet Charron told the committee in a meeting last month that the agency anticipates around 67,000 participants are potentially ineligible and could be removed.

Vander Woude said he initially thought there would be more cost savings from this process.

“We’d have less people on, but the budget would be the same, that’s why I think we need to take a closer look if that’s really the case,” Vander Woude said in an interview.

There are approximately 145,000 participants in Medicaid expansion as of January.

For fiscal year 2024, the division of Medicaid is requesting around $67.4 million from the state general fund for the program, which is a reduction from the previous fiscal year’s expenditure of about $68 million.

However, total spending on the program is expected to increase because of increased federal and dedicated expenditures.

The budget request includes $803 million in federal funds for the program. Fiscal year 2023 federal spending on the program totaled around $778 million. For every dollar spent in the program, 90 cents comes from the federal government, Charron said. The agency is also requesting $20.9 million in dedicated funding for the program, up from $17.5 million in fiscal year 2023.

Charron told the committee that most of the increased costs come from requirements around supplemental payments to hospitals, called the upper payment limit, and an update to the fee schedule.

The upper payment limit supports Medicaid-participating hospitals by paying the difference between what Medicaid paid and what Medicare would have paid; this is paid for with federal and dedicated funds, Charron said.

Rep. Mike Kingley, R-Lewiston, said he supported moving the legislation on to start the discussion on Medicaid’s costs.

“I think it’s really important that we get the eyes open to just exactly how expensive Medicaid is and how our Medicaid expansion (is) and what it’s going to be like in the future,” Kingsley said.

In Charron’s presentation, she said the agency estimates the state would spend around $10 million more than if expansion were not in place because of increased costs associated with indigent patients, hospitalizations, behavioral health crisis centers and substance use disorder services in jails.

If Vander Woude’s proposal is passed, it is expected to save around $58.4 million in state general funds, according to the fiscal note. It estimates a total savings of around $842 million, which includes dedicated and federal money.

Vander Woude opposed Medicaid expansion when it went to the voters, and in 2019, he sponsored legislation that would have added work requirements to the program.

The bill will be up for a full hearing in the committee. If passed, it would go into effect July 1.

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.