Cutting Into Care Lawmakers Plan Sharp Health-Care Cutbacks Despite Medicaid Reforms Agreed To Under Batt

Sharp cutbacks in health care programs for Idaho’s poorest and disabled citizens are under consideration in the state Capitol, and there won’t be a single public hearing or chance for those affected to have a say.

Prompted by Gov. Dirk Kempthorne’s budget proposal, the changes in Medicaid are being hastily thrown together for consideration by the Legislature’s budget committee, the only legislative panel that takes no public testimony.

“That’s not a good way to run the state, in our opinion,” said Kevin Borden, a community organizer with the Idaho Community Action Network.

The move is particularly upsetting for those who attended the 30 public hearings held around the state in 1996, when former Gov. Phil Batt’s Medicaid Reform Advisory Council developed 88 suggested reforms of the program. Many are just starting to take effect.

“I think we could not have formulated what we believed to be 88 very good recommendations without the public input,” said Sen. Gordon Crow, R-Hayden, who served as vice chairman of Batt’s council.

Kempthorne’s budget proposal came because the governor “just said wait a minute,” said his communications director, H.D. Palmer. “You’re looking at remarkable growth in a program. The governor is not going to blindly agree to auto-pilot spending.”

Palmer added, “This is not a cut, this is a slower rate of increase.”

“We figured there’d be a firestorm,” said Sen. Atwell Parry, R-Melba, co-chairman of the budget-setting Joint Finance-Appropriations Committee. “It’s not our intent to cut into the budget of good programs. We just want efficiencies.”

That’s what Kempthorne said, too, when he proposed a budget for the Health and Welfare Department for the coming year that is $39 million below the department’s request.

But Kempthorne didn’t suggest efficiencies in Medicaid, the joint federal-state program that provides health care to the poor and disabled. Instead, his budget recommended no funding for $25.6 million in federally required increases for Medicaid providers and services.

Idaho doesn’t have much say over much of the Medicaid program. Federal law requires many of the services and even sets the rates.

So when the joint appropriations committee formed a subcommittee and asked the Health and Welfare Department to suggest options for how to trim Medicaid, the department identified every place where the state has any flexibility to cut.

Changes on the table range from eliminating one type of service for the developmentally disabled - TESH in Coeur d’Alene estimates that two-thirds of its 165 disabled clients would lose their service - to charging co-payments for most Medicaid services, to cutting back on physical therapy and mental health services.

“The growth in spending in the Medicaid program is a little frightening, from a budget perspective,” said Health and Welfare spokesman Bill Walker. Idaho’s share of the costs for Medicaid, which is 70 percent federally funded, have soared from $110 million in 1995 to as much as $168 million in the coming year.

“Clearly something needs to be done to get a handle on costs,” Walker said.

That’s why the department came forward with proposals like an across-the-board, 3 percent cut in reimbursements to doctors and others who provide services to Medicaid patients. But that idea quickly got the boot, amid complaints that it’s already hard to find providers who will accept Medicaid patients at current rates.

“I don’t think anybody liked this particular option,” Walker said. “But we felt that we had to look at all possibilities.”

Sen. Robert Lee, R-Rexburg, heads the subcommittee that’s going through the possible cuts. “We’re in a very tough situation because we’ve got to find a bunch of money to be able to balance the budget,” he said. “The first objective is to be able to meet the governor’s recommendation, but if there are ways to go beyond, we will.”

The changes in services to the developmentally disabled have aroused the most outcry, so far. More than 2,500 people receive the type of developmental therapy that would be mostly eliminated.

“It would just be nice to have them see the value in what we’re doing,” said a frustrated Pam Bemis, director of rehabilitation for TESH. “The idea is to keep people out of institutions.”

TESH helps adults and children, and it and other providers say the way Health and Welfare is proposing the change, services to hundreds of disabled children would be eliminated.

Walker disputes that, saying another program will pick up the kids. But providers say it doesn’t provide the same type of service.

TESH teaches developmentally disabled people life skills to function on their own, from how to ride the bus to work to how to read a menu in a restaurant.

“There are people that, when we started this program 8-1/2 years ago, were living with their moms and dads and exhibiting very child-like behavior. They are now in their own apartments and have jobs in the community,” Bemis said.

Kempthorne, whose favorite political slogan is “the Generation of the Child,” doesn’t want children’s services cut, Palmer said. “We’re not going to sign off on a budget proposal that is going to make reductions in services for children.”

The confusion over the proposals alone shows a need for public hearings and more careful study of the changes, said Roger Sherman of United Vision for Idaho, a Boise nonprofit group that works with health-care and advocacy organizations.

“This set of cuts is a blind-side to people who have been working on Medicaid issues for a long time,” he said.

Walker said Health and Welfare simply wants to make sure that it’s not providing services to people who don’t really need them, and thereby wasting taxpayers’ money. That theme runs through several of the proposed changes, which focus on adding pre-authorization and screening before Medicaid patients can get services ranging from mental health services to rides to the doctor.

The change in the developmental disabilities program would switch patients to a different program where Health and Welfare has more oversight, Walker said.

Health and Welfare also has proposed reversing several privatization moves, saying the private contracts are costing the state more than just directly providing the services. Those proposals have gotten a mostly positive reception so far from lawmakers.

The co-payment idea has been especially popular among budget committee members looking for savings this year.

“If a service is free, people will flock to it,” Lee said.

Sen. Marguerite McLaughlin, D-Orofino, who served on Batt’s advisory council with Crow, said the issue isn’t that simple.

“We studied it in depth, and I think we ought to go forward with the recommendations we have,” she said. “A lot of people came on there with preconceived ideas, and when you study it you find out it’s very complicated.”

Although there was support for a co-payment plan at the council’s hearings, McLaughlin said after much review, she became convinced that Medicaid recipients are so poor that even a very small co-payment would discourage them from seeking health care when they first become ill. “They could be coming in at a higher cost when their health deteriorates,” she said.

Parry said he’s not convinced. “I’m a great believer in a co-payment,” he said.

Rep. Robert Geddes, R-Preston, the joint committee’s House co-chairman, agreed. He compared the situation to a movie theater showing movies for free - lots of people will come, simply because they don’t have to pay.

The fact that the changes are being considered through budget-setting suggests a conflict with a position Kempthorne has espoused since his election: that policy should drive the budget, rather than dollars and cents driving the administration’s policy.

“The governor doesn’t think it is sound fiscal policy to just take your hands off the steering wheel and let these programs grow unchecked,” Palmer said.

Kelly Buckland, executive director of the Idaho State Independent Living Council, said, “It’s a bad process. It’s closed. There’s no opportunity for any kind of public participation in this. They’re making policy decisions in a budget process, and I don’t think that’s a good idea.’ Parry said Medicaid, with its runaway growth, requires quick action. “I personally think the budget should drive policy on some of these things, because my experience in the past is that program can get out of control,” he said. “It can sound good, but it can break a budget.”

See 2 related stories under the headlines: 1. People with disabilities would feel cuts 2. Statehouse proposals for trimming Medicaid