Another voter-backed Medicaid expansion hits snag

CMS said it cannot approve Idaho's Medicaid expansion plan. (Oscity/Shutterstock)

Federal officials rejected another attempt at a “partial” Medicaid expansion, this time in Idaho. 

The Centers for Medicare & Medicaid Services said in a letter (PDF) to state leaders on Thursday that their waiver request for Medicaid expansion could not be approved. The reason, they said: Estimates on cost were not complete and thus the agency couldn’t evaluate it effectively. 

Idaho submitted a section 1332 waiver under the Affordable Care Act for expansion, typically referred to as ACA innovation waivers. Such applications are governed under four guidance guardrails and CMS’ Center for Consumer Information & Insurance Oversight (CCIIO) said the application did not include information on those topics, which include coverage impacts and federal budget neutrality. 

“Without using appropriate assumptions, the application does not provide sufficient information to isolate and evaluate the effect of the waiver,” CCIIO wrote. 

RELATED: Experts say states may put partial Medicaid expansion on pause after Utah denial 

CMS rejected Utah’s request for a “partial” expansion earlier this month, making this the second state effort to run into major hurdles. Both Utah and Idaho are pursuing the plans—where they would expand Medicaid to only part of the population eligible under the ACA while requesting full federal funds—following voter mandates in 2018. 

In its rejection of Utah’s plan, CMS said it supports state flexibility in Medicaid but would not approve plans that would cover only part of the ACA-eligible population while seeking a full federal match. 

Gov. Brad Little, state Senate Pro Tem Brent Hill and state House Speaker Scott Bedke issued a joint statement on CMS’ decision, saying the feds “pulled the rug out from under us.” 

“For months, state agencies worked closely with the federal agencies on the purpose and goals of the waiver application. We shared multiple strategies and considerations about how Idaho would approach the cost neutrality portion of the application,” the state officials said. 

“At no time during those conversations did the federal government indicate Idaho’s approach to the budget neutrality guardrail would be insufficient for consideration,” they said. 

Implementing the partial expansion remains a key priority for state leaders, the trio said in the statement. 

“It is important to give Idahoans the choice to stay on private coverage rather than forcing them to public assistance,” they said.