By Ruth Brown, Idaho Reports
Providers and advocates for disabled Idahoans remain concerned about the passage of a Medicaid waiver bill and how vague language could prevent funding implementation.
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 contained an emergency clause, putting it into effect immediately upon signing.
But according to Gov. Brad Little’s April 8th transmittal letter to the House of Representatives, the bill has vague language that could immediately halt the distribution of $70 million in rate increases.
Christine Pisani, Director of the Idaho Council on Developmental Disabilities, said implementing rate increases was a high priority for her office this year, and expressed concern that the bill would jeopardize those rate adjustments. In a Friday interview with Idaho Reports, Pisani pointed to the Office of Performance Evaluation’s 2023 report on the direct care workforce shortage and the payrates for direct care workers.
Low Medicaid reimbursement rates affect how much providers are able to pay employees, and those businesses have long struggled to hire enough direct care workers to meet the state’s needs. OPE found in 2023 that the state needs about 3,000 more direct care workers to meet national staffing levels to serve disabled Idahoans.
“There is a direct relationship between the rate increase and being able to address the workforce shortage,” Pisani said.
Pisani’s organization opposed H 398 in committee in both the Senate and the House. If there isn’t a trailer bill by July 1, she’s worried about what that means for disabled people.
“We are concerned about all of the provider rate increases that we worked so hard to get this session,” Pisani said. “We are concerned that they aren’t going to go into effect.”
That’s an alarming prospect for organizations like the Living Independence Network Corporation Idaho, which supports disabled Idahoans who want to live in their homes. LINC employs nearly 300 direct care workers across about 30,000 square miles.
Jeremy Maxland, executive director for LINC, told Idaho Reports that if the Legislature wants to approve every potential Medicaid amendment, rate increases could be delayed by a year.
“A year is a long time,” Maxland said. “It’s really kind of alarming. It is a colossal effort to educate lawmakers about the innerworkings of these programs.”
Little’s transmittal letter 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.
The Idaho Behavioral Health Plan’s amendments for behavioral health services and residential treatment centers for substance abuse and psychiatric disorders will also be immediately stopped, according to the transmittal letter.
Even without the vague language, some stakeholders have concerns about the intent of the bill. Mel Leviton, executive director for the Idaho State Independent Living Council, told Idaho Reports that getting a Medicaid waiver is already a complicated, arduous process. She worried that the new law could create logistical challenges by mandating legislators approve waivers.
“There’s a 30-day public comment period in which there’s generally very little public comment,” Leviton said about the current waiver process. “But it’s open to the public. I catch myself wondering why there isn’t more opportunity from the legislators (at the meetings).”
On Friday, Senate President Pro Tempore Chuck Winder, R-Boise, told Idaho Reports that he did not believe there needed to be a special legislative session to address the issues with the Medicaid waiver bill, and that the state should be able to continue payments to providers.
To see the full interview with Sen. Winder, watch Idaho Reports on Idaho Public Television at 8 p.m. Friday.
Little has not ruled out a special legislative session. In a Thursday statement, spokesperson Madison Hardy said the office is consulting with the attorney general for more guidance.
Maxland argues that one the most important things his organization does is help with cost control to the state by keeping disabled people out of institutions. He hopes the legislature can come back and add a trailer bill to address the uncertainty.
“Actual, real people’s lives depend on it,” Maxland said.
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.