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Idaho Adds Work Requirements to Voter-Approved Medicaid Expansion

Idaho Gov. Brad Little approved legislation Tuesday adding work restrictions and other conditions to the voter-approved Medicaid expansion initiative.

By William L. Spence

Idaho Gov. Brad Little approved legislation Tuesday adding work restrictions and other conditions to the voter-approved Medicaid expansion initiative.

The action paves the way for the Legislature to complete its work and adjourn for the year, possibly as early as today.

In his transmittal letter, Little complimented lawmakers on crafting an "innovative approach" to the Medicaid expansion issue.

The legislation includes a mandatory, 20-hour-per-week work requirement. People can be exempted from the requirement for a number of reasons; however, anyone who isn't exempt and who doesn't satisfy the condition would be deemed ineligible for Medicaid for as much as two months, unless they came into compliance sooner.

"I strongly support the goal to incentivize unemployed and underemployed individuals to engage in work and training opportunities to build financial stability," Little wrote. "We must encourage self-sufficiency among those receiving public assistance."

The House Republican caucus applauded the governor's action, saying the bill "promotes a healthy lifestyle for all Idahoans, while being fiscally responsible with taxpayer dollars."

"These are some of the most compassionate work incentives in the nation," declared Rep. John Vander Woude R-Nampa, in a news release. "They promote self-sufficiency for everyone on Medicaid, which translates to smart use of tax dollars and financial stability for every Idahoan."

Close the Gap Idaho, a network of more than 300 health care and service organizations that support straight Medicaid expansion, condemned the governor's decision and vowed to fight any restrictions.

The bill "will do nothing but cost Idaho taxpayers millions of wasted dollars on growing government, creating a complicated bureaucracy and making it harder for low-income Idahoans to access health care," said Caroline Merritt, with Close the Gap, in a news release.

The group had been hoping Little would veto the bill, given that it only passed the Senate Friday on a 19-16 vote.

That appeared to be the case Tuesday. When it was first posted on the governor's website, the transmittal letter was mistakenly labeled a veto message.

The letter itself also sounds like a veto message, as the governor itemized a number of concerns he has with the legislation.

As implemented in other states, for example, work reporting requirements "have resulted in costly lawsuits and were recently struck down in federal courts," Little said. "Additionally, (they) risk eligibility sanctions associated with reporting errors and result in an unnecessary administrative burden."

Moreover, the governor criticized lawmakers for removing language from an earlier version of the bill that encouraged participation in voluntary work and training programs.

"This bill fails to utilize our existing work and training program, which focuses on outcomes that help individuals find employment, complete training programs and enroll in education programs to increase employment and enhance wages," Little said.

The fiscal note attached to the measure was equally troublesome, he said, as it "does not accurately represent the increased administrative costs associated with the work reporting activities."

Little encouraged the Legislature "to revisit the key tenants of this bill in the interim and early next session to address these issues."

The work restrictions have to be approved by the federal government before they can be implemented. That's also the case with other sideboards proposed in the bill.

The other restrictions include:

Language giving people who earn 100 to 138 percent of the federal poverty level the option to purchase subsidized health insurance through the state exchange;

A potential waiver allowing private mental health facilities to be reimbursed by Medicaid for treating Medicaid-eligible patients;

Language prohibiting any proposed sideboard from being implemented if it results in a reduction of the federal government's 90 percent share of program costs;

Language directing that all Medicaid expansion patients be placed in a "medical home" managed care program, to help coordinate their medical care;

A new waiver prohibiting any Medicaid participant from receiving family planning services or supplies from an outside provider without a referral from their medical home;

Language directing the Department of Health and Welfare to collect information from participants about potential substance abuse issues or addictions, so they can be referred to other agencies for treatment;

Language nullifying Medicaid expansion in Idaho if the U.S. Supreme Court rules that the Affordable Care Act is unconstitutional;

Language giving the state the option to repeal Medicaid expansion if the federal government reduces its 90 percent funding rate;

Language requiring the House and Senate health and welfare committees, by 2023, to review "all fiscal, health and other impacts of Medicaid (expansion) eligibility" and recommend whether expansion should remain in effect.

Spence may be contacted at or (208) 791-9168.

(c)2019 the Lewiston Tribune (Lewiston, Idaho)

Caroline Cournoyer is GOVERNING's senior web editor.
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