Counties Would Pay For Much Of Idaho's Medicaid Expansion Under A New Proposal

Aug 9, 2019

In order to foot the bill for Idaho’s upcoming Medicaid expansion, one House Republican leader wants to cut the amount of sales tax money doled out to the state’s 44 counties.

A legislative committee has been working over the summer to figure out how to pay for the $105 million Medicaid expansion is expected to cost Idaho over the next decade.

House Majority Caucus Chair Megan Blanksma (R-Hammett) will present her idea to the committee Friday afternoon. A draft of the plan obtained by Boise State Public Radio would slash the amount of sales tax money counties get by one third.

That would’ve diverted $19.3 million last fiscal year, according to Seth Grigg, the executive director of the Idaho Association of Counties.

In exchange, counties would be able to levy more money to help pay for county law enforcement and court services.

Anyone written a ticket for not wearing a seat belt would have to pay court fees, with $5 of that going to the new Medicaid Expansion Account.

Blanksma’s proposal would also get rid of the counties’ Indigent Fund and the state’s Catastrophic Health Fund – both of which have paid millions of dollars in medical bills for the state’s uninsured.

Grigg says his organization is still analyzing what this change might mean for each county.

“This is just kind of a discussion draft. I haven’t been overly concerned about it,” until the committee as a whole weighs in, he said.

“It could be that for many counties it’s a net gain in revenue and for others it could be a loss.”

Blanksma didn’t immediately return a request for comment.

Another proposal up for discussion is the plan drafted by Rep. Fred Wood (R-Burley), which stalled in the legislature this past session.

His bill would have forced each county to pay into a fund based on how many residents there enrolled under Medicaid expansion.

State lawmakers paid for the first six months of the program that will begin Jan. 1 through a combination of expected savings and Millennium Fund dollars, which typically pay for anti-smoking initiatives.

Legislators also directed state officials to request several waivers from the Center for Medicare and Medicaid Services. One would allow Idaho to implement work requirements to receive coverage and allow people to stay on the state health insurance exchange if they’d otherwise enroll under the expansion.

The committee meeting begins at 9 a.m. Friday at the Idaho Capitol.

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

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