Rep. Steven Thayn said Rhode Island was able to save a big chunk on its Medicaid program without dropping eligibility, and asked if Idaho could follow suit. Health & Welfare Director Dick Armstrong responded, "One thing I've learned is if you look at a state, you've looked at one state. ... Rhode Island, for example, has fewer people in Medicaid, they have about 176,000 to our 223,000, and they spend about $700 million more than we do. We went down another route years ago." Idaho's "baseline benefits package" has offered much less since about 2005, he said. "So we are actually, with our state plan amendment, we are in a stronger position than they are. Plus, their eligibility was dramatically higher than ours."

Armstrong said, "I didn't see anything in the Rhode Island proposal that would necessarily mean a similar reduction here. We would probably approach it in a slightly different way, because of where we are now."

When Thayn asked what flexibility from the federal government would help Idaho cut costs, Armstrong said, "I would like to see us move away from a fee-for-service system into a managed care environment."