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Idaho lawmakers adjourn without fix for Medicaid bill

Idaho State Capitol building on March 23, 2021. (Otto Kitsinger for Idaho Capital Sun)
Otto Kitsinger
Idaho State Capitol building on March 23, 2021. (Otto Kitsinger for Idaho Capital Sun)

The Idaho Legislature adjourned Wednesday — without passing legislation to fix an issue with a new law that Gov. Brad Little said could disrupt health care services.

On Monday, before lawmakers returned for a single day to wrap up the 2024 legislative session, Little called for imminent action by the Idaho Legislature.

In a letter to lawmakers, he wrote that he worries House Bill 398 — which requires legislative approval for Medicaid waivers — could disrupt health care services, including by halting millions of dollars in payments to medical providers across the state and stopping amendment submissions on the Idaho Behavioral Health Plan, a $1.2 billion contract for Medicaid mental health services.

The bill took immediate effect April 4, when Little signed it into law.

Little’s spokesperson Madison Hardy told the Idaho Capital Sun in a statement that he signed the legislation hoping and expecting “the Legislature would address concerns about immediate and ongoing impacts to thousands of providers of Medicaid services across Idaho.” Little’s office received 118 emails from providers asking for a trailer bill, Hardy previously told the Sun.

But some lawmakers doubted the need for another bill.

“This is a difference of opinion,” Rep. Megan Blanksma, who sponsored the Medicaid waivers bill, told the Idaho Capital Sun in an interview. “The governor has one opinion, and the Legislature has a different opinion. And it’ll all get worked out in the end.”

The Legislature never intended to create the consequences Little outlined as likely, Blanksma said. And while Blanksma said she worked on a trailer bill to address Little’s concerns, she said “all those consequences will be challenged.”

“We believe that the legislation is fine as is, and that those consequences are not reality,” Blanksma said.

The law blocks the Idaho Department of Health and Welfare from seeking or implementing Medicaid waivers or state plan amendments “that would expand coverage … (or) increase any cost to the state” without legislative approval.

Medicaid state plan amendments or waiver programs “already implemented” would not be affected, the new law states. Legislative approval “must be provided in statute,” the law says.

Idaho executive branch looks for legal guidance after Legislature adjourns without trailer bill

Little and his staff were “fully engaged” in discussions about a trailer bill to the Medicaid waiver law, Hardy said.

“We are disappointed the Legislature failed to act on a trailer bill. The governor’s office will continue to work closely with legislators and stakeholders to determine a path forward that minimizes disruption in services to thousands of vulnerable Idahoans,” Hardy said.

The Legislature’s stated intent “does not match the vague and unclear plain text of House Bill 398,” Hardy said.

The Idaho Department of Health and Welfare, which administers Medicaid, and Little’s office will work closely with the Idaho Attorney General’s Office and other attorneys “on how to navigate the challenges of interpreting the ambiguities of House Bill 398,” Hardy said.

A draft of Blanksma’s trailer bill, which she shared with the Idaho Capital Sun, would’ve added exceptions to waiver programs already funded, implemented or subject to renewal.

“We came up with language that the stakeholders were happy with. And it was a belt and suspenders kind of thing — where we don’t think you’re going to have these problems, but just in case, then we can put this language in that should give you safe harbor. Because we didn’t want to damage any of the existing programs,” Blanksma said.

Blanksma said the governor sought delaying the implementation of House Bill 398.

“That wasn’t something that we were willing to do,” Blanksma said.

In his letter, Little wrote that the 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.”

Trailer bill fell through after lack of agreement, House speaker says

House Speaker Mike Moyle, R-Star, told reporters on Wednesday that the House was trying to see if there was a path forward with the governor and the Senate.

As we got toward the end, the Senate made it clear that there wasn’t a path forward right now on that bill,” Moyle said.

He said there’s still not agreement on what action is needed or if there even are problems.

“When you have that kind of a dynamic where there’s not an agreement … in the last day of the session, it’s hard to get anything done,” Moyle told reporters.

Senate Majority Leader Kelly Anthon, R-Burley, told the Idaho Capital Sun in a text message that Senate leaders told House leaders that a bill being worked on by Blanksma and Health and Welfare Committee chairs would be considered by the Senate. By the afternoon, the House told Senate leaders a bill wouldn’t be coming, Anthon said.

“Senate leaders were also not convinced any such bill was necessary,” Anthon said in a text message. “Because no bill came to the Senate, we adjourned sine die.”

Idaho Health Care Association Executive Director Robert Vande Merwe had emailed Little’s office after he signed the new law, asking for a trailer bill. If that bill doesn’t pass, he wrote, “we think this will be the largest cut to the Medicaid program in the history of Idaho.”

But since provider rate increases — which Little said could be affected by House Bill 398 — don’t take effect until July 1, Vande Merwe says there’s time to decide what House Bill 398 really means.

“We would have preferred a trailer bill to clarify and make sure everyone’s on the same page,” Vande Merwe told the Idaho Capital Sun on Wednesday. “… But they couldn’t agree on a trailer bill. So, the House and the Senate didn’t believe that this was really a problem, so they just went home. We hope it’s not a problem. But until we find out how (House Bill) 398 will be implemented by the Department of Health and Welfare, we’re going to try to be optimistic that there’s time to resolve these differences before July.”

But if there is an issue, Vander Merwe said he thinks the Legislature needs to come back for a special session.

Little’s office hasn’t ruled out that possibility.

“Governor Little fully supports and remains committed to delivering critical Medicaid services to vulnerable Idahoans, such as the behavioral health services he advocated for last session,” Hardy, Little’s spokesperson, wrote in a statement. “Idaho citizens can be assured Governor Little will exhaust all options, including potentially calling a special session as needed, to ensure critical services move forward.”

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This story was originally published by the Idaho Capital Sun.