BOISE — The House Health and Welfare Committee plans to hold a hearing Friday on a bill to abolish county indigent health care programs while directing some sales tax revenue counties get now to pay part of the cost of Medicaid expansion.
The new version of the bill, sponsored by Rep. Britt Raybould, R-Rexburg, would boost the county's share from 23 percent to 30 percent of the cost of Medicaid expansion. This would result in a county contribution of $8.5 million a year based on Medicaid expansion enrollment of 63,007 people as of February. If enrollment hits the actuarial firm Milliman's previous forecast of about 90,000, this could rise to $12.3 million a year. Under the last version of Raybould's bill, which was introduced in late February, the county share would have been an estimated $6.5 million a year under current enrollment and $9.5 million under Milliman's higher projection. The sales tax money to cover Medicaid expansion would be deducted from the total amount of sales tax money that goes to counties now.
Even under the higher amount in this bill, though, counties could save money when the county indigent program is abolished after 2021. The fiscal note for the latest bill says counties have spent an average of $20.24 million a year on indigent health care costs from the 2013 to the 2019 fiscal year, and says the average statewide savings to county budgets over what they spend on indigent health care will range from $7.9 to $11.7 million a year.
The committee voted without objection to introduce the bill, paving the way for Friday's expected hearing.
Idaho voters voted in November 2018 to expand Medicaid coverage to everyone making up to 138 percent of the poverty level, and lawmakers have been debating how to fund it ever since. Many Republicans, especially, have called for new levies or redirecting money counties get now that they could save on indigent health care spending due to expansion, while Democrats have generally argued in favor of paying for it out of the state general fund. Some previous proposals suggested levying counties based on the number of Medicaid expansion beneficiaries, which would have led to most eastern Idaho counties paying more since most of them spend less than average on indigent health care but have a higher-than-average number of expansion enrollees. Raybould's bill doesn't do this.
An interim legislative committee last year suggested redirecting $10 million in sales tax money that counties get now to pay for expansion. Gov. Brad Little's budget proposal suggested levying counties for $8.5 million to pay for Medicaid expansion in the next fiscal year, leaving it up to lawmakers to decide how to apportion it, while covering the rest of the $41 million of the state's share of Medicaid expansion (the federal government pays for 90% of the program) with a mix of savings elsewhere and Millennium Fund money.