Supporters Of Idaho Medicaid Expansion Speak Out, But Costs Remain A Big Question

Emilie Ritter Saunders / StateImpact

The governor's panel on Medicaid expansion met for the first time this week. The group will submit its recommendation to the governor late this fall.

More than 236,000 Idahoans are currently enrolled in Medicaid.  That’s the federal-state funded health care program for low-income adults and children.  If the state chooses to expand eligibility in Idaho to 138 percent of poverty, 100,000 people could join the rolls.

Utah-based consulting firm Leavitt Partners presented that data to Idaho Governor C.L. “Butch” Otter’s work group on Medicaid expansion Monday.  The state hired the firm to  study how expanding the low-income health care program could affect Idahoans, and the state budget.

The recent Supreme Court decision on the federal health care law allows states to decide whether to expand Medicaid.  Some states expanded their eligibility long before the health care law passed; others have rejected the expansion altogether.

If Idaho goes the expansion route, the federal government for the first two years will pick up the tab for those who are newly covered.  After that, the feds will phase funding down to 90 percent, leaving Idaho to pay 10 percent.

The state can’t yet estimate how much that 10 percent will cost, in dollar terms.  But, many on the governor’s panel, including Idaho Hospital Association president Steve Millard, say the state can’t afford not to expand Medicaid eligibility.

“The more preventive care we can do, the healthier people will become and the less it will cost the rest of us,” says Millard.  Right now, Millard says many of the people who aren’t receiving health care through Medicaid end up at emergency rooms for basic ailments that have gone untreated.

As StateImpact reported last month, often times those ER costs get shifted to Idaho’s Catastrophic Health Care or CAT fund, which is costing the state about $35 million annually, and counties another $30 million each year.  What’s more, the Department of Health and Welfare expects CAT fund costs to dramatically increase over the next ten years.

“It just doesn’t make any sense to me to fund the CAT program the way it is now,” says Millard, “when there are federal dollars available [to expand Medicaid].”

In addition, the Department of Health and Welfare estimates it could save up to $11 million in other services and programs if Medicaid is expanded.

Leavitt Partners anticipates most of the Idahoans who would become eligible for Medicaid under an expanded system are between ages 25 and 54.  Most, they say, are single adults, most haven’t had regular access to health care, and most suffer from some kind of chronic health condition.

Leavitt’s Laura Summers told the panel the costs to pay for these additional people will vary greatly depending on how long they’ve been uninsured and what their specific conditions are.

Leslie Clement is the Idaho Department of Health and Welfare’s deputy director of Medicaid.  She says it would be smart for the state to expand the program, even with some of the uncertainties Idaho faces.

“I know Medicaid isn’t a popular program,” Clement says.  “But I think it’s far better than dealing with 17 percent uninsured in the state of Idaho.”

Leavitt Partners plans to release its full study September 10.  The governor’s panel anticipates meeting again at the end of September.

Here is Leavitt’s initial presentation to the panel: