Before JFAC

People file into the Joint Finance-Appropriations Committee meeting room in the state Capitol after the doors were unlocked shortly before 8 a.m. Wednesday, Feb. 27, 2019.

BOISE — The Idaho Legislature’s joint budget committee voted unanimously on Wednesday to fund Medicaid expansion next year just as Gov. Brad Little recommended: by tapping the state’s tobacco settlement fund and through savings in the Health & Welfare and Corrections budgets that would result from the expansion.

In the end, that means the state would spend no state general fund money on Medicaid expansion next year, which would cover more than 60,000 currently uninsured Idahoans and start on Jan. 1, 2020. Another 31,000 Idahoans who now qualify for subsidized insurance through the state insurance exchange also could qualify.

The budget bill still needs passage in both houses and the governor’s signature to become law, but budget bills rarely change once they’re set by the 20-member Joint Finance-Appropriations Committee.

“It is JFAC’s work to fund the people’s business, and I believe that’s what we’re doing,” said Sen. Jeff Agenbroad, R-Nampa. “We have been funding budgets consistently, since Day 1, that have pieces and parts of Medicaid expansion in them,” nearly all of those showing savings in various state agency budgets. If Idaho weren’t going to expand Medicaid, he said, “We would have a lot of unwinding to do. I hope that doesn’t happen.”

If legislation passed later that added costs, he said, JFAC could handle that through a follow-up bill called a “trailer bill.”

Sen. Steve Bair, R-Blackfoot, JFAC co-chair, called the governor’s plan “a pretty clear and concise way to do it,” after JFAC’s Feb. 11 hearing on the Medicaid budget. “One of the big concerns I’ve had all along about Medicaid expansion has been that it would take a good amount of general fund dollars. I was pleased to see the governor’s recommendation that showed a clear path forward, that Medicaid could be funded with no new general fund dollars.”

The funding was part of the overall Medicaid budget that JFAC set for next year, which shows a 17.4 percent increase in state general funds for Medicaid and a 15.6 percent increase in total funds for Medicaid. It brings the Medicaid budget to $686.9 million in state general funds next year, $2.8 billion in total funds. The increase is largely due to the rise in the use of services in the existing state-federal Medicaid program, along with a small change in its federal matching rate, which fluctuates slightly each year while staying around 70 percent; it’s going down because the state’s economy is strong.

There was no controversy or debate in the joint committee about including the expansion funding; a bipartisan work group of JFAC members has been working for weeks on the budget. Idaho voters approved Medicaid expansion in Proposition 2 on the November ballot, which drew 60.6 percent voter support.

Rep. Sally Toone, D-Gooding, said in a statement Wednesday, “This vote sends a clear message to all the legislators. We have found a funding mechanism and are ready to implement Medicaid expansion. Idahoans need access to quality health care. There is no time for any more nonsense.”

Still, several lawmakers in both the House and the Senate continue to work on proposals to attach restrictions or “sideboards” to Medicaid expansion, from work or training requirements to outright repeal. So far, only one bill has been introduced, SB 1100 from Sen. Mary Souza, R-Coeur d’Alene; it hasn’t gotten a hearing. Two repeal proposals, one for an immediate repeal and another to repeal Medicaid expansion in 2022, were rejected last week by the House Health & Welfare Committee, which declined to introduce them.

While the budget set by JFAC on Wednesday reflects $9,267,000 in general fund costs for Medicaid expansion next year, that amount actually nets to zero, because of decreases already approved in other Health & Welfare budget divisions and in the Corrections budget, due to savings that accompany Medicaid expansion. Most of those come because participants in various state-funded programs would qualify for expanded Medicaid, for which the federal government picks up 90 percent of the cost.

The successful budget also includes $10.6 million from the Millennium Fund, the state’s tobacco settlement account, for Medicaid expansion, as recommended by Little, and reflects the $177.3 million in federal funds that would flow into Idaho’s Medicaid expansion program as part of the 90-10 federal match. The funding covers six months of the new program, starting Jan. 1, 2020.

The Medicaid budget set by JFAC includes provider rate increases in all categories in which they were requested, some for the first time in more than a decade, including several that Little didn’t recommend, for dental providers and providers of services to developmentally disabled children. Sen. Abby Lee, R-Fruitland, said a combination of reversions and savings covered in already-approved supplemental appropriations allowed those increases to be covered.

Also, working with the Department of Health & Welfare and the governor’s office, JFAC members included in the budget a $2 million federal-funds increase in rates for intermediate-care facilities that care for children with severe developmental disabilities; that was an emergency move to stave off the closing of facilities in Idaho that now serve 75 such children. The department is launching a comprehensive review of all provider rates.

“We had a rapidly moving situation there for the last 12 months, where we actually were seeing (intermediate-care facility) businesses go out of business, and that’s not good for anyone,” Idaho Health & Welfare Director Dave Jeppesen said Wednesday afternoon.

Rep. Melissa Wintrow, D-Boise, said she appreciated that the department will do “a review of all rate and cost surveys that we do for reimbursements. … I think in establishing rates it will help providers and it will help us in our budget process.”

The budget also includes, as recommended by Little, the first rate increase for providers of state-paid non-emergency medical transportation since 2007.

Betsy Z. Russell is the Boise bureau chief and state capitol reporter for the Idaho Press and Adams Publishing Group. Follow her on Twitter at @BetsyZRussell.

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