by Kyle Pfannenstiel, Idaho Capital Sun
September 15, 2023
Idaho Medicaid’s program has asked to add 60 employees, which would grow the program that serves about 400,000 Idahoans on Medicaid to 273 employees.
The request, in the Idaho Department of Health and Welfare’s fiscal year 2025 budget request submitted to Gov. Brad Little, comes while the program’s staff count remained stagnant in recent years, despite Medicaid expanding two years ago to include a broader range of low-income earners.
Idaho Medicaid Director Juliet Charron told the Idaho Capital Sun in an interview she recognized that Medicaid needed more staff when she started in late 2021, but the Department of Health and Welfare must look across the entire agency for budgeting needs.
“It has not been until this budget request that we felt like we could prioritize this type of staffing request because we simply had other priorities we had to put forward,” Charron said.
The ongoing funding request for more staffing — a total of $5.7 million — asks for $2.77 million from the state’s general fund and nearly $3 million in federal funds, the request said.
“Due to the complexity and volume of its work, Medicaid is significantly challenged to remain compliant with federal and state requirements and manage day-to-day operations,” the request said. “We struggle to find capacity for innovation and cost-containment efforts to ensure sustainability and evolution of the program.”
The staff requested will focus on “compliance, increased efficiency including cost containment efforts, and enhanced customer service for providers and participants,” the request said.
In 2022, when the Office of Performance Evaluations published a report on Medicaid’s rate-setting practices that identified a staffing shortage, Medicaid had 17 fewer positions than it did in 2009, the report said, while Medicaid enrollment rose more than 75% and benefit spending about 125% since then.
“… Staff move from crisis to crisis while less urgent work is neglected,” the report said of Idaho’s Medicaid program.
“The Medicaid program is highly complex and is constantly evolving based on federal and state requirements,” the request said. “The Division’s business processes, infrastructure, and current resources are strained to successfully manage the day-to-day operations of the program, innovate toward more efficient operations including cost containment efforts, and respond timely to the needs of stakeholders.”
Idaho Medicaid base budget ‘stabilizing’
Medicaid requested $4.6 billion in total funds for fiscal year 2025, which begins July 1 2024. The program estimated its actual expenses for fiscal year 2023 are $4.36 billion, down from $4.7 billion appropriated to the program.
Medicaid is also planning to give back the state an estimated $92 million reversion of unneeded general funds, Charron said.
“It is funds that we did not need because we had so much in federal funds that created a lesser need for general funds,” Charron said, adding that the state received a higher federal matching rate for the program, has disenrolled people from Medicaid and has a delayed start date for the new Idaho Behavioral Health Plan contract.
While she said the program’s overall base budget does not appear to be shrinking, it is “stabilizing.” The program’s use of general funds has been stable the past few years, she said.
The request for funds for 60 new employees also includes a request to retain two employees already hired.
“If the request is not funded, the Division of Medicaid risks a disallowance of federal matching funds, thus increasing the need for state general funds to sustain the program,” the request says. “The Division will continue to be compromised in its ability to better support cost-containment efforts and the evolution of the program,” and in customer service.
The budget request, like all Idaho state agency budget requests, must go through Gov. Brad Little for a recommended budget to the Legislature. The Legislature’s budget committee, called the Joint Finance Appropriations Committee, would consider the request and propose their own budget.
“The Governor’s Office is currently evaluating agencies’ budget requests, and Governor Little will reveal his budget recommendations to the Legislature during his State of the State and Budget Address in January,” said Gov. Brad Little’s Press Secretary Madison Hardy.
Medicaid is funded primarily through the federal government. Idaho pays $1.5 billion of Idaho Medicaid’s total $4.7 billion budget. The federal government pays $3.1 billion. In Idaho Medicaid’s latest request, the federal government would pay about $3 billion of the program’s costs.
The program grew by more than 100,000 enrollees after expansion, Charron said. Approximately 121,000 people were removed from Medicaid as the state unwinds from pandemic-era protections that required states to not remove people from the program. But she said “we have seen growth in the program overall as the state’s population has grown.”
Most of the people removed from Idaho Medicaid during unwinding were “lower utilizers of Medicaid services,” Charron said, while the people who remain on Medicaid are higher utilizers.
Office of Performance Evaluations identifies needs for more Medicaid staff
The Office of Performance Evaluations report acknowledged the program’s growth despite lower staff counts.
“The Legislature should not expect dynamic management from a division with fewer staff, more than twice the benefit spending, and nearly twice the enrollment of 2009.”Office of Performance Evaluations report
Lacking administrative staff, the Office of Performance Evaluations report said that “some of the (Medicaid) division’s highest-paid and most specialized employees” often conducted tasks like recording meeting minutes.
“More than a decade of our reports, spanning several division administrators, suggest that the division’s management problems will not be fixed without the Legislature investing in sufficient capacity at the division to successfully implement what they have been asked to do,” the report said. “We recognize that Medicaid is a program with many conflicting priorities, from cost containment to provider network expansion. Whatever the priorities, the division does not have the capacity to implement all of the things they are asked to do well.”
Citing the OPE report in its request, the Idaho Department of Health and Welfare wrote in its budget request that “Medicaid does not have the personnel authority to successfully administer day-to-day operations and innovate.”
“Medicaid is not becoming a simpler program,” Office of Performance Evaluations Analyst Ryan Langrill, who worked on the report, told the Idaho Capital Sun in an interview. “And if we want the Medicaid program to succeed, the hope is that this staffing request will frankly cut down on the need for future program failures that led to OPE projects.”
Charron said the year will be a “reset” for Medicaid. Post-pandemic and post-unwinding, it will become clear how many people are on Medicaid, she said.
“We have pandemic, we have changes to per unit cost from policy decisions, inflation, appropriations were made. … We’re in this new chapter of Medicaid after the pandemic. And we need to let the cards play out and the dust settle to see what our budget will look like going forward,” she said.
Kyle Pfannenstiel | Idaho Capital Sun
Kyle Pfannenstiel is a reporter for the Idaho Capital Sun, focusing on health care. He previously worked as media relations manager at University of Idaho and previously covered rural health care and COVID-19 throughout eastern Idaho for the Post Register newspaper as a 2020-21 Report for America corps member.