The Joint Finance-Appropriations Committee, on a unanimous 20-0 vote, has set a budget for Medicaid for next year that’s significantly below Gov. Butch Otter’s recommendation, even though it includes two provider rate increases that he hadn’t included in his budget proposal. The main reason for that: The governor’s proposed Idaho Health Care Plan line item, at $17.8 million in state general funds and $100.8 million in total funds when federal matching money was added in, was zeroed out. Yesterday, the bill to establish the plan to provide coverage for about half of those who fall into Idaho’s current health coverage gap was pulled from the House floor without a vote and sent back to committee.
Overall, the budget set by the joint committee shows a 9.8 percent increase in state general funds for Medicaid next year, 7 percent in total funds. Otter had recommended a 13 percent increase in state general funds, 11.2 percent in total funds.
Most of the increase for Medicaid next year comes from a $38 million increase in the state’s costs for “non-discretionary adjustments,” which include caseload increases, mandatory pricing increases, and changes in the federal matching rate.
The federal government picks up about 70 percent of the cost for Idaho’s Medicaid program, which provides health care mainly for low-income children and disabled people, matching state expenditures on a roughly 70-30 basis.
Otter had proposed covering rate increases next year for two categories of providers: Supported living rates for residential habilitation providers; and community-based personal care services for Medicaid clients. He hadn’t recommended them for two other categories of providers, children’s community-based developmental disability habilitative intervention and habilitative support services; and personal care services delivered in assisted living facilities. But JFAC added those rate increases. Lawmakers who worked on the budget said rate surveys required for those increases weren’t completed until just last week, and they worked closely with the administration once the figures were in to include those.
The group of JFAC members who worked on the Medicaid budget this year included Reps. Melissa Wintrow, Phylis King and Luke Malek, and Sens. Steve Bair, Abby Lee, Mary Souza and Jeff Agenbroad.
“I want to thank the hard-working working group who really tussled through this budget trying to make sure we did everything we could to understand it,” said Wintrow, D-Boise, including working with stakeholders. She said the provider rate increases are “a fiscally responsible thing to do – if we can keep people in their homes and community-based programs, we will save money overall without putting people in institutions. This is a great program in particular for our rural areas that are struggling.”
Lee, R-Fruitland, said, “I would just like to echo support for the group. I know there are a number of folks that are looking at this as a large item increase. We got a lot of information about how long it’s been since there was a rate increase … and the importance for our rural communities. … These are folks who would have nowhere else to go. So it is a cost savings, particularly in those assisted living areas, to provide a rate increase so that those facilities do not close, and those individuals would go into long-term care, which is significantly more expensive. So I think this is a conservative approach.”
Souza, R-Coeur d’Alene, said, “This was a difficult budget. We wrestled with every one of these, and looked at it so closely, because these are huge numbers. This is our most vulnerable population.”
The Medicaid budget that the joint committee set for next year totals $584 million in state general funds – well below Otter’s proposed $601 million – and $2.4 billion in total funds, down from his proposed $2.5 billion.
JFAC also was unanimous today on the budgets for two other divisions of the state Department of Health & Welfare, the Division of Welfare and the Division of Public Health Services. The same working group of JFAC members crafted both of those budgets.
The Welfare Division budget matches Otter’s recommendation, but the general-fund figure is lower, because a system modernization project was appropriated from a newly established technology fund, rather than from the state general fund. The Public Health Services budget is slightly lower than Otter’s recommendation, because three more kids have dropped out of the “expanded access” program that’s supplying Epidiolex, a commercial version of marijuana-derived cannabidiol, to a group of Idaho children with severe, intractable epilepsy. Once children drop out of the program, their spots can’t be refilled; the most recent change brings the number of kids being treated down to 33.