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Politics & Government

Lawmakers: Savings And Counties Should Pay For Most Of Idaho's Medicaid Expansion

James Dawson
Boise State Public Radio

A group of Idaho lawmakers have finalized their recommendations on how the state should pay for Medicaid expansion, with counties expected to pony up for part of the bill.

Budget analysts expect the state’s share of Medicaid expansion will cost about $41 million for the next fiscal year.

A state legislative committee says savings to state agencies should cover about half of that. Republicans in the group also want counties combined to chip in up to $10 million.

The logic, they say, is that counties will be paying less to cover indigent healthcare expenses, since many of these patients will be eligible for the expansion.

That money would come from a share of the state’s sales tax that gets paid out to counties every year.

You can read the committee's full report here.

State Sen. Mary Souza (R-Coeur d’Alene) says it won’t be an extra expense for them.

“We are not asking the counties to write us a check out of their budget,” Souza said.

But just because someone is eligible for Medicaid expansion doesn’t mean they’ll sign up.

County officials are also concerned that people who earn too much to qualify for the expansion and don’t have any health insurance will still need to be covered under the indigent fund in the future. 

During the most recent fiscal year, counties have had to pay $20.1 million in indigent healthcare expenses. Costs related to physical healthcare has steadily fallen over the past seven years but bills for involuntary mental health holds have surged during that same time period.

Lawmakers directed state officials to apply for a waiver that would extend coverage to the significantly mentally ill to help lower those costs. No waiver has yet been granted.

Other recommendations from the interim committee would delay any county costs until Oct. 1, 2020.

If the state still comes up short in funding Medicaid expansion, the group says budget writers should use money from Idaho’s Millennium Fund, which typically goes toward anti-smoking programs.

Open enrollment for the expansion kicked off Nov. 1. About 35,000 people signed up during those first few days. That's more than one-third of the estimated 91,000 people who are thought to be eligible for coverage in the state.

The full legislature will consider these recommendations when they gavel into session in January.

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

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