Many lawmakers got their first chance to scrutinize Idaho’s Medicaid expansion program Monday as it undergoes a mandatory review nearly five years after it was approved through a ballot initiative.
Making up about a quarter of Medicaid’s $980 million state budget, the expansion program serves about 145,000 people. That’s significantly higher than estimates made prior to its implementation in 2020.
The state's portion of Medicaid expansion for the upcoming fiscal year is expected to stay pretty flat at $67.4 million — down about $650,000 from the current year.
State officials expect costs to go down now that they can soon begin kicking off ineligible recipients who were previously shielded by federal law during the pandemic.
Idaho Medicaid director Juliet Charron told a joint meeting of the House and Senate health and welfare committees her division will begin determining eligibility among roughly 67,000 people starting in April. She expects the process to take about six months.
“Is there going to be any effort made to recover any of those costs or are we just going to look at it as funds lost?” asked House Majority Leader Megan Blanksma (R-Hammett).
Such a move, Charron said, could bring a hefty penalty.
“We would be putting the state at-risk for a federal disallowance, which means that we would lose the enhanced funding that we have had through the course of the public health emergency,” she said.
While growth under Medicaid expansion – whether through circumstances brought on by the pandemic or underestimates by contracted consultants – has been more than anticipated, the most significant cost driver has come from recipients with special needs.
The “enhanced” portion of Idaho’s Medicaid budget accounts for 60% of new general fund dollars requested by the state department of health and welfare as compared to the current fiscal year.
State officials are also looking at other ways of controlling Medicaid costs.
Recommendations in a draft report commissioned by the Idaho Division of Fiscal Management could save taxpayers an estimated $65.7 million, though it expects some proposals to be difficult to implement.
Some of those suggestions include renegotiating rates with health care providers and revoking access to optional adult dental care.
House Minority Leader Ilana Rubel (D-Boise) pushed back on the latter point, saying paying for routine preventative dental care saves significant amounts of money compared to treating acute emergencies that stem from oral health problems.
The consultants’ full report will be released in April.
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