Idaho's catastrophic health care program, also known as the CAT fund, had 1,286 cases approved in fiscal year 2011, at an average cost per case of $24,329, CAT  board chairman Roger Christensen told JFAC this morning. The number of new cases dropped slightly in 2011, after years of sharp increases, but Christensen said so far this year, they're going up again. "We are still seeing a fairly significant increase in caseloads, and I think that's due to the economy," he told the Joint Finance-Appropriations Committee this morning.

The program pays for health care for indigent Idahoans, after counties cover the first $11,000 per case as a deductible; Christensen said it'll be seeking a $17 million supplemental appropriation this year to fully cover costs, after this year's state appropriation was set at just $22.2 million, though costs were estimated at $31.6 million.

Legislative changes in the past three years have helped stem the growth of the program, Christensen told lawmakers. Among them: The increase in the counties' deductible from $10,000 to $11,000 in 2009; and requirements to first submit applications to Health & Welfare for a determination if the patient qualifies for Medicaid. That move alone has meant $21 million in what Christensen first said is "savings," then corrected himself, and said, "transfer to another program." The state pays 100 percent of CAT program costs; it pays only about 30 percent of Medicaid costs, as the federal government picks up 70 percent. As a result, Christensen said he estimates the state has saved between $6 million and $9.7 million. "A much higher percentage of those individuals who would have qualified for Medicaid qualified," he said.

Other changes: New board members added under a bill passed in 2010 pointed out the CAT fund was covering weight-reduction surgeries, which most health insurance doesn't; that's no longer covered. "There have been a few cases and now they've been not approved because of that," Christensen said. "These are policy decisions the Legislature has to make. What drives the cost in this type of a program, is the qualifications for the people, the individuals that are covered, and the types of things that the Legislature wants to cover." That legislation also clarified that the program is a "last resource," so there can be no "balance billing" to offset its payments.

When the CAT fund makes payments for an indigent patient, it filed liens against the patient to recover the funds; in fiscal year 2011, it collected $2.3 million in reimbursements, while it paid out $34.9 million in payments to medical providers. Christensen said reimbursements are down as economic conditions leave people with less ability to pay. The program also received $152,832 from seat belt citations in fiscal year 2011.