The Idaho Department of Insurance is seeking public comment on a proposed “Coverage Choice Waiver,” the first of the waivers from federal regulations the state will be seeking under legislation passed by this year’s Legislature attaching mandatory work requirements and other “sideboards” to the voter-approved Medicaid expansion, Proposition 2. The coverage choice waiver, if approved by federal authorities, would allow Idahoans who earn from 100 percent to 138 percent of the federal poverty level to continue to be eligible to purchase subsidized private insurance through the Your Health Idaho insurance exchange, rather than switching to Medicaid. Public hearings on the waiver will be held June 24 in Boise and June 27 in Lewiston; there’s more information online here.
Additional waiver applications still are in the works, to seek federal approval for the work requirements, a restriction on family planning services, and a mental health coverage waiver. Those waivers likely will be proposed through the state Department of Health & Welfare; the department is posting updates on the process online at medicaidexpansion.idaho.gov.
Whether or not any or all of the waiver applications are approved, Idaho’s Medicaid expansion program will launch on Jan 1, 2020, enrolling into coverage Idahoans who currently fall into a coverage gap — they make too much to qualify for the state’s current, limited Medicaid program, but not enough to qualify for subsidies to buy private insurance through the state exchange.
The much-amended Medicaid expanded “sideboards” bill that passed and was signed into law this year includes these 10 provisions:
- SUBSTANCE ABUSE ASSESSMENT: All patients would undergo a substance abuse assessment.
- IMD WAIVER: The state would seek a federal waiver to allow Medicaid to cover services from "institutions for mental disease," a category of care currently not covered under Medicaid. This provision was widely supported on all sides of the Medicaid expansion issue.
- EXCHANGE OPT-IN: Those from 100 to 138 percent of poverty wouldn't automatically be shifted to Medicaid; they'd have the option to shift, under a federal waiver for which the state would apply. If that's not granted, they'd automatically be eligible for Medicaid.
- WORK REQUIREMENTS: All recipients would be required to prove they're working, volunteering or enrolled in training or education programs at least 20 hours a week; those who don't comply would lose their coverage for two months or until they come into compliance. Idaho would have to apply for a federal waiver to implement this; similar requirements were recently overturned in federal court in Kentucky and Arkansas.
- COPAY BACKUP: If Idaho's work requirements and sanctions are deemed illegal, the state would instead require those who don't comply with the work requirement to cover the maximum allowable copays on their medical care for six months or until they comply with the work requirements.
- WAIVER IMPLICATIONS: No state applications for federal waivers would delay implementation of Medicaid expansion, which is set for Jan. 1, 2020; and if any waiver would cause the state to lose the 90-10 federal matching rate for Medicaid expansion, the state would be forbidden from implementing that waiver.
- FEDERAL MATCH: If the federal matching rate dropped below 90-10, the Legislature would be required to consider ending Medicaid expansion.
- 2023 REVIEW: The Legislature would be required to review Medicaid expansion in 2023 and decide whether or not to continue it.
- FAMILY PLANNING CLAUSE: No Medicaid expansion recipient could receive family planning services from any provider other than their assigned primary care doctor, without that doctor giving them a specific waiver. This also would require the state to seek a federal waiver; some backers touted it as a way to de-fund Planned Parenthood, while its sponsors said it was a money-saving move. Opponents said it would prevent women from seeing their gynecologist for pelvic exams, forcing them to instead see a general practitioner.
- TASK FORCE: The Legislature would create a task force to study Medicaid expansion and its costs moving forward. That task force has been appointed and will hold its first meeting June 17.