Fremont Commissioners await state's decision on Medicaid expansion

(Photo by Betsy Z. Russell)

Legislative budget analyst Jared Tatro, right, presents information to the Legislature’s interim committee on Medicaid funding recently at the state Capitol. Tatro examined how the 36 other states that have expanded Medicaid have funded their state share of the costs.


ST. ANTHONY — The Fremont County Commissioners won’t have a Medicaid plan in place until the state approves one next year. That will come after state legislators review recommendations by the state’s Equitable Assessment of Costs Related to Medicaid Expansion committee.

For now, the county is taking a wait and see attitude concerning possible medicaid expansions. While waiting to see what the state plans to do, Fremont County Commissioner Chairman Lee Miller has been meeting with area representatives to discuss the matter.

Miller recently met with the Idaho Association of Counties, Rep. Jerald Raymond, Rep. Rod Furniss and Jefferson County Commissioner Scott Hancock to discuss the issue.

“There are just no answers right now,” Miller said.

While he doesn’t want to see taxes raised, Miller suggested that sales tax be increased by half of a cent to cover Medicaid expansion costs.

“That’s so everyone contributes equally rather than put it on the property taxes which has been a suggestion by some,” Miller said. “In that way, those who are on Medicaid do have an opportunity to contribute to their own cause.”

The county has an indigent fund that’s used by those residents lacking health insurance and require an emergency medical procedure like an appendectomy, he said.

Miller said that he doesn’t expect the state to pay for the entire Medicaid expansion that’s expected to cost the state $40 million a year.

“They’re not going to fund it all. I can tell you that right now. No matter how it’s played out, they’ll place some burden on the counties in some way,” he said.

Last year, Idahoans passed the Medicaid Expansion Initiative with 61 percent in favor of the vote. While Gem State residents approved the measure, there was nothing in place to cover the cost of the expansion.

According to an article written by Idaho Press reporter Betsy Z. Russell, the Medicaid Expansion panel suggested that Idaho counties provide $10 million a year toward the cost of the expansion’s cost.

Currently, property taxes cover the cost of medical indigency and catastrophic health care. That tax money pays for the first $11,000 of bills that a patient can’t pay. After that, the state picks up the tab through the Catastrophic Health Care Fund and by placing liens on property, but often few funds are recovered, Russell reported.

The hopes are that via Medicaid Expansion, Idahoans won’t be as dependent on county indigent programs as they have been in the past, said the committee.

According to Russell’s article, Idaho’s Medicaid Expansion is funded for the first six months of 2020. That’s thanks to the Gov. Brad Little’s efforts in tapping the tobacco-settlement Millennium Fund and state catastrophic health savings to fund the expansion. It’s expected Little will ask for similar funding in 2021, Russell reported.

The 10-member House and Senate panel approved its report and suggested that the counties provide $10 million toward various expansion costs in 2021. That $10 million is about half of what counties currently spend on indigent programs, it said.

“The money would come from the counties’ sales tax revenue sharing distribution and would be contingent on combining county charity and justice levies, so neither would be left short by the move. County participation would be delayed until Oct. 1, 2020 to match the counties’ fiscal year; and, if any county had a spike in medical costs, Millennium funds would be tapped to make up the shortfall,” wrote Russell.

In Fremont County, 12.6% of its 13,000 residents are without health insurance, reports the webpage Around 16.1 percent of Fremont residents rely on Medicaid while 13.3% are on Medicare. Of Fremont County employers, 37.5% offer health care coverage. The webpage also noted that the percentage of uninsured residents declined between 2016 and 2017 from 14.3% to 12.6%.

The Idaho Department of Health and Welfare recently reported that 35,000 Idahoans signed up for Medicaid coverage. That’s more than one-third of the estimated 91,000 people who are eligible. The expansion provides Medicaid to those earning up to a maximum of 138 percent of the federal poverty level. That maximum is around $17,000 a year for one person and $35,500 for a family of four.

The Department of Health and Welfare reported that of Idaho’s 1.8 million residents, nearly 300,000 were covered by Medicaid. To cover those newly eligible would cost a total of $400 million with the federal government paying 90%.

For now, Fremont County Commissioners will wait to see what state legislators will decide, Miller said.

“There’s nothing we’ll really do until the state makes some decisions. That’s why I say this is so preliminary. We have no idea. Until they go back into session, we don’t know what will happen,” he said.