Idaho Plans to Address Medicaid Gap
Medicaid has been an issue for the state of Idaho for several years now. Lawmakers are attempting to come up with creative solutions to address the problem. Idaho has had problems with Medicaid in the past with regard to cuts in services covered as well as billing problems. The Affordable Care Act was intended to help Idahoans by expanding coverage of Medicaid. Idaho elected not to expand. This article outlines the Medicaid gap, Idaho’s history with Medicaid expansion, how officials plan to solve the gap and what the plan would mean for residents.
Understanding the Medicaid Gap
Idaho is currently trying to solve a complex health care problem—getting the poorest in the state covered under health insurance. Right now it faces a Medicaid gap. When it was passed in 2010, the Affordable Care Act (ACA) provided for the expansion of Medicaid in order to give the poorest in each state medical coverage. After a Supreme Court ruling in June 2012 which made Medicaid expansion optional, Idaho decided not to expand the program despite later attempts to expand it.
For states that did elect to expand Medicaid, the ACA provides coverage to people who have incomes at or below 138% of the poverty line. In the case of Idaho, electing not to expand coverage meant keeping the very limited rules of Medicaid. In order to qualify for Medicaid in most states including Idaho, people must have a certain income threshold to meet.
Those that do not meet the income threshold for Medicaid must purchase insurance through the state insurance exchange. The Medicaid Gap forms when there are people who make too much money to qualify for Medicaid and too little to afford regular insurance.
About 2.6 million adults fall into this gap nationally. The Western region including Idaho has 3% of that population.
History of Insurance and Medicaid Expansion in Idaho
- Shortly after the Supreme Court decision in 2012, Governor C.L. “Butch” Otter requested a working group of Medicaid expansion and the creation of an Idaho insurance exchange. In November, the working group for Medicaid recommended expansion. For almost 4 years, bills were introduced in the legislature for expansion and the working group continued to recommend it too. But no progress was made with regard to Medicaid Expansion.
- A plan called “Healthy Idaho” which would ensure those up to 100 percent of the poverty line through Medicaid is introduced in 2014. The remaining 38% in the 138 percent ACA provision are insured through state exchanges. It does not go anywhere at the time.
- At the start of 2016, Governor Otter and Idaho Department of Health and Welfare Director Dick Armstrong introduced a primary care program targeted toward those in the Medicaid gap at a cost of $30 million. It hit a roadblock in the legislature. Democrats thought the coverage provided by the program should be more comprehensive. Republicans, in contrast, were wary of the cost and the idea of a welfare program.
- A Medicaid expansion bill and a bill to implement Healthy Idaho are introduced at that time. But they don’t get anywhere. Around this time, lawmakers begin to discuss getting a Federal Medicaid expansion waiver in order to create their own state plan.
Trying to Get Coverage for All
As of the last attempt to expand Medicaid in March 2017, 78,000 people in the state fell into the coverage gap. They did not meet the income requirement and they didn’t make enough money to purchase insurance through the state exchange.
Instead of trying to expand Medicaid like they have in the past, Idaho officials now want to introduce waiversto the state legislators like they talked about in 2016. If approved, these waivers would ask the federal government to provide subsidies to adults that earn too much for Medicaid. These subsidies would help them afford insurance in the state exchanges. Medicaid would then be preserved for sicker patients to get the coverage they need. If the legislature passes the proposed plan, 38,000 people would be covered under health insurance and premiums would go down by 20%.
Department of Insurance Director Dean Cameron and the now former DHW Dick Armstrong are behind this proposal. They estimate that 40% of insurance claims in the insurance exchange is made by the sickest adults which are about 2,500. Getting them off of the exchange is expected to lower premiums. The cost would be $22 million because the state would be partly matching Medicaid expansion funds from the Federal Government.
The plan will be discussed at the start of the 2018 legislative session.
Officials have said that they have introduced this plan to stabilize the insurance marketplace mainly. This is to ensure that people have as many options for coverage as possible. The second purpose of the plan is to make sure as many people as possible get coverage.
Those who are currently costing the most on the state insurance exchange would not be required to switch to Medicaid. They could still buy insurance. However, it would offer those people access to cheaper prescriptions and their medical care costs would not be as high. Idaho currently gives women who are classified as low-income coverage under Medicaid for certain cancers. The state would simply be using the same framework and give it to more people.
Idaho would fair better under the ACA system if they took the Medicaid expansion provision. Up to 90% of the cost for the expansion would be matched by the Federal Government. But officials say that opting for their own plan is a better solution given the uncertainty of health care under Congress. Under the most recent healthcare bill, Graham-Cassidy, Idaho would receive a boost in funding. It would only be temporary though. Starting in 2027, the state would see massive cuts. So wariness of Federal healthcare is not completely unfounded.
The solution proposed by officials in Idaho is not an instant fix. If it is approved, the plan would take nearly a year to put into place. In the meantime, about 5 percent of the state population will still be in the Medicaid gap.
What to Know
- 78,000 people are currently in the Medicaid Gap
- Waivers would be introduced to the Legislature in 2018.
- They would waive federal Medicaid expansion and request subsidies to cover people in the state exchange.
- Sicker people have the option of going to Medicaid
- Lower premiums would be in effect as a result
- It would take 1 year to implement
- The latest federal health care proposal would hurt Idaho in the long run.