Idaho Medicaid waiver approval bill could immediately disrupt services, governor says

BOISE — Without additional action by the Legislature, Idaho Gov. Brad Little worries a new bill requiring legislative approval for Medicaid waivers could disrupt health care services, including by halting millions of dollars in payments to medical providers across the state.

Little’s office received 118 emails from providers asking for a trailer bill to House Bill 398, said spokesperson Madison Hardy. Little, in a letter to lawmakers Monday, called for imminent action by the Idaho Legislature.

“I support policy that ensures the Legislature is a meaningful partner with the executive branch in our shared goal of Medicaid cost containment. However, this bill contains vague language that, when coupled with the emergency clause, will immediately result in harmful disruption to the delivery of services to thousands of Idahoans,” Little wrote.

Little signed the bill into law April 4. Through an emergency clause, the bill took effect immediately when signed into law.

Bill sponsor Rep. Megan Blanksma, R-Hammett, told the Idaho Capital Sun in an interview that she already has a draft trailer bill, and had met with Little last week on the issue. She said the concerns on the bill — first introduced publicly in January — are last minute, but she said she thinks they can be addressed.

“The governor’s attorneys and our attorneys … don’t read that bill the same way. But in an effort of good faith negotiation, I am trying to put together a trailer bill that could address what he perceives to be his concern. And hopefully we can run that quickly if that’s what we can get everyone to agree to,” Blanksma said.

If Medicaid waiver bill isn’t amended, Idaho governor says some critical services may be interrupted

The Idaho Legislature recessed until Wednesday, wrapping up most of its work for the 2024 legislative session last week.

The bill, which Idaho legislators in the House and Senate widely approved this year, blocked the Idaho Department of Health and Welfare from seeking or implementing Medicaid state plan amendments or waivers to expand coverage to people or “increase any cost to the state” without legislative approval.

If the bill isn’t amended, Little wrote, Idahoans are set for several likely and immediate disruptions in critical services, including:

• Stopping the submission of amendments to the Idaho Behavioral Health Plan for behavioral health services and residential treatment centers for substance use and psychiatric disorders;
• Halting an amendment for approval to pay $30-40 million in directed payments to 149 skilled nursing facilities across Idaho;
• Stopping the submission to distribute $70 million in rate adjustments for 1,406 providers and immediate care facilities across Idaho;
• Stopping the submission for approval of $4 million for reinstatement of personal care services for 287 organizations.

The bill targeted waivers filed under Section 1115 and 1915 of the Social Security Act. Any approval would come “in statute,” the bill said. And any state plan amendments or waiver programs already implemented would not be affected by the bill, the bill stated.

“What we did was … deliberately scoop out anything that was in process,” Blanksma said. “So we want anything that is in process right now to remain whole. What we were looking at is future programs.”

Little wrote that “other amendments and waivers impacted by this bill continue to be evaluated.”

“Imminent action by the Legislature is necessary to provide the state with clarity and confidence that legal authority exists to continue with program implementation. … Unless the issues are sufficiently addressed in a trailer bill, it is possible the Legislature may be required to return frequently for special sessions to ensure compliance with the law,” Little wrote.

Medical providers worried about House Bill 398’s impact in letters to Little’s office

In a joint letter on April 4 to Little’s office, representatives for Cascadia Healthcare, Tanabell Health Services and Pennant Healthcare said the bill’s flaws will lead to “unintended consequences for the care that we provide seniors.”

Losing $40 million in direct federal payments “may likely cause the closure of multiple facilities across the state,” they said, most severely impacting rural health care access.

“As we move beyond the current fiscal year, the effect of the HB 398, given its some lack of clarity in its terms, could be the continued degradation of Idaho’s Medicaid reimbursement system relative to its UPL program, resulting in the increasing loss of access to senior long term care for a significant number of Idahoans,” the providers wrote.

Idaho Health Care Association Executive Director Robert Vande Merwe signed on to that letter. But, in a separate April 5 letter, Vande Merwe wrote Little to support a trailer bill to House Bill 398.

“If this bill does not pass, we think this will be the largest cut to the Medicaid program in the history of Idaho and we doubt this was the intention of most legislators who voted to pass the bill,” Vande Merwe wrote. “There is no option to wait for a special session. It must be fixed now!”

Without the trailer bill, “we are fearful that providing care to Medicaid recipients will be unsustainable,” Vande Merwe wrote. “The cost of providing care already exceeds Medicaid reimbursement.”

To review Little’s letter to Moyle, click here.