Post-Legislative Report

As I have emphasized in previous articles, we are in particularly challenging economic times with state revenues declining and the cost of state programs increasing. The cost of our Health and Welfare programs are no exception as costs of health programs continue to increase at alarming rates.

The Department of Health and Welfare continues to look for ways to implement changes in programs that offset and contain costs "to help avoid eliminating benefits that are intended to meet the health needs of our vulnerable populations covered in Medicaid."

One action being implemented is cost sharing by the beneficiaries for some Medicaid programs. Cost sharing requires that the beneficiary pay some portion of the cost of the service. The three most common methods of cost sharing are deductibles, co-pays and premium charges. The amount of cost sharing required from the beneficiary is usually based on income levels.

The legislature has already approved cost sharing requirements for low-income families receiving benefits for the Children's Health Insurance Program (CHIP), the Worker's with Disabilities program (Buy-In program) and the home and community based waiver program for the elderly and physically disabled populations.

A current program, more commonly known as the Katie Beckett Program, provides Medicaid benefits for children suffering developmental disabilities or other significant medical needs.

The Medicaid Division, following legislative direction provided in the last legislative session, has initiated rulemaking that would require cost sharing for this program in an attempt to reduce costs of the program. This action by the Medicaid Division has created a large amount of concern from many receiving benefits from the program.

The following is background information provided by the Medicaid Division in response to the concerns and opposition to the cost sharing proposal being expressed to the Division and legislators as the division conducts its rulemaking process.

"This is an optional (not federally required) category of children that was first introduced as a means to provide community-based services to children who otherwise would be institutionalized. Our current method of eligibility ignores any family income and establishes eligibility based on a level of care assessment. This group of families is a bit unique from most families covered by Idaho Medicaid in that many or most families are middle and upper income families who have resources to contribute to the cost of their child's care. Some of these families have private insurance and use Medicaid for the Medicaid-only services (such as developmental therapy). As we amend our rules, we will make adjustments in our premiums to account for those private plan payments. The intensity of use of Medicaid coverage varies by child as you would see in any health plan coverage. Overall however, these tend to be one of our more costly groups to cover."

The division held four public hearings on the proposal and had provided for written comments to allow more of an opportunity for public input on the proposal. The division assured legislators that all the comments will be seriously considered before the final proposed rules are published and that the rules will be in compliance with federal law. Based on the comments the division may make amendments to the rules that "result in reasonable and fair cost sharing requirements".

The Health and Welfare Committees of both the Senate and the House will have the proposed rules under consideration next session and may accept or reject the rules at that time.

This is a difficult action for the Medicaid Division to undertake because of the financial impact on program beneficiaries, but as I stated at the beginning of this article, these are economically challenging times and state agencies continue to look for ways to cut program costs without eliminating benefits that are most necessary to meet the health and safety needs of our most vulnerable populations.

These are not easy actions for state agencies to implement and are often met with opposition and controversy by those impacted, but state law requires that we operate with a balanced budget. Because of this we are in better financial shape than many states and continue to provide "governmental stability and fiscal responsibility" that is important to our citizens, and our businesses, as we work through these difficult times.

Thanks for reading: As always, please let me know of issues of concern to you. I can be reached by mail at PO Box 112, Dover, 83825 or by phone at 265-0123.