At the meeting today of the legislative interim committee that’s examining options regarding funding sources for the state’s share of Medicaid expansion going forward, the lawmakers heard a presentation from legislative budget analyst Jared Tatro on how other states fund their state share of Medicaid expansion costs, which is 10%; the federal government covers 90%. “94.4% of the states that have expanded rely on their general fund to cover at least part of it,” Tatro reported.
About half of those used state general funds only; the others used it plus another funding source, he said.
Among the other funding sources: A dozen states of the 36 that have expanded Medicaid have increased or modified their assessments on providers to help cover the state’s share of Medicaid expansion; most of those increased the assessments on hospitals. Five states opted for a tax increase or a redistribution of an existing tax; California and Indiana tapped cigarette and tobacco taxes; Oregon, legal marijuana sales taxes; Utah, a 0.15% sales tax increase that voters approved; and New Hampshire, liquor taxes. Montana voters considered a tobacco tax increase, but rejected it.
At least eight states imposed premiums or co-pays, but in many cases, they cover little of the costs and were more of a personal responsibility tool than a funding mechanism, Tatro reported.
Four states hoped to use savings from people leaving Medicaid as a result of failure to satisfy work requirements, Tatro reported, but “no state has been able to actually implement its work requirements program plan without legal challenges.” Nine states have received federal CMS approval for work requirements and seven more are pending approval; Idaho expects to submit a finalized waiver request in October, after CMS rejected its first version. Federal judges have halted work requirements in three states.
At least five states, including Idaho, have tapped tobacco settlement funds from a major multistate tobacco lawsuit; that’s the source of the funds in Idaho’s Millennium Fund. At least two states have imposed a new tax on HMOs or health insurance plans. North Dakota reduced the rates paid to providers for health care.
After a morning of presentations, the committee took an early lunch break, and will reconvene at 1 p.m. At that point, according to committee co-chairman Rep. Fred Wood, R-Burley, the panel will vote on what items it would like to ask the Department of Health & Welfare to include in a draft bill to bring back to the committee for review at its next meeting. In the end, the joint House-Senate committee will make a recommendation to next year’s Legislature.
“We know what the department is going to request,” Wood said. That would be covering the $41.9 million state cost for the first full year of expansion, starting with the state’s budget year that begins July 1, 2020, the same way the first half-year was funded, through tapping the Millennium Fund and the general fund, including general fund savings to an array of programs, from Corrections to Health & Welfare, that come along with Medicaid expansion. For the first half-year, which lawmakers approved last year — expansion takes effect Jan. 1 — those offsets along with Millennium funds meant that there was no net cost to the general fund for Medicaid expansion.
You can watch the meeting live here at Idaho Public Television’s “InSession” streaming service.