Medicaid for Idaho – Frequently Asked Questions 

Medicaid expansion basics

Q: What is the insurance coverage gap?

A: The Affordable Care Act (ACA) set up a new scheme for helping Americans get health insurance. A main component of this was through new health insurance exchanges, known in Idaho as Your Health Idaho. These allow customers to compare coverage from several insurance companies all at once, and pick which was right for them. People with incomes between 400% and 100% of the Federal Poverty Line (FPL) are eligible for tax credits to help make insurance from the exchange more affordable. The ACA also expanded Medicaid eligibility to anyone whose income was less than 138% FPL; however, this expansion was optional. For states like Idaho that didn’t expand Medicaid, it meant some people made too much money to qualify for Medicaid but too little to get help buying insurance on the exchange. These people fall in the “coverage gap”. If Idaho expands Medicaid eligibility, as the majority of states have done, the coverage gap will disappear. 

Q: Who is eligible for Medicaid now and who will be eligible under the expansion?

A: Right now, about 300,000 low-income Idahoans have Medicaid. These include children and their parents, pregnant women, people 65 years or older, and people with disabilities. While the income levels vary based upon the categories mentioned above—for example, parents of a child on Medicaid are only covered if they make less than about $5,000 per year; their child is eligible as long as they make under about $40,000 per year. Under the expansion, all individuals would be eligible for Medicaid if they make under 138% of the Federal Poverty Line (some documents refer to 133% FPL, but up to 5% of income isn’t counted, meaning 138% FPL is the practical income cutoff). In 2016, that means a total income less than $22,108 for a household of two people or $27,821 for a household of three people. You can visit this site for a list of income thresholds for other household sizes; the specific thresholds are updated each year. The state estimates about 79,000 people will become eligible for Medicaid when expansion passes.

Q: What is the difference between Medicaid and Medicare?

A: Medicaid is the public insurance program for low-income and disabled individuals. Medicare is the public insurance program for all adults over 65 years of age, regardless of income.

Q: Which healthcare benefits and services are covered by Medicaid?

A: Medicaid covers the following benefits and services:  Annual Physicals; Counseling and mental health services; Dental care; Doctor visits; Durable Medical Equipment; Emergency Medical Transportation; EPSDT Services for children under the age of 21 (must be prior authorized); Home health care (Doctor prescribed); Hospice Care; Immunizations; Inpatient and outpatient hospital care; Lab tests; Medical equipment and supplies; Medical Transportation services; Nurse Midwife; Pregnancy and family planning services; Prescriptions; Primary Care Case Management; Prosthetics/orthotics; Substance Abuse Treatment; Smoking Cessation; Vision Services; Weight loss; X-rays.

Q: Will Medicaid beneficiaries be required to work?

No, the Medicaid expansion initiative does not require beneficiaries to work. No Medicaid expansion to date has done so, and there’s evidence to suggest it isn’t a good idea. While the numbers are different in each state, work from the University of Michigan and others show that around half of Medicaid beneficiaries already work, a quarter are disabled, elderly, or are in school, and many of the rest who don’t work have a health condition or other obstacle that would make it tough to work. Imposing a work requirement would add lots of administrative costs for the state and make it harder for people to get the coverage they need.

Q: Do undocumented immigrants have access to Medicaid?

A: No. Only citizens and some documented immigrants may enroll in Medicaid if they meet other eligibility criteria.


Effects of Medicaid

Q: Does Medicaid save lives? Does it help the people who have it?

A: Yes and yes. A 2017 article in the New England Journal of Medicine reviews many studies that answer the first question, and while there is some evidence on both sides, much of the research shows that Medicaid helps get people the care they need to extend life. Plus, Medicaid has been shown to keep people financially and mentally healthy—big reasons to have insurance that get less attention than whether Medicaid prevents death. That sure sounds like helping people to us.

Q: Will this worsen the doctor shortage in the state?

A: Just like when coverage has been expanded in the past, there are concerns that the health care workforce will not be able to care for the newly insured Medicaid population. Medicaid expansions in other states have not led to increased wait times for new Medicaid patients. Idaho’s robust non-physician workforce, including nurse practitioners and physician assistants, will also help care for the newly eligible. 

Q: Do any doctors take Medicaid? Will Medicaid beneficiaries be able to get appointments when they need them?

A: Yes, to both questions—the most recent survey published by the government estimates that 87% of office-based doctors in Idaho were accepting new Medicaid patients, almost identical to the percentage of doctors taking new privately insured (88%) and Medicare patients (86%). And as mentioned above, when other states have expanded, Medicaid patients have not experienced increased wait times for physician appointments.

Q: What do the results of the Oregon Health Insurance Experiment mean?

A: In 2008, Oregon performed a limited expansion of its Medicaid program, giving eligible residents the chance to sign up based upon a lottery. Researchers used this opportunity to compare the outcomes of those that did and didn’t get Medicaid coverage; they named this the Oregon Health Insurance Experiment.

