Bringing the Economy Home

What Gov. Otter Meant When He Said “No” To Expanding Medicaid Eligibility

Emilie Ritter Saunders / StateImpact

Dr. Ted Epperly is the Program Director of the Family Medicine Residency of Idaho.

Gov. C.L. “Butch” Otter said in Monday’s State of the State address that he doesn’t believe Idaho should expand Medicaid eligibility.  “There is broad agreement that the existing Medicaid program is broken,” he said.

That wasn’t all the governor had to say on the issue.  He mentioned a new responsibility for Idaho Department of Health and Welfare Director Richard Armstrong.  “I’m asking Director Armstrong to lead an effort to flesh out a plan for changing Idaho’s system with an eye toward the potential costs, savings and economic impact,” he said.  “I hope to return in 2014 with specific proposals based on that work.”

That left a few people, this reporter included, scratching their heads.  What does that mean, exactly? 

The panel Gov. Otter created to study a possible expansion of Medicaid unanimously supported expanding eligibility, but it also issued two conditions.  The group’s final report to the governor says the Medicaid plan should have “built-in accountability requirements.”  It also recommends Idaho’s health care delivery system be redesigned to create incentives for quality rather than frequent care.

Director Armstrong says it’s now his charge to develop a plan that follows through on those recommendations.

“The way I’m going to pursue it is to build out a proposal that really does detail the inner workings of the various components of the recommendation,” he says.  That proposal will lay out how the state will move away from fee-for-service health care to value-based health care, and also create a benefit plan that holds those enrolled in the program more accountable, he says.  Ideas that have been floated include establishing a low monthly premium for coverage, for example.

But the state does not have the luxury of designing its own program however it sees fit.

Under the Affordable Care Act, the federal government initially would cover 100 percent of the costs of Medicaid expansion, phased down to 90 percent by 2020.  Moreover, according to an analysis by consulting group Milliman, the Medicaid expansion would save the state and counties  $6 million over the next 10 years.  The state could not afford to expand Medicaid eligibility without federal funds.  Consequently, Armstrong says, the state is asking the federal Centers for Medicare & Medicaid Services (CMS) for guidance.  “Whatever we do has to be with the approval of CMS,” Armstrong says.

Dr. Ted Epperly, director of the Family Medicine Residency of Idaho, says he’s disappointed by the governor’s decision that the Legislature should take no action on the Medicaid expansion this year.  Epperly was a member of Gov. Otter’s workgroup, and cast one of the 15 votes in favor of expanding Medicaid eligibility for low-income adults.

“I do believe Gov. Otter has something in mind,” he says.  “The problem I see with this is that the clock is ticking.”  He points out the federal government will pick up the full cost of expanding Medicaid eligibility for a limited time.

“Every day we wait, we lose federal funding to expand health care to many Idahoans,” he says.


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