JFAC votes for $10 million Medicaid increase

BOISE – After months of intensive study and long hearings by a variety of committees and subcommittees, lawmakers set a budget for Medicaid on Friday that calls for spending $10 million more on the program next year than the governor recommended.

Legislative budget writers said the governor’s plan under-funded the fast-growing program that provides medical coverage for the poor and the disabled, possibly by as much as $18 million.

“That $10 million figure was really arrived at through savings we saw as we looked carefully at the (entire Health and Welfare) budget,” said Rep. Margaret Henbest, D-Boise. “I feel like this is as honest a budget as we can come up with.”

The Joint Finance-Appropriations Committee voted unanimously for the $331.3 million Medicaid spending plan, a 15 percent increase over this year’s state general tax budget for the program. Overall, counting the federal funds that match the state dollars, the Medicaid budget for next year totals $1.2 billion.

Lawmakers on JFAC and on the House and Senate Health and Welfare committees closely scrutinized the entire Health and Welfare Department budget this year, reorganized the budget into several funds for better tracking, and identified savings in other areas in order to shift more money into medical care.

“As a Legislature, we’ve taken a positive step forward in truly understanding the intricacies of what is a very complex budget,” said Sen. Shawn Keough, R-Sandpoint, Senate Finance vice-chairwoman and co-chair of a JFAC subcommittee that spent the summer and fall delving into the budget.

In the process, Keough said, lawmakers and Health and Welfare Department officials worked together much more closely than in the past and came to new levels of understanding of each other’s aims.

“I’m excited that perhaps we’ll begin rowing this boat together, as opposed to pulling in opposite directions,” Keough said.

Idaho Health and Welfare Director Karl Kurtz, who’s been recovering from a serious illness in recent months and appeared far more healthy and fit on Friday than he did at the start of the legislative session, told the panel, “We are very delighted and very pleased with the actions of the committee.”

He and lawmakers credited legislative budget analyst Cathy Holland-Smith, who worked with all the different committees of legislators, crunched the numbers and helped craft the reforms in how lawmakers look at the giant budget.

Among the changes: Health and Welfare in the past has transferred money intended for employee positions to benefit payments, in order to cover costs, and left the positions open. But that made it harder for lawmakers to track the spending, and left Health and Welfare short on workers, resulting in such problems as errors in determining Food Stamp eligibility.

“What we said this year was … fully fill these positions to be able to accomplish the work,” Keough said. “We’ll be able to make some clear policy and management decisions.”

The previous system was like a “shell game, in essence,” Keough said, “never really truly addressing the root of the problems.”

The budget that JFAC approved Friday incorporated a suggestion from Senate Health and Welfare Committee Chairman Dick Compton, R-Coeur d’Alene, to put some focus on research and development at the department. The budget includes adding three “program development specialists,” who will be able to focus on designing new programs and getting them up and running, as well as evaluating changes to improve existing programs.

“I’m just glad it worked out pretty well,” Compton said. “I think the department was responsible in their requests, I think the governor took a realistic look at it, and I think the germane committees tried to cooperate and provide as much guidance as possible. I think in the end, JFAC was responsible with the funding.”

The budget bill still needs approval from both houses of the Legislature and the governor’s signature to become law, but budgets rarely are changed once they’re set by the joint committee.

Henbest, a nurse practitioner who serves on both the House Health and Welfare Committee and JFAC, said, “I think the budget overall reflects very careful scrutiny of the functions of the department and its needs into the future. I think it goes a long way toward covering the cost of medical inflation and caseload growth going into 2006, beyond what was recommended by the governor.”

Kempthorne acknowledged from the outset that his recommended Medicaid budget was low, but he pinned some hope on help from Congress, for which he helped lobby through the National Governors Association. However, that help hasn’t materialized.

One change the lawmakers included in the Medicaid budget would end coverage for routine circumcision of male infants, which doctors now say is medically unnecessary.