Idaho Gov. Brad Little signs new law to cut Medicaid expansion. Here’s what it means

BOISE – Idaho Gov. Brad Little on Wednesday signed into law a measure to curtail the state’s spending on its Medicaid expansion program, which provides health care coverage to lower-income Idaho residents who earn too much to qualify for standard Medicaid but not enough for private insurance discounts.

The bill implements a network of medical providers that operate on a fixed budget to reduce costs. It also requires Medicaid expansion recipients to report their hours worked.

“We want Idahoans to become as self-sufficient as possible,” Little said in a Wednesday news release. “House Bill 345 reinforces that goal while reasonably reeling in Medicaid spending so taxpayers are not overly burdened by this program.”

Little in February had expressed reservations about cuts to the Medicaid expansion program. The two-term Republican governor said he was “all about cost control,” but also said it was important to remember that Medicaid expansion “was passed overwhelmingly by the public” through the ballot initiative process just over six years ago, the Idaho Statesman previously reported.

Little’s signature was the final step in a monthslong debate over the future of the state’s Medicaid expansion program. Republican lawmakers in the past few months floated several different proposals to slash the program’s funding or even cut the program entirely.

House Bill 345 was an attempt to compromise on those previous bills while looking for other ways to save the state money. The current cost of the program, which provides access to care for about 90,000 Idahoans, is “not sustainable,” said Rep. Wendy Horman, R-Idaho Falls, who co-chairs the Legislature’s powerful budget-setting committee. The program’s costs have significantly exceeded lawmakers’ expectations: from $32 million in projected costs in 2018 to $110 million in fiscal year 2026, said Rep. John Vander Woude, R-Nampa.

Little expressed appreciation for that compromise Wednesday.

“House Bill 345 is a huge improvement over a previous version that would have reversed voter-approved Medicaid Expansion in 2018,” he said in the release. “I am pleased House Bill 345 improves the Medicaid program without rejecting the will of the voters on Medicaid expansion.”

The federal government pays 90% of the costs of Idaho’s Medicaid expansion. But GOP lawmakers in the state raised concerns that Republican President Donald Trump’s administration might lower the payment threshold as it targets federal spending, and Idaho taxpayers could be left holding the bag.

But opponents of House Bill 345, sponsored by Rep. Jordan Redman, R-Coeur d’Alene, argued it would add red tape, complexity and cost to the Medicaid program. They said the work reporting requirement would be costly to administer, perhaps canceling out other savings the bill could offer.

“I am opposed to this bill because I do think it’s going to increase costs,” Sen. Melissa Wintrow, D-Boise, said on the floor.

During a previous public hearing for the bill, opponents highlighted its similarity to a law passed in other states, which proved expensive and, in some ways, ineffective.

“When Arkansas implemented their (work requirement), it cost them $26 million before the court said ‘stop,’ ” Rep. Ben Fuhriman, R-Shelley, said during the hearing. “When Georgia implemented theirs, they’ve already spent $80 million.”

Sen. Carl Bjerke, R-Coeur d’Alene, a co-sponsor of the bill, said he believes Idaho can “avoid some of the pitfalls” Arkansas experienced.