Posted on

A year in, Idaho is paying more for new Medicaid enrollees with expensive conditions… | Eye on Boise |

MM Curator summary

Idaho Medicaid expansion will cost the state 50% more than projected this year and 100% more than next year, compared to the cost estimates used to decide on expanding.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Clipped from:

The struggle of delayed care leading to costlier and worse conditions rings true for many of roughly 94,000 Idahoans, many of them working poor, who are now covered by Medicaid expansion, write Post Register reporters Nathan Brown and Kyle Pfannenstiel. The cost of Medicaid expansion, which is paid 90% by the federal government and 10% by the state, is coming in higher than expected.

This will create a headache for lawmakers who must decide next year how to pay for a program that will cost the state tens of millions more than they originally thought, and has provided some vindication to conservatives such as Rep. Barbara Ehardt, R-Idaho Falls, who warned before expansion that it would cost more than projected, pointing to the experience of other states.

Ehardt said lawmakers need to control costs moving forward and earmark a revenue stream for Medicaid expansion so they don’t have to scramble for funding every year.

“I definitely feel that it needs to be a dedicated source,” she said.

Higher per-patient spending appears to be driving costs. There were 94,000 people enrolled in expanded Medicaid in November, just a few percent higher than the 91,000 the actuarial firm Milliman Inc. projected in 2018. But many of those people were uninsured for a long time and are now finally accessing care for conditions that have worsened due to lack of affordable preventive care.

“I think there has always been a kind of acknowledgment that the Medicaid expansion population might have pent-up demand,” said Alex Adams, head of the state’s Division of Financial Management.

A state-commissioned 2018 report on the costs and savings of Medicaid expansion projected it would cost the state $41.9 million this year and $44.6 million next year. The new estimates are $67 million this year and the agency’s budget request for next year is $84 million, Adams said, numbers that would also increase the federal share by hundreds of millions from the report’s projections of $370.1 million and $394.9 million, respectively. Gov. Brad Little will unveil his Fiscal Year 2022 budget proposal next month when the legislative session starts on Jan. 11.

“It would be premature to say what the governor’s recommendation might be, but we’re certainly looking at all options,” Adams said.

One thing that could help is that due to the coronavirus pandemic, the federal government is paying 76% of the cost of traditional Medicaid rather than 70% as it had been before. Adams said this savings to the state could be used to cover some of the additional costs of expansion, although he said this isn’t a long-term solution.

Another is that Idaho, unlike many states, is collecting more revenue than expected and has a good deal of savings despite the coronavirus pandemic.

You can read Brown and Pfannenstiel’s full story here at (it originally ran in the Post Register on Dec. 10), or pick up today’s Sunday/Monday edition of the Idaho Press; it’s on the front page.

Posted on

Missouri House budget leader hopes for cost-saving Medicaid reforms, expects tough budget year

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Curator summary


MO lawmakers are signaling that next year’s budget will be where the full impact of the COVID pandemic is seen in terms of decreased revenues and impact on the economy; Medicaid costs savings measures will be required.



Clipped from:


Rep. Cody Smith, committee chair, addresses the state’s joint budget committee Tuesday, May 7, 2019. Photo by Tim Bommel/Mo. House of Reps.

The Missouri House Budget Committee chairman hinted Wednesday during a meeting of the Coordinating Board for Higher Education there may be a lengthy debate in the coming legislative session over cost-saving reforms to the state’s Medicaid program, which would happen as legislators figure out how to expand the program, per voters’ desire.

House Budget Committee Chairman Rep. Cody Smith, R-Carthage, also said next year will be a challenging one from a budget perspective because that’s when the economic effects of the COVID-19 pandemic will appear in tax receipts.

Smith and his Senate counterpart, Sen. Dan Hegeman, R-Cosby, who is chairman of the Appropriations Committee, were included in the higher education board’s virtual meeting Wednesday because the topic of next year’s budget was on the agenda for discussion. It’s the Department of Higher Education and Workforce Development’s priority to restore institutions’ core funding and support financial aid programs.

Gov. Mike Parson in the spring and early summer withheld a combined total of more than $95 million from four-year colleges and universities’ budgets, and more than $18 million from community colleges, because of the pandemic and its effects on the state’s budget. That was for the 2020 fiscal year.

When the new and current 2021 fiscal year started in July, Parson withheld nearly $28 million for Missouri’s colleges and universities, and more than $18 million less for community colleges — though about half of what was withheld from community colleges and four-year institutions was restored in October.

Revenue collections for the state are doing well — more than $100 million, or 14.5 percent, more last month than November 2019, the Office of Administration reported Wednesday.

Smith said, however, that the 2021 fiscal year is complicated by 2019 calendar year tax revenue that normally would have come in during the spring and the previous fiscal year instead coming in during July, on account of the tax filing deadline being pushed back because of the pandemic.

He said the budget for the 2022 fiscal year, which lawmakers will have to craft in the spring, will be the first in which tax receipts were affected by the pandemic, tax receipts from the 2020 calendar year — reflecting businesses closing, unemployment and decreased tax liabilities.

“We are looking to the next year to be one that will be challenging” from a state budget perspective, Smith said.

Complicating that is that voters in August approved expanding the state’s Medicaid program, MO HealthNet, and the program is estimated to grow by about 230,000 people.

Perspectives on the pros and cons of Medicaid expansion vary, but Smith, Hegeman and other Republican lawmakers and leaders stated ahead of the August election they were decidedly against expansion, arguing it would come at the cost of public education, among other claims.

Medicaid expansion is an option given to states under the federal Affordable Care Act, and the federal government pays 90 percent of the costs for people who qualify.

A fiscal note received by the state House Budget Committee over the summer said there is a possible range in cost to expand from an annual expenditure of $200 million to a savings of $1 billion.

“There’s no easy way” to expand Medicaid, Smith said Wednesday, adding, “It will have a cost and an impact on the larger budget.”

To that end, he said, “We will need to have some reforms to our Medicaid program that will generate cost savings,” and that would probably be a work in progress until the last days of the session.

Hegeman said a consensus revenue estimate for the 2022 fiscal year would be released soon, and Smith said it would be what he considers a conservative estimate.

“The saving grace has been federal dollars,” including the use of federal money to supplant general revenue in the state’s budget and offer more flexibility, Hegeman said.

Smith said it’s possible the state will be given an extension on the use of its federal aid money — which currently has an end-of-the-year deadline for spending — and a new federal stimulus package would come through.

In the meantime, as for what higher education institutions could do to advocate lawmakers for more funding, Smith advised: “That is drawing as straight a line as possible from higher education to the workforce needs of our state,” and showing why funding higher education is important to those efforts.