Idaho work group amends Medicaid eligibility expansion proposal

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BOISE, Idaho — An Idaho work group has tweaked its recommendations on expanding Medicaid eligibility in a last-minute effort to make their plan more politically palatable to lawmakers.

Work group facilitator Corey Surber says the 15-member group approved a hybrid model Friday. The group had finalized a proposal to Gov. C.L. "Butch" Otter back in August. However, lawmakers warned the proposal's blanketed support of Medicaid expansion would fail to even be considered when the Republican-controlled Legislature convenes in January.

Under the newly approved plan, adults earning 100 percent to 138 percent of the poverty line may purchase private insurance on Idaho's health insurance marketplace using federal dollars.

Adults below 100 percent of the poverty line, Idaho's lowest-income participants, would be provided Medicaid coverage.

The previous plan expanded Idaho's Medicaid eligibility to adults earning 138 percent of the poverty line.

Yet critics of the August proposal said it would create a new category of nearly 25,000 adults who qualified for private plans on the state-based exchange but would be moved into the Medicaid coverage plan.

"We are trying to figure out something that will work out not just practically but also politically," Surber said, who is also executive director of health and public policy at St. Alphonsus Health System in Boise.

This is the third recommendation the work group has supported in an effort to provide coverage to the state's nearly 77,000 residents who don't currently qualify for Medicaid. The original 2012 recommendation went ignored for two years. This year, the governor asked the same panel to re-evaluate their proposal but reiterated he would not support Medicaid expansion unless the assistance program also changed.

Unlike in August, this proposal won the support of three out of the four lawmakers who sit on the work group. House Majority Leader Mike Moyle of Star voted against the recommendation. Moyle has described Medicaid expansions as a "toxic" in the Idaho Statehouse.

"My vote was actually closer to a no than a yes," said state Sen. Steven Thayn, R-Emmett. "I don't think it's moved far enough to be palatable."

Thayn said he voted in favor of the motion after the group agreed to approve a pilot program he had been presenting at the past few meetings. The program would provide direct primary care to low-income patients using funds from the state's catastrophic care program.

Idaho's GOP-dominated Legislature has avoided addressing expanding the state's Medicaid eligibility requirements, a provision provided under the federal health care overhaul, ever since the U.S. Supreme Court ruled that states can determine on whether to expand.

The situation has become increasingly heated as state lawmakers faced political backlash for supporting the state-based health insurance exchange, another key provision under the Affordable Care Act, which has since caused many to refuse even considering Medicaid expansion despite it being supported by state medical, hospital and insurance groups.

"It's just frustrating to not be able to make the case for it in front of the Legislature," Surber said. "That's what we're asking."

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