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What to do about Idaho's troubling Medicaid expansion

Updated: Jul 21, 2023

The damaging consequences of a bad policy can develop quickly.

It has been four years now since voters in Idaho passed Medicaid expansion via ballot measure in a campaign pushed by Reclaim Idaho. It has been two years since the program was implemented.

What are the results?

There were promises of limited enrollment – 60,000. The latest numbers show more than double the projection and more than 1 in 4 Idahoans now enrolled.

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.

And what about those who are using the program? As a new Foundation for Government Accountability report indicates:

In Idaho, there were 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. If the trend continues, there could be hundreds of thousands of additional ineligible Medicaid enrollees. These ineligible enrollees would come with a monthly price tag of tens of millions of dollars—a figure that will only continue to grow as the public health emergency is prolonged.

The Medicaid expansion is costing taxpayers more, too. In the last legislative session, legislators increased the state’s Medicaid budget. And it’s also now the state’s largest agency budget.

It’s not as if there were no other options. Before Medicaid expansion in Idaho, those who were eligible could join the Your Health Idaho program and get “advance premium tax credits” to help reduce their insurance costs.

Medicaid coverage, on the other hand, 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.

How can lawmakers begin to rectify the situation with Medicaid? The FGA suggests:

Idaho lawmakers should opt out of the handcuffs by rejecting the additional federal funding. This would allow state officials to regain control of their Medicaid program and begin the process of removing ineligible enrollees. The Medicaid program was designed with the truly needy in mind, but while the handcuffs remain in place, the truly needy are shoved to the back of the line. If Idaho wants to regain control of its Medicaid program, and reprioritize those it was intended to serve, the first step is to remove the Medicaid handcuffs.

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