Idaho Senate Taps Mandatory Work Requirements In Amended Medicaid Bill

Apr 1, 2019

Mandatory work requirements for Idaho’s Medicaid expansion program will be debated by the Senate after all.

Lawmakers there voted Monday to amend a bill from Sen. Fred Martin (R-Boise) that would have instead offered up a voluntary training program.

Several Republicans stood with Democrats in opposing the change, but they ultimately failed.

“Work is not a curse, it’s a blessing. It brings joy to our lives,” says Sen. Steven Thayn (R-Emmett), who wrote the amendment.

Under the amendment, those receiving health coverage under the expansion would have to work, volunteer or enroll in a training program or school for at least 20 hours per week to qualify.

Many would be exempt, like pregnant mothers, parents with children under 18, or those who are acting as a caretaker for someone with serious medical issues.

If someone doesn’t meet the work requirements, they wouldn’t be automatically kicked off Medicaid. They’d instead have to cover a copay between $5 and $30 for any covered medical expense until they can show they’re in compliance.

Thayn says he’s not sure how much it will cost the state to make sure enrollees are complying with the proposed rules. But he says it’ll be less than the $1.9 million per year the House’s version was estimated to be.

Democrats tried unsuccessfully to keep the same expansion program approved by nearly 61 percent of Idaho voters in November.

Sen. Maryanne Jordan (D-Boise) says most people slated to get coverage under the expansion are already working.

“They’re people who are cobbling together two, three…odd jobs trying to keep a roof over their heads,” Jordan says.

Keeping them healthy, she says, is much more valuable than tacking on restrictions.

Support for such mandatory work requirements in the full Senate is in stark contrast to last week’s decision by the body’s health and welfare committee. That panel voted 7-2 to hold a bill from Rep. John Vander Woude (R-Nampa) in committee that also included such a program.

Martin says he likely cannot support his own bill now because of mandatory work requirements that were added over his objections and the will of the Senate Health and Welfare Committee he chairs – something that’s typically viewed as sacrosanct by many lawmakers.

That committee vote came just minutes after lawmakers learned a federal judge had overturned similar work requirements in Arkansas and Kentucky. The opinion laid out that such rules kept “a substantial number” of people from being insured – in direct conflict with the intent of the Medicaid expansion law passed by Congress.

Sen. Kelly Anthon (R-Burley) tried to sidestep that potential legal fight by adding a clause to the bill that the director of the Idaho Department of Health and Welfare should prevent any “substantial loss of coverage” while still pursuing these work requirements.

“This is the kind of amendment that actually just messes up bills,” says Sen. Jim Rice (R-Caldwell), who is also a family law and estate planning attorney. “Essentially what that means is [what] any particular judge wants it to mean.”

Anthon’s amendment died after a tie vote.

Several other tweaks to Sen. Martin’s bill make it more closely align with the House proposal.

That includes a change that would force anyone enrolled in Medicaid to get a referral if they want to get birth control from someone other than their primary doctor.

One of Martin’s own amendments will also ask federal officials to let those earning 100-138 percent of the federal poverty level buy subsidized health insurance from Idaho’s exchange instead of enrolling in Medicaid.

Since the federal government is supposed to pay a higher split of costs for Medicaid expansion – 90 percent, compared to the state’s 10 percent – opponents have questioned if that match would stay the same if Idaho doesn’t embrace a full expansion.

On Friday, Utah received permission to immediately extend coverage for up to 90,000 residents making up to 100 percent of the federal poverty level – but the state is picking up 30 percent of the tab.

Utah has asked the Center for Medicare and Medicaid Services to bump up their share to 90 percent, but such a waiver has never yet been granted.

If the Idaho Senate signs off on the amended bill, it would next go to the House.

It’s unclear if Gov. Brad Little (R) would sign such a bill, though he has said he wanted to put some “spring” into Idaho’s social safety net to eventually propel off people from government assistance.

Late Monday afternoon, the Senate killed a bill for a $10.6 million renovation of House lawmaker offices 18-17, with two Democrats signaling their vote against it as a protest over how the Medicaid expansion issue has been handled. Senators were poised to reconsider it, but after more than an hour of negotiations behind closed doors, they chose to punt on it.

"I don't think [the House] will take it very kindly," said Senate Majority Leader Chuck Winder (R-Boise). 

Despite having tacked on several restrictions to the Medicaid expansion bill earlier in the day over the objections of Democrats, Winder says the Senate wanted "as few" and "as light" of amendments as possible.

He says their priority is for the House to pass the Medicaid funding budget, which includes money for the expansion.

"If they pass that budget, we could go home."

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

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