With all of the challenges facing the health care world these days, I decided to write my first blog of 2020 about some good news happening in Idaho. As of January 1st, over 50,000 Idahoans were enrolled in Medicaid expansion coverage finally bringing to fruition the ballot initiative passed handily by voters in November 2018.
One of these Idahoans is Anita Sackuvich, a mom and caregiver for two kids with disabilities, for whom last Wednesday was a momentous day. Having been uninsured for the past six years, Anita shared her story at a press conference in Boise to explain just why having Medicaid is so incredibly important to her life. It’s worth a read.
As regular readers of SayAhhh! know, Idaho was one of three states, along with Nebraska and Utah, that passed a Medicaid expansion ballot initiative in 2018. Sadly, not one of these states moved ahead to quickly enact a straightforward expansion in 2019. Nebraskans still won’t get coverage until October 2020, and even then the state is currently seeking approval of a Section 1115 waiver which imposes nine different requirements on beneficiaries in order for them to receive the full benefits package[1].
Utah’s Governor followed a futile path for months seeking federal approval of a partial expansion waiver that never came. Now on their third backup plan, Utah received federal approval a few weeks ago to move ahead with their version of expansion on January 1st which is good news – but unfortunately includes a ridiculous requirement to apply for 48 different jobs in a three month period in order to be eligible for coverage.
The Idaho legislature also enacted a work requirement last spring (along with a complex choice proposal that was rejected by the federal government last year) which is still pending with CMS. There is a good chance that CMS will approve this in the next few months, however, its future will hinge on a court decision as it will no doubt be challenged. The good news is that the state made the right decision to go ahead and implement a regular expansion through a state plan amendment in the meantime.
And that is what brings us to the happy day last week when Anita and thousands of others became insured with comprehensive, affordable coverage. The state just updated its data and almost 56,000 are enrolled as of today. Some of these folks with incomes from 100 to 138 percent of the poverty line moved over from subsidized coverage in the marketplace to Medicaid. In the process, these folks saw a reduction in their costs and likely more comprehensive benefits so that is a major plus.
We looked at data from the state and overall about 61% of those enrolled are newly covered like Anita. The counties where the largest percentage of expansion enrollees were newly enrolled in Medicaid are presumably areas which will see the biggest reduction in their uninsured population in percentage terms. Below are the top five counties statewide where 70% or more of the new enrollees are below the poverty line.
Another important note on Idaho is that the state conducted a provider survey of primary care clinics accepting new Medicaid patients to assess capacity to handle the new enrollees. The state concludes that “adequate and timely care exists for the potential Medicaid Expansion population.”
And recently the Governor of Idaho announced his plans to fund the state’s ten percent share of the match – which will largely come from offsets in the existing state budget.
As Anita’s story shows, the stakes cannot be higher as states decide whether or not to expand Medicaid. In Idaho’s case, voters had to lead the way. Implementing a work requirement waiver, should it be approved, would add red tape and cause thousands to lose this newly gained coverage. But in the meantime, let’s take time to celebrate the achievement of those who pushed tirelessly to make this happen in the state.
[1] The federal government is taking public comment on this proposal until January 17, 2020.
