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In the world of social programs, Medicaid is one of the hardest to understand. It’s something of a catch-all program for low-income people, covering broad and divergent needs. Included are healthy children and adults with eligible dependent children, people with disabilities or special health needs, and the elderly. Eligibility is income-based and it varies according the category of qualification for the program.During the state’s 2011 fiscal year, more than three quarters of the funding allocated to the Department of Health and Welfare’s budget went to Medicaid. The program received about $1.55 billion in federal and state funding, with 74 percent of those dollars coming from the federal government.Enrollment in Idaho’s Medicaid program has grown substantially in recent years. The average monthly Medicaid enrollment was fairly stable between 2006 and 2008. It grew by about 3.5 percent. But in the last three years, the program’s enrollment has grown nearly 21 percent. Ballooning from about 185,000 in 2008 to 228,897 in 2012.

Medicaid For Idaho Hopes Its Message Can Overcome Ballot Access Laws

It’s a brisk afternoon in January as canvassers hit Boise’s North End. Their goal? Roughly 56,000 signatures to expand access to Medicaid in Idaho.

It’s a popular proposal in this liberal neighborhood, but the Republican-dominated legislature has pushed back against the idea for years.

Medicaid for Idaho volunteer Joe Goode isn’t running into much resistance.

“God, people in the North End are just so nice. It makes it so easy. You just feel like ‘Here, Medicaid bill.’ They’re like, ‘Oh, okay,’” Goode says.

After half an hour, Goode has gotten several signatures.

There’s just one problem. A lot of people who’ve signed Joe’s petition have put the wrong date, meaning they’re invalid.

These kinds of setbacks wouldn’t have been as big of a deal if rules surrounding the ballot initiative process hadn’t changed about five years ago.

Under the new rules, getting those 56,000 people is harder than it once was. Now, it’s not just about numbers – it’s about geography.

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To put a question to Idaho voters on the ballot, you need to collect enough signatures from 18 of Idaho's 35 legislative districts, depending on how many people voted in the most recent general election.

If you’re collecting signatures for an initiative, you have to go to at least 18 of Idaho’s 35 legislative districts and get a set number of people to sign on based on how many votes were cast in the last general election.

This is just the latest complication.

From the late ‘90s to the early 2000s, signature gathering used to revolve around counties. But that didn’t last long because judges found it gave more clout to rural voters.

Then, the pendulum swung back in the other direction, again handing urban centers the power, according to John Thompson.

“The problem we had was that these signature gatherers could stand there without ever leaving Costco in Boise and get every signature they needed to make it a ballot initiative and that doesn’t represent people in rural areas,” Thompson says.

The Idaho Farm Bureau, the organization Thompson’s with, pushed for the 2013 overhaul amid fears out-of-state animal rights groups would force through tighter regulations on agriculture.

“There was people concerned that it’s going to make the process more difficult and more hard. Well, yeah, lawmaking is supposed to be a deliberate, difficult process that includes everyone,” he says.

However, Medicaid for Idaho co-founder Luke Mayville, a Sandpoint native, says while he wouldn’t necessarily choose to gather so many signatures across the entire state, he thinks it gives the cause a broader backing.

“There’s something very challenging about that, but there’s also something really energizing about that,” Mayville says.

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Luke Mayville, co-founder of the Medicaid for Idaho campaign, speaks at a rally this January in Boise.

Still, the reality is his team has to wind through mountain passes, travel through hundreds of miles of farmland and convince enough voters of their cause in one of the most conservative states in America to name just a few challenges.

Mayville thinks it’s still possible to meet these new ballot requirements, but you need two things.

“You have to have a lot of money, and I’m not just talking thousands of dollars – we’re talking millions of dollars, which we didn’t start with at all. Nowhere close. You either have to have that or you have to have an urgent cause,” he says.

Ballot initiatives haven’t ever been a slam-dunk in Idaho. Voters have only approved 14 of them since 1938. Just five have made it on the ballot in the past 20 years, with no initiative appearing since the new changes took effect in 2013.

Jeff Lyons, a political science professor at Boise State University, says these new rules can be problematic for some.

“It’s conceivable that if you don’t have those kinds of requirements you can have something that truly is citizen-led, small budget kind of a thing that if it resonates with a group of people you’re in better shape,” Lyons says. “This makes it a lot harder to do that.”

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Medicaid for Idaho advocates sign the green van they travel the state in, along with a petition to expand access to the healthcare program.

A recent check in with Mayville found the Medicaid for Idaho team has collected 25,000 signatures so far.

But the clock is ticking. They’ve only got about two months left to reach the roughly 56,000 signatures they’ll need to put their question to voters in November.

Follow James Dawson on Twitter @RadioDawson for more local news.

Copyright 2018 Boise State Public Radio

I cover politics and a bit of everything else for Boise State Public Radio. Outside of public meetings, you can find me fly fishing, making cool things out of leather or watching the Seattle Mariners' latest rebuilding season. If you have a tip, please get in touch!