Idaho’s governor has signed off on a scaled-back Medicaid expansion plan, making it the second state to retool what expansion might look like after a voter mandate.
Voters approved the expansion in Idaho and Utah last year, and Republican-led legislatures in these states have opted to take a “partial” approach to grow the program, which would offer coverage to fewer people and institute work requirements for those who are enrolling.
In Idaho, people making between 100% and 138% of the poverty level will be automatically enrolled in the state’s Affordable Care Act exchanges but will also be eligible to buy into Medicaid, reports the Idaho Statesman.
Utah, meanwhile, is planning to only expand its Medicaid program to people making 100% of poverty, lower than the maximum level allowed under the ACA.
“Clearly, these partial expansions are not what the voters voted for,” Joan Alker, executive director of the Georgetown University Health Policy Institute’s Center for Children and Families, told FierceHealthcare. “Eventually, some people will get some coverage. But there are serious limitations in both of these state’s approaches.”
Sixty percent of Idaho voters approved Medicaid expansion, as did 53% of Utahans.
The Centers for Medicare & Medicaid Services has signed off on the initial version of Utah’s plan, a “bridge” expansion that allowed it to begin enrollment this month while it awaits funding from the Trump administration.
Alker said that allowing this partial expansion takes CMS on a previously unexplored path into what it’s willing to approve under section 1115 waivers. A similar request from Arkansas to roll back the expansion population was rejected by CMS, raising questions about how it will view Utah’s final expansion proposal, she said.
“It’s unclear what’s going to happen in phase two,” Alker said.
Between 70,000 and 90,000 people will be eligible for coverage under Utah’s partial expansion, while 150,000 people would have been eligible under a full expansion as allowed under the ACA.
While industry experts are keeping an eye on how a permanent partial expansion plan is addressed by CMS, the agency remains full speed ahead on work requirements in Medicaid, as both Utah and Idaho are looking to implement.
A federal judge tossed work requirements in Kentucky and Arkansas last month, saying that CMS has failed to consider the impacts of such requirements on coverage, which is the central goal of Medicaid.
However, CMS officials have been undeterred in their support for work requirements, and this week appealed the judge’s ruling.
Idaho Gov. Brad Little also said he “strongly” supports these requirements, according to the Statesman, though he said he has concerns about them amid the legal controversy.
“We must encourage self-sufficiency among those receiving public assistance,” he said.
Alker said that other states have pumped the brakes on work requirements following the judge’s decision, too. Legislators in West Virginia put a bill proposing them on the back burner, while Nebraska has taken a tiered benefits structure that may skirt the legal concerns.
“Since a key part of the judge’s decision is related to coverage losses, I think that may be in part a reaction to litigation,” she said.