Idaho trailer bill could tweak Medicaid law

BOISE — Idaho’s Medicaid program may face unintended hurdles after Gov. Brad Little signed a bill into law Thursday.

There is an expected trailer bill, which is designed to follow and amend previous legislation, that will be proposed to address the concerns about HB 398, which requires the Medicaid Division to seek legislative approval to seek plan amendments and federal waivers to make changes to the program and services.

Little sent a transmittal letter Monday outlining his concerns about the bill, which went into law immediately after he signed it. He urged the passage of the trailer bill to clarify that work on changes that are underway can continue. He said he supported the goal of cost containment of the Medicaid program, but thought the language of the bill was “vague” and thought it could disrupt services.

“Imminent action by the Legislature is necessary to provide the state with clarity and confidence that legal authority exists to continue with program implementation,” Little wrote.

The state is required under federal law to submit plan amendments and waivers to the Centers for Medicare and Medicaid Services (CMS) for review and approval to adjust how the state administers the program.

The division is in the process of seeking waivers for some of its programs, including a state behavioral health plan update, which guides how the state provides mental health and substance use disorder treatment and services. There are also amendments that would ask for approval to provide direct payments to substance use and psychiatric residential treatment centers, and for reimbursement rate adjustments for providers and intermediate care facilities.

These programs and rate adjustments have been appropriated for in the division’s budget, but the way the bill is written caused several providers to worry that changes in the plan in process would need to be paused until the Legislature returns next year.

The division’s budget included a total of $65.8 million in state and federal funds for the provider rate adjustments, which were requested in response to the annual provider rate review process, according the the agency budget request; these funds go to pay for developmental disability and senior service providers.

The budget also included $6.3 million to increase the rate paid to licensed intermediate care facilities for individuals with intellectual disabilities. The “extraordinary rate,” which is an add-on payment above the daily reimbursement for caring for individuals with more complex health needs had been frozen at $11.13 an hour since 2011, according to the budget book. The agency asked to bring the rate up to $30 an hour.

Providers who would potentially be impacted expressed concern to Little and asked for the passage of a trailer bill.

The Idaho Health Care Association said in an April 5 letter to the governor that the “exact language is problematic.”

“There is no option to wait for a special session,” Idaho Health Care Association Executive Director Robert Vande Merwe wrote. “It must be fixed now!”

Vande Merwe said in an email that the organization had initially thought the bill wouldn’t interrupt programs until CMS did not fully approve a state plan amendment, “which requires (Idaho Department Health and Welfare) to send a new one with significant differences.”

“Rate increases to assisted living and intermediate care facilities approved by the legislature could be in jeopardy, depending on how the existing statute is interpreted,” Vande Merwe wrote. “An increase in federal funds for nursing facilities is also possibly at risk. We urge all legislators to please take the time to pass a trailer bill.”

Magellan Healthcare, Idaho Association of Health Plans, and a group of operators of skilled nursing facilities in the state also wrote letters to Little expressing concerns and supporting passage of a trailer bill.

Bill sponsor Rep. Megan Blanksma, R-Hammett, said she did not interpret the bill language in a way that warranted the concern, but she agreed to work on getting a bill introduced and passed when the Legislature returns today.

Blanksma noted that the bill has been around since it was introduced in mid-January and said she didn’t hear any of these concerns until right before the governor signed it. She said that introducing and passing a trailer bill in one day will be a significant challenge.

“It’s very last-minute,” she said. “I can do my best. I’m working in a best-faith effort, but it’s not just me, there’s 105 of us.”

During hearings on HB 398, only Christine Pasani, executive director of the Idaho Council on Developmental Disabilities, testified.

Pasani said at the Feb. 19 House Health and Welfare Committee hearing that the organization opposed the legislation because of concerns that it could delay processing complicated waiver requests and impact services.

“Adding steps to an already complicated process will only lead to service delays and harm to people that are in most need of support, including adults with intellectual and developmental disabilities,” Pasani said at the meeting.

Blanksma at the hearing said “the Legislature needs to be more active in its oversight” of the health agency “due to their, at many times, overreach without policy to back them up.”

She also said she found the state has never had to do a waiver request within 12 months, so there wouldn’t be an emergency situation that might require approval before the Legislature meets for session.

The Department of Health and Welfare and the governor’s office declined to comment.

The bill passed 58-10, with two absent in the House, and 27-6 with two absent in the Senate. Only Democrats voted against it in both chambers.

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.