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Eye on Boise: Idaho lawmakers debate health budgets, but not coverage gap

Betsy Russell (Colin Mulvany / The Spokesman-Review)
Betsy Russell (Colin Mulvany / The Spokesman-Review)

BOISE – Idaho lawmakers have just finished a full week of hearings on health and human services budgets, and while major changes and initiatives are underway in some areas, there was little talk about how to close the state’s health coverage gap.

A joint legislative working group that held months of hearings voted unanimously in November to call for this year’s Legislature to take action to close the gap, which includes 78,000 uninsured Idahoans unable to access health insurance because they make too much to qualify for Medicaid but too little to qualify for subsidized coverage through the state’s insurance exchange. That panel didn’t recommend how the Legislature should take action, however.

“A policy to provide health care of some kind to the gap population should be enacted by the 2017 Legislature,” said the committee’s final report to the full Legislature.

Idaho has been debating for four years whether to expand its Medicaid program, largely at federal expense, under the national Affordable Care Act to cover that population, but now it’s uncertain if that will even be an option for the state.

Several bills likely will be introduced next week to tap the state’s Millennium Fund, which comes from a nationwide tobacco settlement, to fund some type of primary care for Idahoans in the gap. But those funds already are committed to other programs including smoking cessation and prevention programs.

Meanwhile, Idaho Health and Welfare Director Dick Armstrong told legislative budget writers that his department’s top budget priority this year is a redesign of the children’s mental health program. “It is a pragmatic approach to expand services to more Idaho children through Medicaid,” Armstrong said. “We are taking the money we are spending to pay for care now, and using it to leverage Medicaid federal funds to reach more children who have trouble functioning in their day-to-day lives. There are no additional costs for treatment, though we can provide services to a far greater number of children.”

Armstrong said the proposal is “based on some hard-earned lessons,” saying, “This request is the result of the Jeff D lawsuit which began in 1980. It took us years of court wrangling to come up with something we could have come up with decades earlier.” He added, “We are determined to do this right.”

The effects of improving children’s mental health treatment in Idaho will ripple through an array of other state budgets and programs, Armstrong said, and have a real impact in Idaho communities, on everything from improving outcomes in school, juvenile corrections and the foster care system to state prisons, social services and people’s productivity. “Our world would be different today if adults with mental illness had accessed and received evidence-based mental health treatment as children,” he said.

He also highlighted a proposal to increase stipends to foster parents in Idaho by 20 percent, to address a shortage of foster families for children in need; his proposal to provide mental health treatment to high-risk felony probationers and parolees; and funding for a secure mental health facility. “These are all tied together,” Armstrong said.

Here are some of the news items that emerged from this week’s budget hearings.

Marijuana-derived drug working for kids

Gov. Butch Otter’s 2015 executive order authorizing a “compassionate use” program for up to 25 Idaho children with a severe, intractable form of epilepsy to be treated with a new British drug, Epidiolex, that’s non-psychoactive but derived from marijuana, has been a success. Of the 25 slots, all were filled, but one child had to withdraw for lack of ability to withstand needed blood draws.

Now, the Department of Health and Welfare is requesting state funding to expand the program to another 15 children, for a total of 39. Under questioning by members of the Joint Finance-Appropriations Committee, Elke Shaw-Tulloch, director of the department’s Division of Public Health, said that would serve all Idaho children currently on the waiting list for the program.

“The program is being conducted in concert, on a national basis, with a clinical trial,” Shaw-Tulloch told lawmakers, but under the “compassionate use” program, all Idaho kids in the program receive the real drug, not a placebo. “We are seeing some great progress,” she said, and the manufacturer is reporting strong results in its national trial.

Epidiolex, which the manufacturer is providing to the program for free, is not yet commercially available, but is expected to win FDA approval within one to two years.

Gov. Butch Otter is recommending approval of $128,600 in state funds for the program expansion. He issued the executive order after vetoing legislation in 2015 that would have allowed Idaho parents of children with intractable epilepsy to treat their children legally with CBD oil, a marijuana-derived oil.

A new state mental hospital

Otter is proposing a big shift in psychiatric hospitalization, moving the state’s psychiatric adolescent hospital from State Hospital South in Blackfoot to a new $10.3 million facility to be constructed in the Boise area, to be called State Hospital West; and converting the old adolescent unit in Blackfoot into a 20-bed secure facility for adults.

Services for the newly released

Otter is recommending moving ahead with Armstrong’s proposal to spend $11.2 million in state funds next year to provide mental health services to about 7,400 felony probationers and parolees who are deemed at risk for reoffending without continued services, which they received while they were behind bars. It’s part of the state’s Justice Reinvestment Initiative.

Behavioral Health Division Administrator Ross Edmunds told JFAC that Idaho state law requires the Department of Health and Welfare to pay for mental health services for the felony probation and parole population. “The individuals who get those services are determined not by us, but by the court system,” he said.

Last year, as required by law, Health and Welfare and the Idaho Department of Correction commissioned a “gap analysis” for the services from WICHE, the Western Interstate Commission for Higher Education. That provided the numbers on who needed the services, and prompted the request. “It’s a result of that gap analysis and a result of the code,” Edmunds said.

Rep. Melissa Wintrow, D-Boise, asked about Idaho’s health coverage gap. Pondering the $11.2 million for the parolees and probationers – who all would have been covered if Idaho had expanded Medicaid to cover the full 78,000 people in the gap – Wintrow said she was “wondering if that money could be used to leverage … and include all these people as well.”

Edmunds said the proposal for the parolees and probationers allocates only $126 per person per month, to be delivered through a contract. “We believe we can do this very efficiently,” he said.