House H&W committee recommends Medicaid expansion stay in place

By Melissa Davlin, Idaho Reports

The House Health and Welfare Committee has recommended Medicaid expansion stay in place – with some caveats.

Idaho Code 56-267 requires the Health and Welfare committees in both the House and Senate to submit a letter with recommendations as to whether Medicaid expansion should remain in effect. The deadline to submit those letters was Jan. 31. 

As of Tuesday afternoon, the Senate Health and Welfare Committee had not yet submitted its letter.

“Although the committee has serious concerns regarding the unsustainability of the current increased budget request, we concluded Medicaid Expansion should remain in effect,” wrote House Health and Welfare Committee chairman John Vander Woude, R-Nampa.

The letter gives six recommendations:

• People no longer eligible for Medicaid expansion should be notified and removed from the program by July 1, 2023.
• The department must submit a revised budget request accounting for the removal of ineligible participants. 
• The Idaho Department of Health and Welfare must submit a waiver to the federal government asking that people with a household income between 100% and 138% of the federal poverty line be given the option of using either the Idaho insurance exchange or Medicaid.
• The department must also submit a waiver, if necessary, to place the expansion population on managed care.
• The department must report to the committee on the implementation of the recommendations in 2024.
• The committee must re-evaluate Medicaid expansion during the 2025 legislative session.

The recommendations come two weeks after Idaho Health and Welfare director Dave Jeppesen presented the $4.7 billion Medicaid budget to the Joint Finance Appropriations Committee, and a week after the Division of Medicaid presented to both the House and Senate Health and Welfare Committees. 

During those presentations, IDHW officials fielded multiple questions about the rising Medicaid budget, as well as the state’s inability to remove people from Medicaid expansion who no longer qualify. 

Currently, about 145,000 of Idaho’s 450,000 Medicaid participants are enrolled under Medicaid expansion. Expansion allows people younger than 65 years old who are under 138 percent of the poverty level to enroll in Medicaid. Juliet Charron, administrator for IDHW’s Medicaid Division, told lawmakers last week that Medicaid expansion participants have a lower utilization rate for services than adults enrolled under traditional Medicaid programs, and that the main drivers for the increased budget are rising costs of care, increased case loads, and rising fee schedules.

As part of the federal COVID-19 public health emergency, states weren’t allowed to remove anyone from Medicaid, even if they no longer qualified for the program. Congress recently decoupled that provision from the public health emergency, and states can start removing unqualified people from Medicaid beginning April 1. 

Starting this month, IDHW is re-evaluating approximately 150,000 Medicaid participants with whom they haven’t had recent contact to see who is no longer eligible because of increased income levels, out-of-state moves, or other factors. Jeppesen had told the budget and health and welfare committees that he hoped the department would finish the audit by August 2023. The recommendation from the House committee would move that target up to the start of the state’s fiscal year on July 1. 

Under Medicaid expansion, the federal government pays 90 percent of the costs for care, while the state picks up the rest of the tab; The public health emergency temporarily increased the federal share. Nationwide, Medicaid enrollment went up 28 percent in two years, partly due to continuous enrollment and partly because of economic conditions during the beginning of the pandemic. 

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