Batt Unveils Medicaid Plan Governor Accepts 84 Proposals Which Could Save Idaho $18.3 Million Over 5 Years

Idaho could save $18.3 million or more over the next five years by reforming a Medicaid system that’s inefficient, duplicative and not responsive to real needs, Gov. Phil Batt said Thursday.

Batt unveiled a reform plan that calls for sweeping changes. He accepted 84 of the 88 proposals submitted to him by a special council he appointed last year and said some of the changes can begin immediately.

For Medicaid recipients, the changes may mean new fees and co-payments for services that previously were free. Some may find they no longer qualify for benefits. But the governor said there also will be new services available that better fit Idahoans’ needs.

“These proposals will strengthen Idaho’s Medicaid program,” Batt said. “This package is both compassionate and fiscally sound.”

He added, “We should give Medicaid to those people who need it, and we should not attempt to qualify those who should be self-sufficient on their own.”

Toward that end, the plan includes a recommendation that all Idaho college and university students be required to purchase health insurance that covers pregnancy for themselves and their dependents. Batt referred that proposal to the state Board of Education for consideration.

Medicaid covers pregnant women and children whose income is less than 130 percent of the federal poverty level. In 1995, the program paid for 37 percent of all births in the state - 40.6 percent of the births in North Idaho.

Batt’s plan calls for tightening eligibility rules for pregnant women and taking into account both parents’ income - even if the two don’t live together. The state can make some of those changes on its own, but some require congressional action or waivers of federal rules.

The governor said the $18.3 million in savings is based on only the changes the state can implement now. If it gets federal approval, the savings will be greater.

Batt’s Medicaid Reform Advisory Council held 35 hearings around the state before developing its recommendations and presenting them to the governor last December. Batt then asked the state Health and Welfare Department to review the plan in depth.

Now, he said, the changes are ready to go.

“A lot of them are going to start July 1. Some of them are already under way. We’re going to be off and running.”

Accountability will be one focus of the reforms. Idaho aggressively will go after Medicaid fraud and seek new penalties.

It also will try to end what the council called perverse incentives in the system that prevent people from going to work and becoming self-sufficient.

Those problems occur because Medicaid is structured as an “all or nothing” system, Batt said, providing either full care for indigent people or nothing.

The new system is envisioned as a staircase, with recipients able to stop at the lowest possible step that meets their needs.

A person who needs expensive prescription drugs, for example, might be able to qualify for prescription-only coverage and still go to work.

People who can stay at home with some level of care could avoid going to nursing homes.

Though fewer than 5 percent of Idaho’s Medicaid recipients are in nursing homes, nursing home care gobbled up nearly a third of the $367 million budget in 1996.

Said Batt, “Advocates for the aged and the disabled say home and community-based services are more cost-effective and offer greater independence as well.”

State Health and Welfare Director Linda Caballero said she believes most Medicaid recipients will see an opportunity to get “a selection of services rather than the whole array.” State Sen. Gordon Crow, R-Hayden, who served as vice chairman of the advisory council, said some recipients no longer will “find themselves trapped in the social welfare system.

“We have, on balance, an expansion of services to Idaho’s neediest citizens,” he said.

Sen. Grant Ipsen, R-Boise, another council member, said, “Welfare is made for those who can’t, not those who won’t.”

Medicaid is a government-funded health insurance program for the poor and disabled. The federal government pays 70 percent of the cost, while the states pay 30 percent. Idaho’s Medicaid costs more than tripled from 1989 to 1996.

, DataTimes MEMO: This sidebar appeared with the story: Medicaid reforms Here are some highlights of Gov. Phil Batt’s plan to reform Medicaid: Medicaid will move to sliding fees and co-payments wherever possible so recipients help pay for their care. The state will work with the Idaho Hospital Association to develop a way to keep non-emergency patients away from emergency rooms. Disabled people who want to go to work could keep their Medicaid coverage through a transitional period of up to a year. Idaho will look into putting mental health services under a separate managed-care program. The system will try to offer patients the lowest level of care that is appropriate.