Idaho Medicaid seeks staff increase

As Idaho’s Medicaid program has been under the microscope the past year while state decisionmakers look for ways to decrease costs by increasing its efficiencies, many have noted that the division may lack the staff to achieve those goals.

This year, the department will go to the Legislature to address this capacity need by requesting $5.2 million in federal and state funds to fund 62 positions in the Division of Medicaid, staff told the Board of Health and Welfare on Tuesday amid discussion of other budget requests.

The positions will support things like rate setting, policy, contract management and outcomes measurement, said Deputy Director Miren Unsworth.

“It’s a large request,” Unsworth said Tuesday. “We’ve had lots of conversations with lots of stakeholders about that request, and we will see what comes of it, but we are very optimistic for some additional staff for that Medicaid team.”

The request will be for about $2.8 million in state general funds and $2.9 million in federal funds. The full Division of Medicaid request for fiscal year 2025 is about $5.5 billion, including both state and federal funds.

This year, Medicaid faced a five-year review of the program’s voter-approved expansion, in which lawmakers looked critically at how to lower the rising costs of the program overall. The Medicaid Managed Care Taskforce was created and met 10 times over the interim, looking for ways to administer the program that may reduce expenses. Last week, the group recommended more legislative oversight into the program and its contracts.

A study into potential cost-saving measures was also completed by an outside firm and presented to lawmakers in February. The consultants noted in their report that more administrative staff may be needed to implement some of their recommendations.

In the fiscal year 2025 budget request, the department also noted a report by the Office of Performance Evaluations on Medicaid rate setting that found the division doesn’t have adequate personnel to properly administer the programs.

“Inadequate funding contributes to Division staff lacking capacity to complete, maintain, and update all federally required reporting,” the budget request said. “While the division has a good working relationship with federal regulators and continues to work to achieve compliance, this is a significant risk that could lead to a disallowance of federal matching funds.”

The funds would be used to hire 60 new personnel and fund two existing staff members in the division.

OTHER BUDGET PRIORITIES

The department’s full request submitted to the Department of Financial Management is more than 500 pages, including separate requests from all of its divisions, and totals nearly $154 million in new ongoing funds from all sources.

“We have a top 10,” Lisa Hettinger, deputy director and CFO for the department, said of the budget prioritization. “This is a very difficult decision, we’re a big department, and finding just 10 is like picking your favorite grandkid.”

Among the other priorities in the department’s request is staffing for three employees who conduct contract management for the Youth Empowerment Services program as part of an ordered settlement from a class-action lawsuit.

The lawsuit was active for over 30 years and the settlement, reached in 2015, includes a description of how the state will run YES, the children’s mental health system of care. Hettinger told board members those positions weren’t funded last year, which is why they are such a high priority to come into compliance with the settlement.

The department is asking for continuation of spending authority for the $3.6 million federal Strengthening Public Health Infrastructure, Workforce, and Data Systems grant. The funds, which came from the federal American Rescue Plan Act, will be used for hiring, retaining, and training public health workers and supporting operations at local public health districts, according to the request.

Another notable request is $41.8 million in ongoing funds to improve reimbursement rates for health care providers to those in the Children’s Services, Adult Developmental Disability, and Aged and Disabled programs. This request includes $12.5 million in state general funds and around $29.3 million in federal money.

This request is, in part, a response to a 2023 OPE report showing severe shortages in the direct care workforce, and many in the industry cited low pay for home care workers as a primary cause.

The department cited the report in its budget request and said the workers were also identified as part of the annual Medicaid provider rate review process.

Once the agency brings forward its budget request, the Legislature’s budget-writing committee and the governor will consider it and decide what to include in separate recommended budgets. The full Legislature will need to approve each division’s proposed budget when they return for the session starting in January.

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.