The Idaho Department of Insurance is accepting public comment on one of the proposed changes to Medicaid expansion lawmakers approved this year.
Public comment opened May 31 on the “Coverage Choice Waiver,” which would give people making between 100 and 138 of the poverty level the option of getting insurance through either Medicaid or the Your Health Idaho state exchange. About 18,000 people in this group are estimated to be insured on the state exchange, and if the federal government approves this waiver, they would be able to keep the federal tax credits they get now for exchange policies.
People can submit comments by email at DOI.Reform@doi.idaho.gov or by mail to Product Review Bureau Chief, Department of Insurance, P.O. Box 83720; Boise, Idaho 83720-0043. The department has also scheduled two public hearings on the proposal, one in Boise on June 24 and one in Lewiston on June 27.
The chances the Centers for Medicare and Medicaid Services will approve this waiver request are uncertain. CMS has declined to approve similar requests in Arkansas and Massachusetts; it approved one in Utah earlier this year but at a lower funding match rate.
This proposal was one of the less controversial of the changes lawmakers made to the Medicaid expansion voters approved in November 2018. By far the most controversial of the waivers Idaho is requesting is one to add work requirements for some Medicaid expansion beneficiaries. People who don’t follow the work requirements would lose their coverage for two months or until they come into compliance, although the state also is applying for a waiver to charge co-pays to people who don’t comply with the work requirements in case either CMS or a court deems it illegal to deny them coverage for a period.
These waivers, along with two others related to mental health and reproductive health care, will be part of the “Section 1115” waiver request that the state plans to open public comment on in mid-July. The Trump administration has been supportive of work requirements and has approved them in numerous other states, although a federal judge blocked work requirements in Kentucky and Arkansas in March and more litigation seems likely before the issue of their legality is settled.
The waiver request to let Idaho use some Medicaid money to pay for long-term institutional mental health care that wouldn’t be covered otherwise is uncontroversial and has been approved in numerous other states. The family planning waiver request, however, which would require Medicaid patients to get a referral from their primary care doctor to seek outside family planning services, was opposed by Democratic lawmakers and Planned Parenthood. Supporters say it is a cost-saving measure.
Many Republican lawmakers opposed expanding Medicaid in the first place, and the fight over whether to put restrictions on it was one of the defining issues of the 2019 legislative session. Supporters of work requirements and other limits said they would protect taxpayers, while Democrats, Medicaid expansion advocates and a minority of Republicans wanted to implement Medicaid expansion with few or no “sideboards.” The pro-Medicaid expansion group Close the Gap Idaho sent out an email Tuesday urging people to support the mental health waiver, saying it is neutral on the Coverage Choice Waiver and urging people to oppose the others.
Public comment on the Coverage Choice Waiver will close June 30, and the earliest date the state could submit it to the federal government would be July 17. The state has requested a decision on the Coverage Choice Waiver by Sept. 3 and in November on the Section 1115 waiver.
Idaho has already submitted a full Medicaid expansion plan to the federal government. Medicaid expansion enrollment will start on Nov. 1, and coverage on Jan. 1, 2020, regardless of which waivers are approved.