Nurse Leaders of Idaho

2014 Idaho Legislature

Second Week

January 13-17, 2014

The Legislature continues to move forward at a brisk pace. Health policy and health financing issues figured very prominently during this second week of the session as last week was “Health and Welfare Week” at the Joint Finance and Appropriations (JFAC) committee. JFAC has the responsibility to create the budgets for all state agencies, so it begins that work by taking testimony from the departments and agencies of state government so it can understand what their current trends and needs of the are.

One of the most significant hearings that took place this week was a presentation on the Justice Reinvestment Project in Idaho. The project analyzed why Idaho, with the 8th highest incarceration rate and rising recidivism, has one of the lowest crime rates in the country. Recommendations coming out of the projectinclude improvements in treatment, supervision, parole and probation, and data systems. An investment of $33 million is estimated to save Idaho $255 million in prison costs, savings which then could be used to invest in other priorities including education, higher education, health services and tax relief.

The Joint Finance and Appropriations Committee also voted unanimously this week to accept the report from the change in compensation (CEC) committee for a 2% average pay boost for state workers. This was not a recommendation included in the Governors budget.

Few pieces of legislation have yet to be introduced though; current health related bills are highlighted at the end of this letter.

HEALTH CARE:

During his presentation to JFAC, Director Armstrong of the Department of Health and Welfare (DHW) highlighted three initiatives that are coming this next year and also updated the committee on the interface between the Idaho Health Insurance Exchange (Your Health Idaho) and Medicaid, as well as the Medicaid and Welfare budget proposals themselves.

  • Behavioral Health Community Crisis Centers: These three new centers would respond 24/7 to mental health and substance abuse crises. The centers have the potential to reduce incarceration, because today few resources exist for law enforcement who respond to behavioral health related calls. Based on the success and cost of the centers, the goal is to expand to seven.
  • Child Welfare Project: Idaho has received a five year federal grant designed to fund in home preventive services that will allow children to safely stay with their families while problems in the family are addressed.
  • State Health Innovation Plan (SHIP): This is a grant funded partnership with providers, insurers and others to transform healthcare in Idaho from a volume driven to a value driven system of care. Essential components include a medical home, electronic medical records, monitoring outcomes and using evidence based practices.
  • Medicaid Eligibility and the Health Insurance Exchange: An estimated 2500 families have been told they qualify for Medicaid when they shop for subsidized insurance on Your Health Idaho (YHI), when in fact they may not qualify. The eligibility for Medicaid is currently done by the federal government- Idaho will transition to a fully state based exchange before the end of 2014. Until that time, DHW has created a small team of eligibility workers to expedite applications and make a correct determination within a couple of days.
  • Medicaid budget: The request reflects an increase of 4%, or $496 million in state funds. When these funds are combined with federal matching funds, the increase overall is 1%. The budget proposes to reinstate the adult dental benefit which was cut in 2011 and which has resulted in increased emergency room utilization for dental emergencies.
  • Community Based Treatment for Development Disabilities: The budget is down to $12 million from $14 million as a result of efforts to provide therapy, housing, employment, service coordination and respite instead of institutionalization.

The committee also heard an update on the Catastrophic Medical Care program (CAT fund) which is a partnership between the counties and the state to pay for indigent medical costs.

  • The fund has more than doubled from 2002 to 2013
  • The program covers catastrophic health care bills for those who cannot afford to pay. The county places a lien on their property in an attempt to recoup costs.
  • The program is not matched with federal dollars, as the Medicaid program is.
  • The payments frequently are for heart disease, cancer and diabetes. The program doesn’t allow for the provision of preventive care.

LEGISLATION:

H0351:Medicaid Managed Care for Dual Eligibles: replaces current language to allow for the creation of a Medicaid managed care plan with a focus on people who dually qualify for both Medicaid and Medicare.

H0348:Prescription Drug Monitoring Program: allows individuals to access information about themselves in the Board of Pharmacy controlled substance database, and to designate access to others, such as peer assistance entities.