Idaho’s voters passed an unrestricted Medicaid Expansion last November as state law.
Idaho’s Republican led legislature passed a convoluted Medicaid Expansion this week.
There is a lot going on in the law that requires significant policy waivers from the federal government. Work requirements are de rigeur and will likely be challenged in court.
The interesting, to me, segment concerns optionality of Exchange versus Medicaid coverage for people who earn between 100-138% Federal Poverty Level.
Another piece of the bill would put people on private health insurance, through the Your Health Idaho exchange, by default. If someone wanted Medicaid coverage instead, they could opt in. The carve-out would apply only to people with incomes between 100% and 138% of poverty level — $12,490 to $17,236 for a single person.
It’s a lighter version of Utah’s “bridge” expansion — a federally approved plan to expand Medicaid in Utah only up to the poverty line, leaving people who are slightly above poverty out of Medicaid but allowing them to get private insurance on Utah’s exchange.
Supporters said Idaho’s carve-out would save Idaho money, since those people would be getting insurance paid for by federal tax credits.
This idea is not shocking. Idaho has been playing around with partial expansions and carve-outs to pull people with high medical costs out of the Exchange risk pool before. If this optionality is approved, it would lead to a complex set of choices for people who make between 100% and 138% FPL.
Within the context of previous Idaho initiatives, this optionality makes local sense given local assumptions.
Staying on Exchange means no work requirements, continuation of network and some predictable cost sharing and premiums. Looking at the RWJF HIX Compare data, Idaho has few low net of subsidy Silver plans as the Silver Gap is minimal in most rating areas. Premiums will be a little higher.
An individual who elects Medicaid would face potentially more restrictive networks and potentially face work requirements and eligibility requirements but would gain lower premiums and lower cost sharing.
I am not sure which way the risk will flow if this waiver is approved. I could see an argument that high cost individuals would move to Medicaid as they would be eligible for a work requirement exemption and see their premiums and cost sharing go down. I could see an argument that low cost individuals would move to Medicaid as they would see their premiums go down and since they don’t use medical services all that much, networks and cost sharing are almost irrelevant.
The actuaries have to be sweating bullets. And the academics have to be submitting data requests to Idaho Medicaid and the Idaho exchange board for de-identified, risk stratified microdata for the 2020 policy year already.