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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Medicaid costs will continue to rise for state

Betsy Z. Russell Staff writer

BOISE – Medicaid is the fastest-growing part of Idaho’s state budget, and there’s no quick or easy way to change that, state lawmakers were told Wednesday.

“I hope someday we’re going to actually level this out so we can budget for it,” said Sen. Mel Richardson, R-Idaho Falls, after hearing a detailed presentation on the state’s Medicaid budget.

Rising caseloads, soaring health care costs and a drop in employer-sponsored health care coverage all are helping push up Idaho’s costs, division administrator David Rogers told the Joint Finance-Appropriations Committee.

“We’re obligated to pay,” he said.

Rep. Scott Bedke, R-Oakley, asked, “Is it within the state’s power to … ratchet down the percent of poverty? Could we drop that a point or two or five or 10 so that the most vulnerable would still be covered? … Is it within the state’s prerogative to manipulate those numbers that drive caseload?”

The answer wasn’t what the lawmaker hoped for. Idaho already sets eligibility for most of its Medicaid program at the stingiest level federal law allows – 133 percent of the federal poverty level as a maximum household income.

“That’s the federal minimum,” Rogers told the lawmakers. “We are at the minimum coverage.”

Rep. Darrell Bolz, R-Caldwell, noted that most of Idaho’s Medicaid program now consists of optional services rather than federal requirements. In 2004, 55 percent of the program consisted of optional services, up from just 25 percent in 1993.

“Are we seeing people moving to Idaho to take advantage of some of the options that we have for medical coverage?” Bolz asked.

“I don’t know that. I have not seen that in the data,” Rogers responded.

In fact, Idaho’s Medicaid program is one of the least generous among states.

According to “Idaho Fiscal Facts 2004,” compiled by the legislative budget office from state and national figures and surveys, Idaho ranks 35th among the states for the percentage of its population enrolled in Medicaid – 11.3 percent in 2002 – and 45th in the nation for its per capita expenditures on Medicaid.

By contrast, Washington ranks 15th for having 15 percent of its population enrolled in the state-federal health coverage program for poor people and people with disabilities, and 19th among states for its per capita expenditures on the program.

Rogers said Idaho actually has relatively few truly optional programs.

“I think the fact that prescription drugs is an optional service under federal law – given the importance of medications in health care today and that every state in the nation covers this benefit under its Medicaid program – demonstrates that much of federal Medicaid law still reflects health care delivery and financing in 1965,” the year Congress enacted the program, he said.

Rogers said the bulk of Idaho’s program consists of serving those who must be covered under federal law.

“There are optional populations that the state can elect to cover and that we have here in Idaho. Those optional populations are few in number,” he said, and mainly consist of the Children’s Health Insurance Program, a legislative mandate to cover breast and cervical cancer, and coverage of nursing home residents with higher than the minimum income.

Idaho’s Medicaid program will cost the state about $300 million in general tax funds this year, nearly 14 percent of the state budget. A decade ago, Medicaid spending was just 7.3 percent of the state budget, and in 1987, it was only 3.9 percent.

The federal government spends about $2.33 for every $1 Idaho spends on its Medicaid program, bringing the total Medicaid program in Idaho to about $1 billion.

In the coming year, Health and Welfare officials expect Idaho’s costs to rise, despite a slew of cost-control programs.

Gov. Dirk Kempthorne is in Washington, D.C., this week, meeting with a group of governors who hope to lobby Congress to increase aid to states to offset rising Medicaid costs.

This morning, the joint budget committee will hear details from Health and Welfare on efforts to control costs in Medicaid, both in recent years and into the future.