By Ruth Brown, Idaho Reports
A bill passed by the legislature and signed into law by Gov. Brad Little regarding Medicaid waivers could present legal reimbursement issues for providers that accept Medicaid.
H 398 is intended to reduce Medicaid costs and provide more oversight by requiring legislative approval of waivers and state plan amendments. Waivers are granted when the state agrees to waive some program requirements to meet the needs of individuals in a certain group, such as those at risk of being institutionalized without home care, or developmentally disabled people. The bill contains an emergency clause, putting it into effect immediately upon signing.
But according to Little’s transmittal letter to the House of Representatives, the bill is problematic.
“I support policy that ensures the Legislature is a meaningful partner with the executive branch in our shared goal of Medicaid cost containment,” he wrote in the April 8th letter. “However, this bill contains vague language that, when coupled with the emergency clause, will immediately result in harmful disruption to the delivery of services to thousands of Idahoans.”
Little cited several potential disruptions, including approval to pay up to $40 million to 149 skilled nursing facilities, $70 million in rate adjustment distributions for 1,406 providers and care facilities, and pending approval of $4 million for personal care services management affecting 287 organizations.
It isn’t clear why Little signed the bill after citing those concerns.
“Governor Little fully supports and remains committed to delivering critical Medicaid services to vulnerable Idahoans, such as the behavioral health services he advocated for last session,” said Madison Hardy, Little’s press secretary. “Idaho citizens can be assured Governor Little will exhaust all options, including potentially calling a special session as needed, to ensure critical services move forward.”
“The stated intent of the Legislature does not match the vague and unclear plain text of House Bill 398,” Hardy said. “There were multiple versions of a trailer bill that the Governor’s Office felt addressed the issue. In the end, no trailer bill was introduced. The Governor’s Office and DHW will work closely with Office of Attorney General and other legal counsel on how to navigate the challenges of interpreting the ambiguities of House Bill 398.”
On Wednesday morning, the legislature did draft an amendment to the bill, stating the provision of their bill shall not affect programs “statutorily authorized, in the process of being implemented, implemented, or subject to renewal.” But lawmakers never introduced the draft before the Legislators adjourned Sine Die later in the day.
That may prompt a special legislative session.
“Unless the issues are sufficiently addressed in a trailer bill, it is possible the Legislature may be required to return frequently for special sessions to ensure compliance with the law,” Little wrote in his transmittal letter.
In a Wednesday afternoon press conference, House Speaker Mike Moyle, R-Star, put the blame on the Senate, saying there wasn’t yet a path forward.
“Hopefully we can make things work until we get here next year and fix it,” Moyle said. “There’s not a total agreement between everybody, so when you have that dynamic where there’s not an agreement and it’s the last day of session, it’s hard to get anything done.”
When asked if he anticipated having to come back for a special session, Moyle said he wasn’t sure. “I don’t know yet, because I think there’s not unanimity on what we need to do, or how bad the problem is, or if there even is a problem,” he told reporters.
Democratic leadership from both the House and Senate disagreed.
“Why is there such a fight over this bill and why can’t the majority party get it together to make sure that nursing homes, elderly people, to make sure these payments are coming and being paid for?”’ said Senate Minority Leader Melissa Wintrow, D-Boise, on Wednesday. “…We have to put political posture aside and think about the health care of our citizens. The bigger question here is why is there such a fight?”
Wintrow argued the Legislature approves waivers already, making the bill unnecessary.
“We certainly anticipated this was going to be a big problem,” said House Minority Leader Ilana Rubel, D-Boise, said about the bill. “I believe every member of our caucus voted against it, seeing that it was going to create real problems. Unfortunately, there were not enough of us to stop it in the first place. I think the next question is why did the governor sign it? Because by the time it reached his desk I think initially maybe our colleagues across the aisle didn’t realize the scope of the problem it was causing, but that certainly had become clear by the time it got to the governor’s desk.”
Rubel said she was under the impression there would be a trailer bill, even on Wednesday.
“I suspect we very well may get called back,” Rubel said.
The Idaho Department of Health and Welfare referred Idaho Reports to the Governor’s Office for comment on H398.
Ruth Brown | Producer
Ruth Brown grew up in South Dakota and her first job out of college was covering the South Dakota Legislature. She’s since moved on to Idaho lawmakers. Brown spent 10 years working in print journalism, including newspapers such as the Idaho Statesman and Idaho Press, where she’s covered everything from the correctional system to health care issues. She joined Idaho Reports in 2021 and looks forward to telling stories about how state policy can impact the lives of regular Idahoans.