Legislative budget writers have set a budget for Medicaid that reflects only 0.4 percent growth next year in total funds, 3.1 percent in state general funds. That’s in part because the “woodwork effect” of more people signing up for Medicaid who already were eligible, but just hadn’t realized it, hasn’t materialized to the extent it was expected to. “Medicaid numbers are flat,” budget analyst Jared Tatro told the Joint Finance-Appropriations Committee. Sen. Dan Schmidt, D-Moscow, who crafted the budget plan with Rep. Thyra Stevenson, R-Lewiston, said the two slashed the funding for caseload increase in half from the governor’s recommended level. “We haven’t been seeing the growth that we were expecting from the woodwork,” Schmidt said. “We’re taking a bit of a risk. ... It’s a budget for growth, but it’s not as much as they asked for.”

Because when people apply for health insurance plans on the state insurance exchange, they’re first evaluated for eligibility for Medicaid, the state anticipated lots of people “coming out of the woodwork” to sign up for Medicaid without any change in eligibility for the program. Thus far, Tatro said, those signing up for the Medicaid basic plan are up slightly, but numbers for the enhanced plan, for those with disabilities or special health needs, are “way down, and that’s the big expense driver.”

JFAC voted 17-2 in favor of the proposed budget, which totals $492 million in state general funds for next year, and $2.03 billion in total funds; just Sens. Nuxoll and Bayer dissented. Medicaid is funded roughly 70 percent by the federal government, and 30 percent by the state. It provides health coverage for the state’s disabled and poorest residents.

The joint budget committee also approved a budget for the Division of Welfare in the state Department of Health & Welfare, which includes the process of determining eligibility for Medicaid. That budget shows a slight decrease in state funds, but a 5.9 percent increase in federal funds, largely because of the $11.8 million federally funded project to integrate the eligibility determination system with changes in Idaho’s insurance exchange. In its first year, the state exchange has used the federal eligibility determination system, but next year, it will be transitioning to a state-operated eligibility system. That budget cleared JFAC on a 15-4 vote, with just Sens. Nuxoll, Bayer, Mortimer and Thayn dissenting.