Medicaid Cuts May Prove Hard to Reverse

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Medicaid service providers and advocates for people who receive Medicaid voice many concerns about the nearly $35 million cut in state spending approved by the Idaho Legislature early this year.  Underlying their anxiety about provider layoffs and service reductions for adult Medicaid recipients is the fact that all of the changes approved in the last legislative session went into state statute. For Katherine Hansen, Executive Director of Community Partnerships of Idaho, that’s a problem.  “All of those changes went into law, so now you have to go into law to get those things changed,” she said.  “And yet those were things that were proposed as short-term, temporary things to help save.”

Legislators knew, in the 2010 session, they were looking at a Medicaid funding problem.  Enrollment was rising, and the federal contribution to Idaho’s program, which temporarily increased thanks to federal stimulus dollars, was scheduled to go back down.  So they started the hard work of figuring out how to cut spending. 

Leaders of the House and Senate Health and Welfare Committees and staff from the Idaho Department of Health and Welfare and the Division of Financial Management began meeting.  Rep. Carlos Bilbao (R-Emmett), Vice-Chair of the House Health and Welfare Committee, was among them.  “When we came to the point of services and funding, we called in people such as the head of the dental association, the Idaho Medical Association.  We pulled in the people who provide the services to the people on Medicaid and we let them know what we were doing,” he said.  “And we said, ‘Here it is.  Give us your response.  Tell us what you can live with, and what you can’t live with.'”

In other words, people like Katherine Hansen, a Medicaid service provider, did have a chance to give their two cents.  They told lawmakers where they thought it would be safest to make reductions, if services had to be cut.  But then those changes were written into law, without a sunset date, and without a clause to reverse them when revenue rises.  “The result is that there are things that were never intended to be – at least from my opinion – permanent, long-term changes in law,” Hansen said.

Representative Bilbao says the intent of the House Health and Welfare Committee, where last session’s Medicaid bill originated, is that some services and funding will be reinstated, if money allows.  “The agreement was on the committee that if our budget was going to be increased, we would do our best to replace the money across the board this next session,” he said.

But Leslie Clement, who oversees  Medicaid, Behavioral Health and Managed Care Services for the Idaho Department of Health and Welfare, has a different view of legislators’ aims with respect to the cuts.  “I think having them in state law was an intentional decision on the part of state legislators to make those changes less susceptible to changes in the future,” she said.  “When they made statute changes that reflected a reduction in service, they wanted to make sure those reductions would stick.”

Rep. Shirley Ringo (D-Moscow) has been conducting an informal survey of Idaho Medicaid recipients in an attempt to understand the effects of last session’s cuts.  She believes the changes will be hard to reverse.  “We have people in the Idaho Legislature that want to shrink government,” she said, “and I think they have embraced the economic downturn as an opportunity.”  Ringo  believes that, if some of last session’s changes are to be reversed, the push will have to come from outside the legislature.  “It looks to me like it’s really going to come down to whether the public finds this way treating people who have special challenges acceptable,” she said.