Idaho’s catastrophic health care program costs climb

BOISE – Costs to the state and counties for Idaho’s unique catastrophic medical care program more than doubled from 2002 to 2013, and they’re expected to continue to mount if the program stays as-is.

Next year, the state’s portion of the bill is expected to jump 10.6 percent to $38.5 million, state lawmakers learned Thursday. The rest of the cost is paid by each county’s property taxpayers.

“This is the nature of our program,” Roger Christensen, a Bonneville County commissioner and chairman of the state Catastrophic Health Care Cost Program board, told legislative budget writers. “It doesn’t allow for preventive care, so we deal with the results after it becomes catastrophic, which is much more expensive, and it’s paid for dollar for dollar.” No federal matching funds are available.

The program covers catastrophic medical costs for patients who can’t pay the bills off in five years; liens are placed on patients’ property, but little is generally recovered. State general funds and local property taxes cover the full cost of the program.

Combined state and county costs were $52.7 million in 2013, down slightly from the prior year due to a temporary federal program that picked up some costs but is now expiring. In 2002, the combined state and county costs were $25.3 million.

Alternatives include expanding Idaho’s Medicaid program, which now is limited to children, indigent parents and the disabled, to provide coverage for patients who otherwise would turn to the catastrophic program. Federal funds would cover most of the cost, and the existing program could be repealed. Although the governor isn’t supporting that for the coming year, more lawmakers are talking about it now.

Other options include sending some of the patients to the new health insurance exchange, through which roughly 40 percent likely would qualify for subsidized insurance; or cutting back the program to cover only emergencies.

Currently, the program’s highest costs are for heart disease and related conditions, followed by cancer, and then diabetes.

The average claim paid has risen from $24,127 in 2010 to $26,602 in the latter half of 2013.

“One area that’s a real concern to our counties is the issues of mental health,” Christensen told legislative budget writers. “We’re seeing quite an increase.”

He said, “This is an area where prevention pays dividends. When we deal with it, it’s usually after an episode. It’s unfortunate, because people are being treated in our jails. … We just want to point that out as an area of major concern and pressure on program costs that we may have in the future.”

Costs would be reduced if the patients who turn to the Catastrophic Care Program instead were covered under health insurance, he noted.