The state Department of Health and Welfare has released a waiver that would require most Medicaid patients to get a referral before seeking family planning services from anyone other than their primary doctor.

Public comment has opened, the department said in a news release Wednesday, and will continue through Oct. 12. The state will then submit the proposed waiver to the Centers for Medicare and Medicaid Services for approval.

Idaho voters voted to expand Medicaid to everyone making up to 138 percent of the poverty level in November 2018. The Legislature approved funding for expansion this year but also passed a bill to request a number of waivers to make changes to the program.

While a waiver to add work reporting requirements for expansion enrollees was by far the most controversial, there was also some debate over the family planning waiver. Some opponents and supporters alike cast it as an attempt to steer Medicaid money away from Planned Parenthood, while its legislative backers said it was a cost-saving measure.

The waiver, if approved, would cover not only expansion enrollees but all Medicaid participants who are part of a managed care plan. DHW estimates 321,471 people will be impacted by it. The waiver’s intent, DHW said in its news release, is to see if monitoring and knowing about external family planning services can help achieve better care coordination and improved health outcomes. The waiver request says costs would be the same with or without the waiver.

“In contrast to the coordinated system of Patient-centered Medical Homes, Medicaid participants seeking family planning services frequently seek care outside of their primary care practice,” the waiver request says. “This can lead to disengagement with primary care and a lack of information on their whole healthcare experience, which may constrain a primary care provider’s ability to provide whole-person care.”

The state is accepting written comments on the work requirements waiver through Sept. 22. Idaho already submitted another waiver request to give people making from 100 to 138 percent a choice between going on Medicaid and buying insurance through the state exchange. CMS said in late August that the request was incomplete but that even if the state resubmits it, that waiver likely won’t be approved since it would cost the federal government more money. State officials have said they plan to resubmit.

Comments on the family planning waiver can be emailed to or mailed to Clay Lord, Medicaid Program Policy Analyst, Division of Medicaid, P.O. Box 83720, Boise, ID 83720-0009.

DHW has also scheduled two public hearings in Boise, one on Monday, one on Sept. 20. The first will be from 9 a.m. to 10 a.m. in the Medicaid Central Office, 3232 Elder St., Conference Room D, the second from 10:30 a.m. to 11:30 a.m. in the Lincoln Auditorium at the state Capitol. People can call in to either at 1-877-820-7831 and use the code 301388#.

Reporter Nathan Brown can be reached at 208-542-6757. Follow him on Twitter: @NateBrownNews.