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posted on September 28, 2012 16:52

The Idaho governor’s workgroup to evaluate possible expansion of Medicaid for low-income adults in 2014 studied three options during a meeting in Boise on Thursday, Sept. 27th. The options include:

1. Do not expand Medicaid.
2. Do not expand Medicaid, but redesign the county indigent and state catastrophic healthcare programs.
3. Expand Medicaid.

The 15-member workgroup was tasked by Gov. C.L. ‘Butch’ Otter to study the advantages and liabilities of expanding Medicaid to adults who earn up to 138 percent of the federal poverty limit as part of the Affordable Care Act (ACA
). A U.S. Supreme Court decision in late June allows states the option of expanding Medicaid beyond the mandatory changes already laid out in the ACA.

Steve Millard, president and CEO of the Idaho Hospital Association, center, and Health and Welfare Director Dick Armstrong discuss Option 2 with Dan Chadwick, executive director of the Idaho Association of Counties.

Option 1
Department of Health and Welfare Director Richard Armstrong presented information to the workgroup on Option 1: Do not expand Medicaid.  Even without expansion, he explained that enrollment in Medicaid is going to increase by an estimated 36,000 people.

Two-thirds of this enrollment growth is due to new rules for eligibility determination, which calculate income differently than today, removes an asset limit and changes the definitions for a household. These individuals are not currently eligible for Medicaid, but will be considered newly eligible in 2014. The remaining third of new enrollees are people who currently qualify for Medicaid but have never applied for coverage. With the mandate for people to have insurance coverage in 2014, many are expected to opt for Medicaid coverage.

Taking into account normal annual Medicaid growth and the enrollment “surge" of new Medicaid participants in 2014, Armstrong estimates Idaho Medicaid will grow from last fiscal year’s 229,000 to almost 300,000 people in 2016 without Medicaid expansion.

Workgroup member Dr. Bill Woodhouse said the group needs to help the working poor.

Option 2
Dan Chadwick, executive director of the Idaho Association of Counties, presented Option 2: Do not expand Medicaid, but redesign the State Catastrophic/County Indigent Care programs. Chadwick said charts the workgroup reviewed do not include the enormous administrative costs for managing the program.

“In a neighboring county today, there are 53 hearings being held on indigent claims,” he said. “That includes hospital staff, county staff, attorneys, and county commissioners spending a whole lot of time and effort. It is a big deal, a very large cost.”
Possible redesign of the county/state partnership in covering indigent healthcare includes system design standardization for all of Idaho’s 44 counties for:

• Claims processing;
• Forms;
• Transitioning to electronic records; and
• Expansion of utilization management and medical reviews.

Option 3
Mike Baker, CEO of Dirne Community Health Center, presented Option 3: Expand Idaho Medicaid to low-income adults in 2014. Baker reiterated the expansion population characteristics presented earlier in the workgroup meeting by a Leavitt Partners’ report. Expansion will add approximately 100,000 new eligible participants, with two dominant populations:

1. A young and healthy group.
2. An older population suffering from chronic conditions such as diabetes, coronary illnesses, and obesity.

Baker presented a chart with three lines that shows:

1. Medicaid projected enrollment without ACA impact;
2. Medicaid enrollment without expansion, but with anticipated eligibility surge; and
3. Total Medicaid enrollment with expansion.

The chart projects that eligibility surge and expansion will increase Medicaid enrollment in SFY 2016 from a projected 262,000 participants to 414,000.

Steve Millard, president and CEO of the Idaho Hospital Association, called the numbers scary. “That’s a large number of people, so what we have to do in the industry is to make sure the costs per person start going down,” he said. “We have to start with the payment system — the fee-for-service system is driving costs up.  The more you do, the more you make does not work. There is a lot going on in Idaho and across the country right now to change that” and move away from a fee-for-service system.

Baker said the group’s discussions show all the holes in the current system that are paying money out. “An uninsured person who walks through the door impacts every single one of us” because of cost shifting, he said. “People are accessing care at the wrong time, the wrong place and at the wrong price. Let’s move to a family practice, preventive model and be smarter by using the healthcare system more efficiently.”

Roundtable Discussion  
After the presentations, each member was asked for guiding principles going forward.

Rep. Fred Wood tells workgroup members that he would like to see simple charts that show the costs associated for options 1 and 3.

Dr. Bill Woodhouse asked the committee to look past the numbers to the individuals who would benefit from expansion.   “Health statistics represent folks with the tears wiped off,” he said. “It’s time to put some of those tears back on. This is a group who serves us in society and is important to us; they are the working poor. We need to commit ourselves to act and find a way to make it happen.”

Rep. Fred Wood wants the committee to develop a simplified graphic that shows the total annual costs associated with no expansion, as well as costs for expansion over the next 10 years.  “I think that is paramount, to be able to show the costs on an annual basis,” he said. Health and Welfare Director Armstrong said the state is contracting with a consulting firm that may help the committee develop a simplified graphic showing annual costs. 

Wood also expressed concern about “creating an adverse business environment” in the state if it doesn't expand Medicaid to the point that a business with 1,000 jobs considering relocating to the state might say, “Wait a minute, you want me to come to the state of Idaho and pick up a part of your indigent care? We're not coming.”

Presentations from workgroup members are available
here. An audio recording is available from Idaho Public Television at:

The next workgroup meeting is tentatively scheduled for Tuesday, Oct. 23.