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Idaho Medicaid budget set in party-line vote

Sen. Nicole LeFavour, D-Boise, center, argues Friday for adding back in $2.2 million in funding for mental health services for patients who otherwise would be a danger to themselves or others; her move failed on a party-line vote. (Betsy Russell)
Sen. Nicole LeFavour, D-Boise, center, argues Friday for adding back in $2.2 million in funding for mental health services for patients who otherwise would be a danger to themselves or others; her move failed on a party-line vote. (Betsy Russell)

BOISE - Splitting along party lines, legislative budget writers have set a budget for Idaho’s Medicaid program for next year that makes more than $34 million in cuts to services for the poor and disabled, but still grows substantially.

That’s because the federal government, which pays roughly three-quarters of the cost of Medicaid, is paying less next year; this year’s federal matching rates were boosted under economic stimulus legislation. Plus, there are more and more poor people needing the program.

“We are not abandoning anybody,” declared Rep. Fred Wood, R-Burley. “Are we looking for efficiencies in the system? Yes we are. Are we looking for better ways to deliver health care in the state of Idaho? Yes we are. Is that going to be easy? The answer is no.”

Minority Democrats, who decried as “cruel, heartless and foolish” the Medicaid cuts that were outlined in a reform bill that passed the House on Thursday and were written into Friday’s budget bill, spoke out against the plan, and all four Democratic members of the Joint Finance-Appropriations Committee voted against it; it passed on a 15-4 vote.

“These are people’s lives we’re talking about in these budgets,” protested Sen. Nicole LeFavour, D-Boise.

Wood and Sen. Joyce Broadsword, R-Sagle, crafted the budget plan, which sets a state general-fund budget for Medicaid for next year of $436 million, a 46.2 percent, $137.8 million increase from this year. In total funds, the Medicaid budget would grow by 16.2 percent to $1.8 billion, but it grows only 3.6 percent in federal funds, which make up the majority of the program.

HB 260, the Medicaid reform bill that passed the House Thursday and now awaits action in the Senate, actually cuts $108 million out of the Medicaid program, because the $34 million in state cuts means giving up $74 million in federal matching money. The cuts include trimming certain health care services for the disabled and poor; cutting payments to health care providers; charging millions in assessments to hospitals and nursing homes; discharging 35 patients from state institutions; imposing co-payments and more.

The Joint Finance-Appropriations Committee, which hasn’t met for the past week, reconvened Friday to set budgets for the state Department of Health and Welfare, one of the state’s largest agencies; it had waited for the outcome of HB 260 before starting work on the budget.

The budget still needs approval from the House and Senate and the governor’s signature to become law, but budget bills rarely are changed once they’re set by the joint committee.

Medicaid is the largest chunk of the Health and Welfare Department’s budget, but another fight came in another division, mental health services, when Democrats attempted to restore some of this year’s cuts in mental health services, a move Wood dubbed an end-run around HB 260.

Sen. Nicole LeFavour, D-Boise, led a move to spend $2.2 million in tobacco settlement payments that will come in to the state over the course of fiscal year 2012 on a backstop for people cut off from mental health services by the state - to restore their services in cases where they’d be a danger to themselves or others, or would cost the state general fund more by being institutionalized or needing crisis or emergency services.

Idaho made big cuts in mental health this year, she said. Her motion failed on a party-line vote in JFAC, with only the joint committee’s four Democrats supporting it.

Sen. Diane Bilyeu, D-Pocatello, pointed to a shooting in her area, where a man was shot outside a coffee shop by a patient who’d recently been cut off from state mental health services. Rep. Wendy Jaquet, D-Ketchum, said, “I just think that this is a vulnerable population and we incur costs.”

Rep. Shirley Ringo, D-Moscow, said the state Health and Welfare Department has been able to track only some of the patients it’s cut off from mental health services; it’s documented at least two suicides and more than a half-dozen incarcerations. “When we make these cuts, we know that the need doesn’t go away,” she said.

Wood spoke out against LeFavour’s move, which he called “just an end-around HB 260,” the Medicaid cuts bill. “It is just further reducing the $34 million from HB 260 by putting it into another Health and Welfare budget,” he said.

As for tapping the tobacco-settlement Millenium Fund, Wood said, “This is not typically the way we do it, we let it accumulate and then we spend it, as opposed to spending it before it accumulates.”

He said, “Yes, I understand that we’ve had some incidents of people getting hospitalized, people committing violent crimes, people committing suicide etc., and those are all very unfortunate. The real issue however is how is that different than the last two years, in the previous 10-year baseline before that, because unfortunately that happens. And to date, we’ve never figured out a perfect system to completely prevent all of those horrible mishaps to our citizens.”

Wood said the proposed budget for mental health services for next year - without the additional money - fully funds the department’s request. “We’re going to need all the money for 2013 we can get, and we’ve got an adequate amount for 2012 in my estimation,” he said. His motion, without the extra money, passed on a 15-4 party-line vote.