The Idaho House today voted down the state's $4,691,777,000 Medicaid budget.
The rejection is not necessarily a huge surprise. The nearly $4.7 billion proposal is about a 17% increase from the previous year. While most of that comes from the federal government, the state portion continues to grow which is giving some legislators heartburn.
It's been five years now since Idaho voters approved a ballot measure adopting Medicaid expansion. As we've previously written, the promises of the expansion went out the window a long time ago. The latest numbers show enrollment is more than double the projection - more than 1 in 4 Idahoans are now enrolled. There were also at least 83,000 ineligible enrollees reported in January 2021. These enrollees do not meet traditional eligibility standards, but state officials are unable to remove them from the program because of the congressional handcuffs. There were state-sought waivers to make changes to the program for the betterment of Idaho. Four were requested, and only one has been approved. In the last legislative session, legislators increased the state’s Medicaid budget. And it’s also now the state’s largest agency budget. The House Health and Welfare Committee has made a recommendation that Medicaid expansion stay in place, at least for now. The committee said it had "serious concerns" about the program at the present time, including the “unsustainability of the current increased budget request.” So what should have been done? We laid out some ideas here, courtesy of the Foundation for Government Accountability. One of the recommendations was to remove previously ineligible enrollees. It appears at least that part is being addressed and the timeline to do it is being moved up. And re-evaluating the program again in 2025 is also a good thing. In addition to concerns about the cost of the program, Medicaid coverage can be extremely limiting. Not only do providers run into billing problems, but reimbursement rates are also extremely low. Many health care providers will only take a limited number of patients. So, while citizens may have coverage, it might not mean much.
The budget now goes back to the Idaho Legislature's Joint Finance-Appropriations Committee.