Idaho Association of Counties head Dan Chadwick briefed the governor's Medicaid expansion working group on what's been designated Option 2 - Don't expand Medicaid, but redesign Idaho's medical indigency program. "I've talked to my peers around the country and they all scratch their heads," Chadwick said. "There is no other state that does it the way we do it."
He said there's no simple way to redesign Idaho's program - he describes it as a "scraper," that would have to be scrapped and a new system developed from scratch. Possible elements of redesign could include standardizing claims processing and expanding utilization management and medical review, he said. But possible savings would be difficult to estimate - perhaps coming to 2 percent from efficiencies. Because the indigency program is incident-based, not eligibility-based - meaning a person is eligible for benefits only if their medical bills from a particular incident are more than they could pay off in five years - it's very difficult to predict costs, because there's no way to know when someone will get sick or be in an accident. "It's a really unique system," Chadwick said.
"I don't think anyone think there is a silver bullet or a magic wand that's going to change this program," Chadwick said. "Many of the providers and the counties really don't like this system. I think we'd all be happy to see it go away. ... It's a difficult system to administer, and we don't know even where to start in terms of capturing the administrative costs for this." You can read my full story here on the program, from the Sept. 9 Spokesman-Review.
The working group is now headed on a lunch break, and will discuss Option 3 - expanding Medicaid - when it reconvenes at 1:15.