Two Idaho Medicaid funding bills fail

BOISE — A nearly yearlong effort to tap counties for a portion of Idaho’s Medicaid expansion costs was on life support Friday, after two proposals died and a third, last-minute option was introduced.

With less than a week remaining in the 2020 session, only one of the three measures has had a public hearing.

That bill, sponsored by Rep. Britt Raybould, R-Rexburg, puts counties on the hook for 30 percent of the state’s share of Medicaid expansion costs, or about $12 million annually.

It also phases out the county medical indigency program and state catastrophic health care program, which together serve as the “payer of last resort” for Idahoans who otherwise can’t afford medical treatment.

The bill had an initial public hearing in the House Health and Welfare Committee on March 6. Lawmakers postponed action for a week; when the bill came back up Friday, the committee immediately killed it on a unanimous voice vote, with no discussion.

“I was stunned,” said Rep. Mike Kingsley, R-Lewiston, who sits on the committee. “I was trying to decide which way to go. I wanted to hear (the debate).”

Health and Welfare Chairman Fred Wood, R-Burley, said “there weren’t enough votes to get the bill out of committee, and apparently there weren’t enough votes to move forward with (an alternative) health district proposal.”

Republican lawmakers have insisted for months that counties pay for at least a share of Medicaid expansion — a position they’ve held ever since voters approved the program by initiative in 2018.

Democrats object to the effort, saying it simply punishes counties for supporting the initiative. Republicans, however, characterize it as an attempt to prevent a local government “windfall,” given that counties will save upward of $20 million in indigent care costs because of Medicaid expansion.

Whatever the case, the joint budget committee left an $8.5 million “hole” in next year’s $3.1 billion Medicaid Division budget, with the intent that it be plugged by funding coming from the counties.

Raybould’s bill grabbed a bit more than that. She’s worked on the legislation since last summer, when she served on an interim committee that was tasked with examining this specific issue.

Wood, however, noted that her plan was “very complex and difficult to understand.” It billed each county based on the number of residents who were enrolled in the expansion program. It also eliminated almost three dozen sections of state code.

The bill “just never picked up steam,” he said.

The state’s 10 percent matching share of Medicaid expansion costs is estimated at about $40 million; the federal government would cover the remaining 90 percent.

Wood had a second, indirect approach to tapping counties for a share of those costs. He would have absolved them of any responsibility for Medicaid expansion, leaving the state to pay the full freight. In return, the state would no longer contribute any funding to county health districts.

“Right now, the state funds about 16 percent of the health district budgets, or about $10.5 million,” he said. “The counties would need to backfill that amount.”

Wood was scheduled to introduce that bill Friday morning, but pulled it back. Given the ongoing concerns about the COVID-19 virus, he said, people were a bit leery about meddling with health district funding.

At that point, after the morning meeting, it looked like the Republicans’ yearlong effort to tap counties was all for naught.

However, a third proposal was introduced during a hastily announced afternoon committee meeting. It grabs 17.5 percent from the counties’ share of the state sales tax distribution and puts the money into a Medicaid Expansion Fund.

That would amount to about $12 million per year at present, but it would increase as gross sales tax collections grow.

It’s possible the bill could still be approved this session, but given the late date — with House and Senate leaders pushing for a midweek adjournment — the opportunity for public input and public scrutiny will likely be severely limited.

Spence may be contacted at bspence@lmtribune.com or (208) 791-9168.