Medicaid costs committee 11-4-19

Members of the Idaho Legislature’s “Equitable Assessment of Costs Related to Medicaid Expansion” meet at the state Capitol on Monday, Nov. 4, 2019.

BOISE – A panel of state lawmakers looking into “equitable” ways to fund the state’s 10 percent share of the cost of Medicaid expansion next year has produced a majority report calling for Idaho counties to kick in up to $10 million, and a minority report opposing that.

Rep. Megan Blanksma, R-Hammett, said the idea would be to tap state revenue-sharing funds that the state currently parcels out to counties, rather than “go to the counties and take funds away from them.”

Sen. Mary Souza, R-Coeur d’Alene, said, “We’re not asking the counties to write us a check out of their budget.”

But Sen. Maryanne Jordan, D-Boise, said, “Whatever you call it, it’s still coming out of the county’s budgets, and that’s going to hurt property taxpayers. That’s the reality.”

Currently, counties assess local property taxes to pay for the medical indigency and catastrophic care program, under which county property taxes cover the first $11,000 of each approved catastrophic medical bill that local residents can’t pay. The state picks up the rest when the bill runs higher. People who get assistance get liens placed on all their assets, and even their estates after they die, in search of repayment, but little is recovered.

With Medicaid expansion, the hope is there’ll be far less need for that program.

Sen. Jim Rice, R-Caldwell, said even if the state didn’t try to tap counties, there’s no guarantee that lower medical indigency costs at the county level would bring about property tax relief. “Just because you have an expense reduction in one area doesn’t mean they won’t spend in another area,” he said.

Rice said the committee’s recommendation isn’t necessarily what will happen, and the state still could make separate moves to ease property taxes at the local level. “I think it throws down a marker,” he said. “I think we need to be frugal with the citizens’ money.”

The first six months of Idaho’s expanded Medicaid program, which begins Jan. 1, already is funded at no cost to the state general fund or the counties. Lawmakers this year approved Gov. Brad Little’s proposal to tap a tobacco-settlement fund, plus savings in other state budgets, from Corrections to Health & Welfare, brought about by expanding Medicaid. Little has called for a similar approach next year, and has expressed little interest in turning to counties to pay the state’s share; the federal government covers the other 90 percent of the cost.

After Monday’s meeting, Blanksma sent out a statement on behalf of the House Republican Caucus, saying, “Those of us in the House Republican Caucus are committed to not raising your taxes to expand Medicaid. This is a difficult task, and we cannot guarantee that all of our recommendations will be taken. If a funding source was laid out during the initiative process, we would’ve had a clear path to paying for all this. Nevertheless, we will continue to look at offsetting the costs of expansion so that we remain respectful of the Idahoans who elected us to be fiscally conservative with their tax dollars.”

After some negotiation, the 10-member House-Senate panel voted unanimously to approve its final report, including three points on which all members agreed: That general fund savings and offsets from Medicaid expansion should be used to fund the expansion; that savings in the state’s Catastrophic Health Care Fund should similarly be tapped; and that the committee should be reauthorized to continue examining the issue next year.

Majority members backed Rice’s proposal to ask counties to kick in up to $10 million toward the state’s share of Medicaid expansion costs in fiscal year 2021, with several caveats: 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.

The minority report said there’s not yet enough information on how Medicaid expansion will impact county budgets. Little already has identified sufficient funding for the coming year, so “additional funding from county assessments does not appear to be needed,” it said. The minority report also charged that there’s no basis for the $10 million figure and said it “appears to have been selected at random.”

Rice said the figure was selected because it’s roughly half of what counties are now spending on medical indigency programs.

Jordan noted that earlier presentations to the committee showed widely differing financial situations in Idaho’s 44 counties.

“The impacts of this will not be realized for at least another year,” she said, “and we need that data to make proper decisions.”