A new report from the Idaho Center for Fiscal Policy found that an upcoming state House bill to modify Medicaid expansion could end up costing Idaho more than $32 million per year than unmodified expansion.
House Bill 277 would include several modifications to the “clean” Medicaid expansion that would increase the cost to Idaho, including a mandatory work requirement and extensive waiver system that would cost more than $2.5 million in staffing and management.
The bigger financial risk of the House bill, according to the policy report, came from the attempt to exclude Idaho residents earning between 100 and 138 percent of the federal poverty level from the Medicaid expansion. Policy analyst Sasha Pierson said the limitation would exclude nearly 32,000 residents from the state expansion but also would jeopardize the maximum 90 percent federal matching rate offered for state expansions.
If the limited expansion in House Bill 277 did decrease the federal matching rate, the Idaho government would go from paying 10 percent of the state Medicaid costs to around 30 percent. The combination of the increased state cost and the bureaucratic expansion to enforce the sideboards would increase the state’s total cost from $9.9 million to $42.1 million.
“There’s no precedent for the federal government matching these costs at the full rate if the entire population is not covered by the expansion,” Pierson said.
Arkansas and Massachusetts had been rejected from receiving the enhanced match rate in their limited expansion, while Utah recently submitted a waiver to receive 68 percent matching.
The report also provided an analysis for Senate Bill 1204, its version of the Medicaid expansion, and the “clean” version without any sideboards. The Senate bill included an optional work program that would cost the state some additional money to implement but had no impact on the federal match and would cost the state slightly more than $10 million, or nearly the same as the unmodified expansion.