When lawmakers gather in Boise in January for the 2020 session, one of the big issues on the table will be how to pay for Medicaid expansion going forward.
The state pays for 10 percent of expanded Medicaid, the federal government the rest, and while the cost will depend on enrollment, the state’s share is expected to come to $41 million during the first full year of expansion from July 1, 2020 to June 30, 2021. The Department of Health and Welfare’s budget request for the next fiscal year asks for $30.66 million for expansion from the state general fund and $10.5 million from the Millennium Fund, a fund set up with Idaho’s share of the settlement of a major lawsuit against the tobacco companies in the 1990s.
A legislative committee studying Medicaid expansion funding recommended earlier this month that the state take $10 million out of the sales tax revenue counties get now, which equals about half of what the counties spend on indigent care, to help pay for expansion. The Equitable Assessment of Costs Related to Medicaid Expansion interim committee also recommended savings in the state’s Catastrophic Health Care program and in other budget lines be used to help fund it. The report doesn’t specify a formula for how sales tax money going to the counties now would be redirected to fund expansion.
“We needed to let it develop a little bit,” said Sen. David Lent, R-Idaho Falls. “There are so many unknowns with the waivers and everything.”
One of the committee’s recommendations was that it be renewed for another year to study the issue more. Lent said lawmakers would have a better idea of how to proceed after more people have signed up for Medicaid. As of Nov. 14, two weeks into enrollment, 39,696 people had signed up, according to DHW.
“That will give us a much better feeling of what, financially, we’re going to be up against,” he said.
Rep. Britt Raybould, R-Rexburg, said lawmakers are still considering every option and haven’t made any decisions about how to fund expansion.
“I think at this point everything is on the table,” she said. “Nothing has been taken off.”
Democratic lawmakers have opposed the idea of levying counties for part of the cost or diverting money that counties get now.
“I think the state should pay its share of Medicaid expansion,” said Sen. Maryanne Jordan, D-Boise. “The state is able to pay for it out of savings. That has been demonstrated on several different occasions” by the state’s financial analysts, she said.
Jordan said she worries counties could be treated unequally. While it is impossible to guess at how different counties would be impacted until a formula is proposed, analysis of a proposal earlier this year to levy counties based on Medicaid expansion enrollment suggested counties in eastern Idaho, which generally are expected to have higher expansion enrollment but spend less on indigent health care, could be hit harder than other parts of the state.
“It’s very clear that the impacts on counties vary from county to county,” Jordan said.
Jordan said lawmakers should wait to see how Medicaid expansion impacts county spending and also consider the work of the Property Tax Working Group that is meeting now before making any decisions on Medicaid funding.
“We can’t be dealing with these things as a one-off,” she said.