November 17, 2010 in Idaho

Director outlines Idaho’s gloomy Medicaid outlook

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BOISE – Idaho’s Medicaid program is facing such a big potential shortfall next year that officials are considering using volunteers to help those who now rely on its services.

State Health and Welfare Director Dick Armstrong told state lawmakers Tuesday that back in the 1950s and 1960s, volunteers performed many services that Medicaid provides today, such as driving disabled people to doctor’s appointments and checking on whether mentally ill patients have taken their medication.

Idaho, he said, could “see if there could be a resurgence of voluntary assistance specifically around keeping adults stable in the home environment.”

His suggestion came after he told legislative budget writers that Idaho’s Medicaid program could be short a projected $171.6 million in the fiscal year that starts in July.

“We would have to eliminate major categories of service,” Armstrong said.

Sen. Joyce Broadsword, R-Sagle, vice chairwoman of the Senate Health and Welfare Committee, said Armstrong was onto something with tapping volunteers. “I think it’s a good idea,” she said. “That’s part of helping our community as a whole. If we don’t all pull together, we have less opportunity to come out of this as a healthy state.”Armstrong is projecting a $42.3 million shortfall for Medicaid, the joint federal-state program that provides health coverage for the poor and disabled, in state general funds in the current year. He’s proposing filling most of that hole with a one-time draw on the state’s tobacco-settlement fund, but the next year, the budget hole would grow to several times that.

The projected shortfall – caused by a drop in the federal match for Medicaid as the economic stimulus funding ends, along with growing caseloads – would likely mean cutting services.

Children are protected, Armstrong said, so “we would have to focus on adult services.” He said every state is looking at the same “draconian” type of cuts.

In Washington, for example, officials are examining eliminating all coverage for pharmaceuticals for adults. “That’s terrible health care policy,” Armstrong said, and would just drive up hospital costs.

Idaho provides some services that are considered optional under federal law, including prescription drug coverage and services for the developmentally disabled. Also considered optional: hospice care, dentures, eyeglasses, preventive care, mental health treatment and prosthetics, among others. But Armstrong said he doesn’t know what could be cut from that list. For now, he’s submitted a budget request to have the full shortfall covered by the state – but he said he has little hope that can happen given the grim budget outlook.

Last year, Idaho pushed $89.4 million in Medicaid bills into the current fiscal year – leaving providers waiting up to three months for payment. But if that were tried again, Armstrong said Tuesday, the delayed payments would then fall under the reduced federal matching rate for Medicaid that Idaho will see next year.

“That doesn’t mean it might not be a good strategy, but it has a significant cost attached to it that we didn’t face last year,” he told the Legislature’s joint budget committee, which wrapped up two days of hearings Tuesday on the state’s budget challenges.

Six comments on this story so far. Add yours!

• 

  pakidaho on November 17 at 11:44 a.m.

  My understanding is during the fifties and sixties, persons with disabilities and mental illness were living in state run institutions, not cared for by volunteers. Staff were paid and costs were very high then; imagine what they would be now days.

  Taxpayers are being sold a one sided story filled with deception and bull. Legislators have told Health and welfare to work with providers to seek cost saving solutions to these current problems. Health and welfare would tell you that is what they did, however that is not the case.

  These persons they are talking about, persons with disabilities and mental illness, are not Corky the movie star. Despite what the average person may think, these persons need supervision from people that know their job, will commit to twenty four/seven work hours and handle behaviors that range from self harm to sexual crimes that would curl your hair and at a cost that is no where close to federal minimum wage standards. The state has yet to reveal the money providers do save the state, and we do. Many of these persons have self harm issues that, without continuous supervision, would be making daily visits to emergency rooms. Jails and prisons would be much fuller without the services of providers, as persons with disabilities and mental illness do not always understand the consequences of their choices or play by society’s rules. They don’t get it, they are mentally ill and developmentally disabled.

  If taxpayers think for one minute that volunteers are the way to go you better do some serious research. If you think the state is spending money now just wait. These uneducated solutions will cost taxpayers more than they can understand.

  Since legislators, health and welfare and our governor is on the subject of volunteering maybe they could lead the charge and do the same. Lets all do our part here. Fact is the governor and legislators are going to be paid regardless of what havoc they wreak on Idaho.

  Do the research, do not count on the word of a few people that have never been providers and have very little understanding of the nature of those who’s lives depend on them.

• 

  Julia70 on November 17 at 12:16 p.m.

  Yeah, and we know who kicked all of the mentally ill patients out of the Mental institutions don’t we, who cared less for the sick and suffering, as do most the republicans in Idaho, Yep, it was good ole’ Ronnie Reagan. Idaho, the most selfish right wing nut case state in the USA. Only they will all tell ya what great christians they are.

• 

  straighttalk on November 17 at 4:54 p.m.

  Who should be taking care of these individuals are their families not government.

• 

  Julia70 on November 18 at 7:28 a.m.

  And what if they don’t have a family, oh I forgot, we have plenty of underpasses for these folks, right? You are your brother’s keeper, now what the hell kind of a concept is that? Wow, right wing christianity alive and well, keep on livin in that box, pretty soon it will take you where you need to be and transform in to a hand basket. There for the Grace of God go I.

• 

  misjustice on November 18 at 7:15 p.m.

  The same legislators that cut the budget for Health and Welfare, also voted themselves a pay raise. Go figure!
  ; )

• 

  Mrs_Peppylady on November 19 at 6:01 p.m.

  I do home care and if you think I’m going to volunteer my time. I have to live in reality someone in this household needs to earn a living.
  I don’t mind trading my time for our bills at $11.00 an hour to cover our bills. I know Mr. Armstrong will be glad to send a check to Northern lights (electrical) frontier and credo (phone) avista (gas) and cabinet mountain (water) so I would only need to volunteer 5 hours a week. If your wondering we live frugal and with in our means but this doesn’t mean I’m into being exploited

  I haven’t heard anyone every trying to get those who need home-care any type of help that actual would improve there life’s that they could be come more independent
  One thing could be done close down these home-care agency and let medicaid pay us directly. Some agency pays hardly anything and so we employees of those who does home-care can get food stamps.
  Demand the home-care agency to pay there employee $10.00 to $15.00 an hour.
  I do make a decent wage compare to some what I hear they get.
  Physical therapy, nutritional counseling, general counseling, money management, and life skills would be help for some who now receive home-care and could be come less depended or even complete taking care of them self.
  No I see medicaid being penny wise and pound foolish.
  But those who could improve and want to I would say let them have full advantage of these programs and up to 5 years.(not limited it up to 24 hours yearly for each of these program but let them have 240 hours a year for above programs which is 1 hour weekly some may not need as much If they choose not to improve in their life limited their home-care max hours they would every get is 10 hours a week
  I understand that they are people who can’t improve and will always need some type of assistants

  Maybe Mr Armstrong mom volunteer in 50 and 60’s. We had one earner income and unions then made sure that the American worker made a living.
  This isn’t how life work now.