Idaho’s catastrophic health care cost program has received a “tune-up” over the past five years to try to cut costs and make it more efficient, but there’s little more than can be done, Roger Christensen, chairman of the CAT Fund board, told JFAC this morning. “We’ve done about as good a job as we can to get this program operating as efficiently as possible,” he said. “We’ve done what we can, changed the oil, given it a tune-up. It’s still a Model T Ford, and you probably don’t want to get on the freeway in today’s driving environment.”

Under the program, people who can’t afford to pay their catastrophic health care bills with all the resources they’ll have for the next five years go to their counties, which consider them for the medical indigency program. If they qualify, that program pays the bills from county property tax funds, but also slaps a lien on everything the patient owns to try to recover the money. Generally, the only cost recoveries come when the patient’s home sells, and the program takes the money; that brings in roughly $2.5 million a year.

For bills of more than $11,000 per patient, the state fund steps in, paying the balance above that amount entirely with state general funds. Concerned about ballooning costs for the program that had risen to more than $60 million a year between the state and the counties, lawmakers called for a series of reforms that were instituted over the past five years. Among them: When anyone applies for the medical indigency/catastrophic care program, they are first run through a Medicaid eligibility check. If they qualify for Medicaid, they’re sent there to cover their costs, rather than to the CAT fund. Medicaid is funded 70 percent by the federal government and 30 percent by the state; it also includes full health coverage, rather than just paying emergency-room bills after the fact. Also, medical reviews were instituted to ensure only medically necessary costs were paid; and additional levels of review were instituted to make sure all other possible payers were tapped before the CAT fund. Plus, health care reform brought new options for some of those patients, with the state health insurance exchange the latest major one – hospitals are now sending eligible patients with no coverage to sign up for coverage through the exchange, rather than turning to the CAT program. As a result, caseloads have been falling for the state fund. But at the same time, the cost per case has been rising, and 40 percent of the cases now involve mental health care.

In fiscal year 2014, the combined state and county costs were $51.5 million. Christensen is forecasting a 7.7 percent drop in required state general funds for the program next year, based on these trends. “We’re cautiously optimistic,” he said.

“The thing that concerns us most is the mental health increase. … The overall dollars and case load have gone down, but that line has gone up 11 percent, which directly affects the counties more than it does the state fund,” said Christensen, who is a Bonneville County commissioner. He noted that the number of mental health protective-custody holds is way up, but commitments haven’t risen. “We continue to struggle with that, especially the jails,” Christensen said. “There’s some efforts in place to try to divert some of those with new crisis centers. … Mental health continues to be a major concern of ours.”