Idaho Medicaid director sees Florida model as option to save Idaho program some expense

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Sen. Sheryl Nuxoll listens to testimony about Idaho’s Medicaid program.

An Otter administration official says Medicaid reforms enacted by Florida to reduce costs and improve patient care for that state’s poor and disabled have proven to be impressive.

Paul Leary, the head of Idaho’s Medicaid program, told the members of the Legislature’s budget committee that he is “really impressed” with Florida’s reforms that have allowed Medicaid participants to choose the types of services they want. Representatives of a Florida think tank, Foundation for Government Accountability, were in Idaho last week to share that state’s experience with Idaho lawmakers.

“I’m really impressed with a presentation that the Senate Health and Welfare Committee got to see last week from the state of Florida,” Leary told the legislators. “In that state they’ve created an outcomes-based Medicaid program and costs have declined while patient health has improved. We need to continue to move toward an outcomes-based Medicaid program here in Idaho, as well.”

Leary’s remarks came as members of the Idaho Legislature’s Joint Finance-Appropriation Committee (JFAC) were presented with a dollar figure for the program: $2.06 billion. That’s the amount of money that the state Department of Health and Welfare is proposing to spend on Medicaid in fiscal year 2014.

“We expect the woodworking effect to generate approximately 60,000 new recipients in the next year,” Russ Barron, administrator of the Division of Welfare, told the legislators. That’s the term used to describe people who are currently eligible for Medicaid benefits but who are not receiving them, yet they are likely to “come out of the woodwork” and apply for the program once the federal laws requiring the states to provide interactive Medicaid web portals take effect.

Begun in 1965, the Medicaid program provides certain health care services to individuals and families with low incomes and limited resources. Financed with a combination of federal and state tax revenues, the expanding costs of Medicaid have in recent years become a topic of growing concern among the individual states.

In his State of the State address earlier this month, Gov. Butch Otter recommended that Idaho should not seek to expand Medicaid eligibility in the coming year, noting that “there is broad agreement that the existing Medicaid program is broken.”

Yet even without expanding Medicaid eligibility, the number of recipients continues to increase in Idaho, as does the cost. The request for fiscal year 2014 represents a boost of approximately 7.6 percent over the previous year, while leaving Idaho taxpayers liable for roughly $500 million of the costs (the remaining costs are paid with federal tax revenues). Barron noted to the legislative members that while the bulk of Medicaid costs were being driven upward by the increased demand for services, federal mandates for electronic records keeping and online service delivery were also causing Idaho’s Medicaid bill to rise.

“It’s a huge budget,” Sen. Steven Thayn, R-Emmett, told IdahoReporter.com after the JFAC meeting. “Medicaid is bigger than public schools funding. We really have to make some serious adjustments, and this situation provides us with that opportunity.”

During a question-and-answer period, Rep. Shirley Ringo, D-Moscow, noted to Leary that she hears complaints about the Idaho Medicaid program’s lack of services in the realm of vision care, auditory health care and chiropractic care, and asked if he (Leary) saw an expansion of those services on the horizon.

Leary said that, increasingly, the costs of Medicaid in Idaho are being funded proportionately with more federal tax dollars, and suggested that such expansion of services might be an option in the future. Leary explained that the Idaho Medicaid program is experimenting with a small number of home-based health care facilities, which he believes is crucial to bringing costs down and is consistent with the reforms in Florida.

“The Affordable Care Act (Obamacare) was presented as a means of lowering health care costs,” Sen. Sheryl Nuxoll, R-Cottonwood, told IdahoReporter.com after the committee meeting. “Yet what we see is that costs for health care, both to our state and to individuals, continuing to rise. This is very disturbing.”

Thayn echoed Nuxoll’s concern about rising costs, but told IdahoReporter.com that “this is a pessimistic forecast at the moment, but I am optimistic that we can do better. I know this. We’ve got to try.”

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