Fiscal Fitness: How States Cope
Idaho Medicaid preparing for 100,000 new eligibles
The single biggest challenge with health care reform is "the increased resources needed to implement this legislation," says Leslie Clement, administrator of the Department of Health and Welfare's Division of Medicaid. "Idaho is currently experiencing budget deficits. Projections do not indicate that this will change much in the near future."
There will also be significant restructuring needed to meet the requirement to provide seamless enrollment procedures between Medicaid, the Children's Health Insurance Program, and the health insurance "exchanges" to be set up by the state, which will allow individuals to shop for health insurance coverage.
About 100,000 new eligibles are expected to come onto the program when Medicaid is expanded in 2014. "We have a fairly high uninsured rate in the state, in the neighborhood of 15%," says Ms. Clement. "We also have a lot of kids who are eligible, but aren't covered. So, we will get the 'woodwork' effect as well. We think that will be significant."
The updated drug rebate program in the health reform legislation, however, will not help Idaho Medicaid. "It was written to reduce federal government costs. It is going to hurt Idaho, because all our pharmacy costs are in a fee-for-service environment," says Ms. Clement. "We have estimated that we will lose $5 million in state supplemental rebates."
On the positive side, there may be opportunities for Idaho Medicaid to expand quality improvement initiatives. "We will look for opportunities to make the state plan amendment to add health homes, to further develop that effort," says Ms. Clement.
Ms. Clement notes that Idaho is one of the leading states in terms of a rebalanced long-term care system. "Our nursing home population, in terms of Medicaid residents, has been flat for six years or so," she says. "We have many high-need individuals that are being managed in the community, and our aged and disabled waiver has continued to grow." More than 8,000 individuals are currently in that program.
Many of the individuals assisted by the indigent program, operated out of state and county general funds, are expected to become part of the expanded Medicaid population.
"For Idaho hospitals who see a lot of uninsured, I think the health reform will provide them with paying patients. It will be a good thing to not have so many uninsured in this state," says Ms. Clement.
The overall impact of health care reform on Idaho Medicaid, however, says Ms. Clement, "is a challenging analysis to do, and it hasn't been done. I'm jealous of states that could do that kind of analysis, but we just don't have the funds."
Although in the initial years, funding of benefits will be covered exclusively with federal funds, an increase in human resources to process applications will be required to accommodate this large influx of individuals, notes Ms. Clement. Eligibility and other automated systems also will require modification, which will necessitate an increase in state spending.
Currently, analysts are looking at how much the expansion population will cost the Medicaid program, but there are also potential positive results that are as yet unknown. "What we don't yet see, is how bad debt, charity allowances, and uncompensated care that is provided throughout the state today will be reduced," says Ms. Clement.
The single biggest challenge with health care reform is "the increased resources needed to implement this legislation," says Leslie Clement, administrator of the Department of Health and Welfare's Division of Medicaid. "Idaho is currently experiencing budget deficits. Projections do not indicate that this will change much in the near future."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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