Idaho Seeks Flexibility In Medicaid Expansion Plan, But Feds Have Yet To Weigh In

Joe Jaszewski / Idaho Statesman

Gov. Otter delivered his State of the State and budget address on Monday.

In Monday’s State of the State address, Gov. C.L. “Butch” Otter made clear to lawmakers and the public that he’s not pushing to expand Medicaid eligibility at this time.

Instead, he has asked Idaho Department of Health and Welfare Director Richard Armstrong to develop an Idaho-specific plan.

As StateImpact reported yesterday, Armstrong says the federal Centers for Medicare and Medicaid Services (CMS) will have to sign off on any effort by the state to build cost-sharing and accountability mechanisms into its plan.  On this point, there’s a great deal of uncertainty. 

Last month, CMS released answers to some of the many questions it has received from states regarding implementation of the Affordable Care Act.  In that document, CMS says it will support options promoting personal responsibility for the Medicaid expansion population “depending on its design.”

Robin Rudowitz of the Kaiser Commission on Medicaid and the Uninsured says more explicit federal guidance is still to come.  It’s not yet clear how receptive the federal government will be to states’ requests to include cost-sharing requirements (like monthly premiums or co-pays) in the coverage they extend to the expansion population.

Rudowitz says it’s hard to know how willing the federal government will be to waive federal Medicaid rules and allow states flexibility in structuring their plans.  “I think there are two forces that will be at work: states that want waivers, and the federal government that wants them to move ahead with the expansion,” she says.

The federal government will initially cover 100 percent of the cost of expanding Medicaid eligibility to 138 percent of the federal poverty level.  According to consulting group Milliman, the optional Medicaid expansion would extend health care coverage to about 80,000 low-income adults in Idaho.  Milliman also estimates the expansion would save the state and counties $6 million over 10 years.