By Melissa Davlin, Idaho Reports
The Idaho Department of Health and Welfare has formally requested a written legal opinion on whether the state can continue providing certain Medicaid programs.
In an April 23rd letter to Chief Deputy Attorney General Phil Broadbent, IDHW interim director Dean Cameron outlined 26 Medicaid programs and benefits that a new Medicaid cost containment law may affect or delay, including extended postpartum coverage for new mothers, the Children’s Health Insurance Program, behavioral health centers and programs, residential treatment for minors in foster care, and the Tribal Community Health Aide Program. While many of those benefits have been in place for years, the federal government requires periodic updates and amendments.
IDHW is requesting that the attorney general’s office provide a written analysis for each of the pending waivers, and to provide guidance on whether the governor needs to call a special legislative session to clarify the new law.
The Legislature passed H 398 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 Medicaid 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.
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 and disrupt payment and approval for other services.
While legislative counsel disagreed with Little’s assessment, as new laws aren’t typically applied retroactively, Cameron pointed out in his letter that a number of new and existing programs have pending waiver updates.
“H398’s enactment created immediate concerns that the Department no longer possesses legal authority to seek and implement (Medicaid) waivers and amendments that are necessary to execute pending programs and fulfill current stakeholder and legislative expectations,” Cameron wrote, pointing out that the ongoing uncertainty may undermine the state’s efforts to contain Medicaid costs.
Cameron provided a chart outlining each of the 26 pending waivers IDHW has identified. Some are minor, like updating the definition of family size or making changes to existing plans to comply with new federal acts. Other pending waivers have bigger implications, like a request to provide an extended 12 months of postpartum coverage through Medicaid after the legislature approved the additional coverage this year. Another waiver would shift Idaho Behavioral Health Plan benefits, like psychiatric residential treatment, from the Division of Behavioral Health to Medicaid to expand the availability of those services.
Some of the pending waivers deal directly with cost containment, such as a new contract for recovery audits to identify over- and underpayments.
In his letter, Cameron asks the attorney general’s office for guidance on whether the legislature needs to come back for a special session to clarify the new law.
Earlier this month, Little cited several potential disruptions the new law may cause, 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. The Legislature adjourned without passing a trailer bill to clarify the bill’s effects, and legislative majority leaders have since said they don’t believe the clarification was necessary.