By Tom Shanahan

The Idaho Legislature adjourned Thursday and may best be remembered as a session in which legislators pro-actively engaged stakeholders and citizens in two key areas —education and Medicaid.

Shortly after the session began, the Joint Finance-Appropriations Committee set two days aside in January to listen to public testimony on these two stalwart issues, with the Medicaid meeting on January 28th attracting an estimated 1,000 people.  In the past, public testimony was not allowed before the JFAC committee, which only accepted presentations from state agencies.

“I think the Legislature’s efforts to give people the opportunity to voice their concerns and opinions had a distinct impact on the legislative and budget setting process for Medicaid,” Director Armstrong said.  “Some tough decisions had to be made, but the voice of the public decidedly influenced the end result in the Medicaid reductions.  It made for a more challenging session, but it was the right way to do it.”

Director Armstrong began DHW’s budget presentations with a review of the reductions the Department made over the last four years including office closures, employee furloughs and layoffs.  Director Armstrong focused the committee on the cost drivers of the Department’s budget, mainly increases in Medicaid benefit costs.  He pointed out that over the last four years Medicaid’s budget has increased 39%, while the rest of the Department has held expenditures at 2008 levels.

Legislators focused their attention on Medicaid benefits, carving out $34 million general funds and $97 million total funds to balance DHW’s budget.  The rest of the Department’s divisions were appropriated funds that are similar to the current fiscal year.

Some of the highlights for each division include:

Medicaid

When the legislative session began, Administrator Leslie Clement addressed the Joint Finance-Appropriations Committee and presented several options to meet the Governor’s original recommended budget, which reduced the Medicaid benefit appropriations by $25 million in general funds.  Clement’s message — you can take a  blunt approach by eliminating programs, or a tailored approach by identifying cost-cutting and revenue producing options across the board.  The committee ended up taking the tailored approach, but had to increase the reduction from $25 to $34 million general funds based on changing revenue projections.

The tailored approach of HB 260 spread the reductions over pricing adjustments, benefit changes, implementing co-pays, expanding provider assessments and increasing program integrity staff to reduce Medicaid fraud.  The Medicaid program also was instructed to compile information about managed care opportunities that could save money in future years.  Decisions on managed care will be addressed during the 2012 legislative session.

Other actions taken that affect Medicaid include:

• The Legislature approved the Children’s System Redesign, which provides families who have a child with developmental disabilities additional options for treatment, giving families the opportunity to direct the services for their child.
• Approved the Medicaid program’s new statewide transportation broker, which is the result of legislative direction to pursue selective contracting arrangements for delivery of benefits.  It also approved expansion of Medicaid’s managed care contract for dental care, Idaho Smiles, to include the majority of Medicaid enrollees.
• Most of the rule dockets that passed this session temporarily reduced costs for SFY 2011 through a variety of pricing, benefit and administrative reductions.  Legislators gave DHW direction to extend these rules to be effective for SFY 2012 as part of the overall Medicaid cost reductions. 

