by Logan Finney, Idaho Reports

Lawmakers on the House Health and Welfare Committee advanced a bill on Monday that would require legislative approval of any future waivers or amendments to how Medicaid operates in Idaho.

“This is a really straightforward bill,” said Rep. Megan Blanksma, R-Hammett. “This is not retroactive, so existing waivers and state plan amendments will stay in place.”

The proposed move comes as Republican lawmakers seek to limit growth in the state Medicaid budget, as well as tighten their leash on the Idaho Department of Health and Welfare.

Medicaid oversight

“There’s been two policies that have been set by attempting waivers through the Department of Health and Welfare without coming through the Legislature. One is for home visitations that they attempted. The other was services for pregnant women,” Blanksma said. “Now, regardless of how you feel about what those waivers are and whether you find them valuable or not, the fact was all of them had fiscal consequences to the state of Idaho and were run through the department without any legislative oversight.”

IDHW director Dave Jeppesen retired at the end of the year amid disputes between the department and the legislature over audit findings describing flaws in how a certain grant program was distributed. While that program is not related to Medicaid, it is an example of the ongoing tension between the branches.

“We have seen over the years that the Legislature needs to be more active in its oversight of Health and Welfare due to their, at many times, overreach without policy to back them up,” Blanksma said.

Idaho Council on Developmental Disabilities executive director Christine Pisani spoke in opposition to House Bill 398.

“This proposed legislation will add unnecessary steps to an already complicated process,” Pisani said.

Pisani expressed concern at lawmakers wading into the most complex parts of Medicaid policy, and she said that waiver applications often see several iterations between input from public hearings as well as negotiations with the Centers for Medicare and Medicaid Services.

“There are a number of questions related to how the Legislature will respond to short-timeline waiver and plan amendments throughout the year,” Pisani said. “What if, through the course of public comment or CMS review, Idaho is required to make changes to the application? How will that work with this legislation?”

Blanksma, however, largely dismissed concerns over timelines and hypothetical special sessions.

“There’s never been any instance where they would have less than 12 months to do any sort of emergency waiver, so there’s plenty of time for the Legislature to review it,” Blanksma said.

Immunization notifications

The committee on Monday also approved House Bill 438 from Rep. Dori Healey, R-Boise. That bill would require school districts to “describe that immunizations are not mandatory and may be refused on religious or other grounds… in any communication to parents and guardians regarding immunization.”

Idaho law states that an immunization record for children is required upon school admission, but also includes broad exemptions and states that vaccines are not mandatory. Healey said in communications with parents, some schools have referenced one section of the immunization code but not the other.

“They’re providing half the story, and I’m seeking to provide transparency and complete information,” Healey said. “If schools wish to send out immunization requirements and cite this code, I’m asking them to cite the complete code.”

The committee advanced both HB 398 and HB 438 on party lines for a vote on the House floor.

New legislation

The committee also introduced a new bill from Rep. Jacyn Gallagher, R-Weiser, which would clarify that students can exempt themselves from vaccine requirements at all secondary and post-secondary schools in the state if they are over the age of 18.

Rep. Jordan Redman, R-Coeur d’Alene, presented an additional bill for introduction that would establish parameters and standards in state law for pharmacy benefit managers.

“This has become a very hot topic nationally due to some unfair business practices by some PBMs,” Redman said. “This bill offers an Idaho solution to many of the issues that we’ve seen by adding transparency, limiting patient steering, and providing better access and patient care.”

The two newly introduced bills, HB 597 and HB 598, must receive public hearings to move forward.

---