At the close of the dispiriting presentation on the trend in the state’s medical indigency/catastrophic health care fund program, JFAC Co-Chair Maxine Bell, R-Rupert, told CAT board Chairman Roger Christensen, a Bonneville County commissioner, “We appreciate having you as a partner. We probably don’t like the situation any better than you do, and we’ll continue to struggle to find a better way to do things.”

Rep. Steven Miller, R-Fairfield, asked why county costs for the program are so varied. “It’s difficult to predict ... it’s kind of like the lottery,” Christensen responded. “You could have one huge case in your county” that would cost $1 million. “It doesn’t depend on the size of the population.”

The Joint Finance-Appropriations Committee then took its morning break, and members joined in animated discussions in the meeting room and outside in the Capitol's hallways and rotunda on the dilemma Idaho faces with the program and the possible alternatives, from the Arkansas model – taking federal Medicaid expansion money and using it to buy private insurance for uninsured residents – to other options. “Some are coming to the realization we’re spending those dollars already on the indigent program,” said JFAC Co-Chair Dean Cameron, R-Rupert. “None of us are happy about having to spend those dollars.”

Sen. Dan Schmidt, D-Moscow, a physician and a CAT fund board member, said, “We have done as many things as we can to control those costs. We’ve put in medical reviews. We only pay at the Medicaid rate. We have a good contract with the counties for oversight. In essence, we’ve done what we can on paying a bill after we get it, to control the costs. The premise of this sort of payment is the question. It, in my opinion, needs to be addressed as a policy decision. We need to have that discussion.”