Welfare

• Legislators approved a new asset limit for Food Stamp applicants of $5,000.  This means that people applying for Food Stamp assistance cannot have savings accounts or possessions, such as boats or RVs, that have a total value of $5,000 or more.  The Idaho Food Stamp program historically had an asset of limit of $2,000 for most people until two years ago, when it was suspended due to economic conditions.  At that time, Self Reliance workers reported that some people applying for assistance had assets exceeding the $2,000 limit, but could not sell the assets because there was no market for them.  Reinstating the asset limit will add workload to Self Reliance workers who will not only have to factor in the assets into Food Stamp eligibility determinations, but also redeterminations, which occur every six months or 1 year, depending on the type of case.
• Considered several bills that would expand Food Stamp distribution from the first of each month to multiple days.  With the tremendous increase in Food Stamp use, some grocers complained that they could not keep their store shelves stocked on the first of each month, when the benefits are loaded on recipients’ EBT debit cards.  Due to costs of changing the system, and the possibility the federal government may issue new rules on the frequency states shall issue benefits, legislators tabled the idea for now. 
• The Legislature appropriated an additional $1.1 million to the Aged, Blind and Disabled (AABD) cash assistance program due to increasing caseload growth in a program that is 100 percent funded through state funds.  Even with this additional money, the AABD program had to reduce or eliminate payments to approximately 2,000 of the 14,000 Idahoans receiving cash assistance through the program.
• A new rule that allows the use of electronic/telephonic signatures for public assistance and child support applications was approved.  This opens the door to future technology possibilities that will modernize the application and recertification process to help people living in rural or remote areas to apply for assistance through the use of secure, telephone based interviews and associated signatures.
• Approved rules that require people applying for medical indigency funds through the counties to have their eligibility examined for Medicaid to determine if their expenses could be covered by Medicaid.  For those who are determined eligible for Medicaid, federal funds can be leveraged to help pay their medical bills. 
• Passed legislation that extends the timeframe in which unpaid child support can be collected and allows for renewal of judgments from the obligated parent.
• Appropriated $390,000 for the ongoing maintenance of the Idaho Benefit Eligibility System that allows us to make required adjustments in policy changes, federal reporting requirements, and productivity improvements to meet the high demand in delivering services to hundreds of thousands of Idahoans.  

Public Health

• Amended rules for entry into daycares and schools to bring Idaho’s required immunizations in line with national recommendations.  The new rules allow the state to exclude children who are not current on their vaccines from school during an outbreak if they do not have an exemption.  Parents can still exempt their children from vaccines for religious, medical or personal reasons.  
• Passed legislation that makes it easier for parents to provide their immunization records to schools and daycares, while also relieving the burden on physicians to provide immunization certificates by expanding the healthcare professionals who can sign immunization documents.  Prior to this, only physicians and health districts could sign immunization certificates.  The bill broadens the medical providers to include nurse practitioners, physician assistants, registered nurses licensed professional nurses, and pharmacists.  It also allows the use of electronic records, such as IRIS, to verify immunization status.
• In an effort to prevent identity fraud, Vital Records attempted to extend the time that birth and death records become public.  SB 1083 proposed to increase birth record privacy from 100 years to 125 years, and death records from the current 50 years to 100 years.  Unfortunately, due a misunderstanding of the legislation, the Idaho House voted the bill down 44-26 due to concerns it could impede efforts to research history and family genealogy.

Family and Community Services

• Passed a daycare bill that sets a points system to determine staff/child ratios for child care licensed by the state.  This bill resolves some of the confusion that surfaced in 2009 during the rules' making process.  In particular, the bill clarifies that each child in the home must be counted by DHW for purposes of child/staff ratios under state licensure.   
• Changed the name of Idaho State School and Hospital to the Southwest Idaho Treatment Center to align the name with the mission of the facility.  The institution had been neither a school nor hospital for over 25 years.  In addition, the legislation established a process for discharges and admissions to the facility.

Behavioral Health

• Using expenditure data from SFY 2010, JFAC transferred $ 15.1 million in substance use disorder treatment funds from the Division of Behavioral Health to Department of Correction, Department of Juvenile Corrections, and the Courts.  The transfer reportedly was made to ensure that treatment funds would continue to be spent on certain criminal justice populations with the sunset of the Interagency Council on Substance Abuse.  In theory, the treatment funds for the populations in which these agencies are interested will be limited to the appropriated amounts rather than allowing unlimited use of DHW treatment funds.
• JFAC transferred another $1.8 million in community mental health funds from Behavioral Health to other agencies.  About $1.1 million went to the Department of Corrections for the Region 7 Community Corrections grant project.  An additional $787,400 went to the Office of Drug Policy for Allumbaugh House, the detoxification/mental health crisis facility in Region 4.  DHW is in the process of transferring its membership on the joint powers entity that oversees Allumbaugh House to the Office of Drug Policy.  The Division’s funds for Allumbaugh House were previously used to fund a mental health crisis facility known as Franklin House, also in Boise.