Bill threatening Idaho Medicaid expansion killed

BOISE — A proposed bill that would have threatened to repeal Idaho’s Medicaid expansion if various conditions weren’t met will not move forward.

The House Health and Welfare Committee on Thursday voted 8-5 to hold HB 419 after about two hours of overwhelmingly negative testimony. The bill is dead in committee and won’t be voted on by the full House.

The bill’s sponsor, Rep. Jordan Redman, R-Coeur d’Alene, said the bill was aimed at improving accountability and cost-savings in Idaho’s Medicaid system.

“I believe that we can all agree that it’s important to have a healthy and sustainable welfare program within the state of Idaho for its most vulnerable and in-need citizens that isn’t abusing or misusing tax dollars but stewarding them well,” Redman said.

Most of the items in the bill target Medicaid expansion, which was approved by voters in 2018 to open up eligibility of the program to those who couldn’t afford health care under the Affordable Health Care Act but didn’t quite qualify for traditional Medicaid coverage.

The department said around 100,000 people are currently enrolled through the program.

Redman co-presented the bill with Scott Centorino of the Florida-based Foundation for Government Accountability. Centorino lives in Lexington, Va., according to the foundation’s website.

Centorino told committee members the bill is innovative in its way of seeking federal waivers, which are required in many cases to change how Medicaid can be delivered, because it would require them to be submitted as a package, rather than one at a time.

Redman had previously said that under the bill the state would only face the repeal of expansion if the department failed to apply for the waivers by the deadline, but it wouldn’t require the federal government to take action on them. After further discussion on Thursday, Redman said the bill would require the changes to the program be implemented by July 1, 2025.

Many of those who testified against the proposal Thursday said the requirements under the bill — which included an enrollment cap on the expansion population, work requirements for able-bodied adults, and a lifetime cap of 36 months for receiving benefits for those in expansion — were unrealistic and would threaten the health care coverage of thousands if Medicaid expansion was repealed.

“Medicaid allowed me to get the surgery that now makes me cancer-free and able to stand before you today,” said Carol Augustus, who said she received coverage through expansion.

The Idaho Department of Health and Welfare has already unsuccessfully tried to receive many of the waivers that would be required under the bill. In some cases, other states have sought these waivers and been denied.

One of the requirements would be to implement a cap on Medicaid enrollment of 50,000 people. Or, the cap could be set at whatever the total number of adult enrollees who are disabled and those older than 65, whichever is less; there wasn’t a number provided for what this might be.

Idaho Medicaid Administrator Juliet Charron told the Idaho Press that the department is aware that a number of other states have attempted to implement caps, and the federal Centers for Medicare & Medicaid Services under the Trump administration rejected those waivers.

The agency, as directed under previous legislation, had also already sought some of the other requirements included in the bill — such as for work requirements to remain eligible.

Idaho’s 2019 waiver application is still considered pending, but is unlikely to be approved under the current administration as nearly all work requirement applications that were granted under the Trump administration were later revoked by the Biden administration. There are also court decisions, including a U.S. Court of Appeals D.C. Circuit court decision Gresham v. Azar that found that eligibility for Medicaid couldn’t be tied to work requirements.

Gov. Brad Little said this year in his State of the State address that seeking work requirements for Medicaid eligibility was one of his priorities.

Charron said the agency has been looking into options that can address some of the governor and lawmakers’ concerns in other ways that might be more attainable. She said she’s looking into incentive-based programs that have been pursued by other states to encourage and help more participants to be able to find and sustain full-time work.

“We’re continuing to evaluate what opportunities we may have in that space,” Charron said.

Fred Birnbaum from the Idaho Freedom Foundation was one of the two who testified in support of the bill Thursday.

He echoed Centorino’s confidence that the state would have a better chance of getting waivers approved because the net result of them could save the federal government money, which would add incentive to approve them.

He also thought the weight of the impending repeal of expansion if conditions aren’t met might help sway the results of the waivers in the state’s favor.

“You actually have a dual incentive here, that’s why this is such a good bill,” Birnbaum said.

A number of doctors testified that many of their patients are insured through Medicaid expansion and they might have poor health outcomes if they were to lose coverage.

Scott Dunn, a family medicine doctor in Sandpoint, noted that many small businesses don’t provide health insurance. He gave an example of one of his patients who owns a business who wouldn’t be able to afford treatment for his health conditions if he were to get kicked out of the program.

“We have to look at the fiscal note of the bill, but we also have to look at the humanitarian note,” Dunn said.

Many testifiers noted Medicaid expansion passed with more than 60% of the vote in 2018, and several cited a 2023 poll commissioned by Idaho Voices for Children that found 73% of Idaho residents supported Medicaid expansion and thought it should be left in place.

“We reject the notion that Idaho voters made a mistake in passing medicaid expansion,” Gwynne McElhinney, said in testimony on behalf of herself and her husband.

After lengthy testimony, Rep. Mike Kingsley, R-Lewiston moved to approve HB 415. He didn’t speak to his motion.

House Minority Leader Rep. Ilana Rubel, D-Boise, made a substitute motion to hold the bill in committee.

She expressed skepticism that the threat of repealing expansion would change the outcome of federal waivers, and that the consequences of so many people losing their coverage would be grave.

“Frankly, even if they were to grant them, I have serious concerns about the fallout of still having to kick hundreds of thousands off Medicaid to hit the cap,” Rubel said. “So I think it would ultimately wreak untold grief upon the people of Idaho.”

Rep. Jacyn Gallagher, R-Weiser, made an amended substitute motion to send the legislation to the House without a recommendation to approve or reject it.

“This is obviously a very big issue,” she said. “ and I think we should include the body of the House in this conversation.”

House Majority Leader Rep. Megan Blanksma, R-Hammett, said that as one of the lead negotiators in trying to seek some of these waivers before, she had a number of questions she wanted answered before passing something like this.

Gallagher’s motion died in a 5-8 vote.

Members then voted on Rubel’s motion to hold the bill, which passed.

Guido covers Idaho politics for the Lewiston Tribune, Moscow-Pullman Daily News and Idaho Press of Nampa. She may be contacted at lguido@idahopress.com and can be found on Twitter @EyeOnBoiseGuido.