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The struggle of delayed care leading to costlier and worse conditions rings true for many of roughly 94,000 Idahoans, many of them working poor, who are now covered by Medicaid expansion, write Post Register reporters Nathan Brown and Kyle Pfannenstiel. The cost of Medicaid expansion, which is paid 90% by the federal government and 10% by the state, is coming in higher than expected.

This will create a headache for lawmakers who must decide next year how to pay for a program that will cost the state tens of millions more than they originally thought, and has provided some vindication to conservatives such as Rep. Barbara Ehardt, R-Idaho Falls, who warned before expansion that it would cost more than projected, pointing to the experience of other states.

Ehardt said lawmakers need to control costs moving forward and earmark a revenue stream for Medicaid expansion so they don’t have to scramble for funding every year.

“I definitely feel that it needs to be a dedicated source,” she said.

Higher per-patient spending appears to be driving costs. There were 94,000 people enrolled in expanded Medicaid in November, just a few percent higher than the 91,000 the actuarial firm Milliman Inc. projected in 2018. But many of those people were uninsured for a long time and are now finally accessing care for conditions that have worsened due to lack of affordable preventive care.

"I think there has always been a kind of acknowledgment that the Medicaid expansion population might have pent-up demand," said Alex Adams, head of the state's Division of Financial Management.

A state-commissioned 2018 report on the costs and savings of Medicaid expansion projected it would cost the state $41.9 million this year and $44.6 million next year. The new estimates are $67 million this year and the agency's budget request for next year is $84 million, Adams said, numbers that would also increase the federal share by hundreds of millions from the report's projections of $370.1 million and $394.9 million, respectively. Gov. Brad Little will unveil his Fiscal Year 2022 budget proposal next month when the legislative session starts on Jan. 11.

"It would be premature to say what the governor's recommendation might be, but we're certainly looking at all options," Adams said.

One thing that could help is that due to the coronavirus pandemic, the federal government is paying 76% of the cost of traditional Medicaid rather than 70% as it had been before. Adams said this savings to the state could be used to cover some of the additional costs of expansion, although he said this isn't a long-term solution.

Another is that Idaho, unlike many states, is collecting more revenue than expected and has a good deal of savings despite the coronavirus pandemic.

You can read Brown and Pfannenstiel's full story here at postregister.com (it originally ran in the Post Register on Dec. 10), or pick up today's Sunday/Monday edition of the Idaho Press; it's on the front page.

Betsy Z. Russell is the Boise bureau chief and state capitol reporter for the Idaho Press and Adams Publishing Group. Follow her on Twitter at @BetsyZRussell.

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