Idaho counties would end up paying about half the cost of Medicaid expansion next year, under proposals being considered by an interim legislative committee.

The awkwardly named Equitable Assessment of Costs Related to Medicaid Expansion interim committee met for about six hours in Boise on Friday. Although no final decisions were made and various ideas were considered, most options involved tapping counties for a significant share of Medicaid expansion costs.

Idaho voters approved the Medicaid expansion initiative last fall. It raised income eligibility limits for the program from 100 percent of the federal poverty limit to 138 percent. The federal government will cover 90 percent of the program costs; Idaho’s 10 percent share is estimated to cost $42 million next year, rising to $58 million by 2030.

Rep. Megan Blanksma, R-Hammett, presented a tentative proposal Friday that would reduce the state sales tax distribution to counties, while simultaneously eliminating the state and county medical indigency programs. The basic idea is that, if counties no longer have to cover medical expenses for indigent citizens, they can slash their budgets by a corresponding amount and won’t need as much state funding.

“This is a series of ideas that attack the problem from a different angle,” Blanksma said Friday. “We’re just throwing it up in the air for future discussion.”

Rep. Fred Wood, R-Burley, offered a similar plan. Although it technically wouldn’t eliminate the medical indigency programs, it eliminates eligibility for anyone earning more than 138 percent of the federal poverty level.

It also charges counties a quarterly assessment, based on the number of residents who enroll in expanded Medicaid. The assessment would be paid out of county indigent levy funds; it would raise about $20 million per year, based on an initial enrollment of 91,000 people.

“This is a very simple bill,” Wood said. “It just answers two questions: How do we pay for Medicaid expansion, and (who) will be eligible for indigent health care after expansion takes effect?”

Counties currently spend about $20 million annually on indigent medical costs. The state spends another $21 million or so.

“To pay for expansion, we need $42 million in (fiscal year) 2021 and $58 million by 2030,” Wood said. “Where do we want that money to come from? That’s the first charge for this committee.”

Sen. Jim Rice, R-Caldwell, who is co-chairman the interim committee with Wood, repeatedly encouraged committee members to offer different ideas for consideration.

“Today is a discussion day. It’s a day for brain-storming,” he said. The Wood and Blanksma bills “aren’t presented as bills. They’re presented for the purposes of discussion. We’re here to kick the tires and think about (options).”

The tire-kicking only extended so far, though. When Madison County Commissioner Todd Smith asked about the possibility of a state sales tax increase, Rice quickly shut him down.

“Has the question of raising the sales tax by a quarter of a percent been discussed, or will it be?” Smith wondered.

“I don’t think a tax increase is something on the horizon,” Rice replied.

Democrats pushed back against the direction the committee seems to be going. For example, Sen. Maryanne Jordan, D-Boise, questioned “whether accessing county funds for a state initiative is something we should do.”

Given the expected reduction in county indigent expenses once expansion takes effect, she said, “I think they would take advantage of the opportunity to reduce the (property) tax burden on their citizens.”

Following the meeting, Democratic leaders issued a news release accusing the Republican majority of trying to “punish” counties for supporting the Medicaid initiative.

Another funding alternative the committee reviewed Friday was to use the Millennium Income Fund to pay a portion of the Medicaid expansion costs.

The account receives about $18 million per year in funding related to the 1998 Master Settlement Agreement with the tobacco firms. The money has historically been used for various tobacco cessation and substance abuse treatment programs, but there’s no legal obligation for that to continue. Some lawmakers see it as an appropriate source for Medicaid matching dollars.

Rice encouraged committee members to keep “kicking the tires” for another month. During their next meeting Sept. 13, they can decide which of the various options deserve further study.

“We need to make a serious recommendation that’s going to work, and that’s practical,” he said.

Spence may be contacted at or (208) 791-9168.

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