Based upon Oregon’s expansion, researchers have released a series of studies about the effects of Medicaid. Its impact on financial status was profound. After all, this is a main purpose of having health insurance in the first place, just like car, life, or home insurance. Extremely high medical expenses almost vanished, and the amount of money paid out-of-pocket by Medicaid beneficiaries also dropped. More people were treated for depression and fewer overall were depressed. Some of the measures of other health outcomes, like blood pressure, cholesterol, and blood sugar control, didn’t change much, possibly because there weren’t many people with those diseases in the study or medications for those conditions were already inexpensive and accessible. People tended to use the emergency department a bit more.

So, in the end, the Oregon Health Insurance Experiment is a good example of a “glass half-full, glass half-empty” study. The way you interpret it depends on how you feel about Medicaid in the first place. Some like to say the experiment shows Medicaid isn’t good for people on it—that’s simply not true. While the health effects of Medicaid didn’t pan out in this particular study, others have shown significant health benefits. What Oregon did show was that Medicaid helped many people stay financially and mentally healthy—major victories that Idaho should aim for, too.


Paying for Medicaid

Q: How does the government pay for Medicaid? How much will this cost the state?

A: The federal government will cover 93% (2019) to 90% (all years beyond) of the costs of Medicaid for the newly eligible population. The state pays for the remainder. Importantly, Idaho already provides health care for many uninsured residents through indigent care funds, and expanding Medicaid would mean the state wouldn’t need to spend as much money on such programs. In fact, Gov. Otter’s 2012 Medicaid workgroup report suggested the state would actually save money by expanding. This means there would be no need for new taxes to offset the costs of insuring more Idahoans. Idaho residents and businesses are already paying the taxes used to fund Medicaid expansion, but aren’t reaping any of the benefits—the money is being spent in other states.

Q: Will this help or hurt the economy?

A: By bringing in more federal dollars to be spent in the state, the state’s economy is likely to grow. Gov. Otter’s 2012 report about Medicaid expansion suggested up to $615 million in tax revenue and 16,000 new jobs could be generated due to expansion. Other states have experienced a similar boost after expanding Medicaid. 

Q: Will my taxes increase if Medicaid is expanded?

A: It is not likely. See above for more information.


Politics and policy: Medicaid expansion, the Idaho Health Care Plan, and the Affordable Care Act

Q: What is the difference between the Idaho Health Care Plan and the Medicaid expansion initiative being put on the ballot? Does Medicaid for Idaho support the Idaho Health Care Plan?

A: We are excited about any effort to close the coverage gap in Idaho. Too many people have been unable to get affordable coverage for too long. We hope the Idaho Health Care Plan passes with unanimous support. That said, we think Medicaid expansion will be a better bet for the state.

In brief, the Idaho Health Care Plan uses the insurance exchange (also called Your Health Idaho) to close the coverage gap. It moves some of the most expensive-to-insure people from the insurance exchange to Medicaid coverage; the expected effect is that insurance premiums for everyone else on the exchange will decrease. In addition, their plan calls for everyone with an income below 400% of the Federal Poverty Line to get federal dollars to help them buy insurance on the exchanges.

While this is a good solution to a tough problem, it won’t end up covering as many Idahoans as Medicaid expansion—about 80,000 fewer, according to the state’s estimates. And as we talk about above, the more people gain coverage, the more jobs are created, and the better the economy does. In addition, for the poorest Idahoans, Medicaid is much more affordable. It doesn’t have the same per-month or out-of-pocket costs that coverage from the insurance exchange has, and there’s evidence showing that even with small copays at the doctor, people cut back on necessary care. That’s not something we want Idahoans to do.

Q: Is there any chance this ballot initiative will succeed? Why expand via ballot initiative?

A: Absolutely. We think there is a great shot that it will, and we’re doing everything we can to make it happen. Medicaid expansion has great support across the country, and a Boise State poll in 2016 showed that around 70% of Idahoans want the coverage gap closed. Maine voted in November of 2017 to expand Medicaid via a ballot initiative—and Maine bears some political similarity to Idaho. Our state hasn’t chosen to expand Medicaid, leaving many without coverage and billions of federal dollars untapped. A ballot initiative lets Idahoans decide for themselves whether to expand without waiting any longer.

Q: What happens if both the Idaho Health Care Plan and Medicaid expansion succeed?

A: The first, best thing is that Idaho’s coverage gap is finally closed—everyone in the state would have access to affordable health insurance. Beyond that, the most likely scenario is that Medicaid expansion would occur sometime in 2019. People with incomes under 138% FPL (see “Medicaid expansion basics”) who bought insurance through Your Health Idaho for 2019 would then be eligible for Medicaid. Most likely, they could either continue paying for their plan from Your Health Idaho or switch to Medicaid. The “expensive-to-insure” individuals would move back to coverage through Your Health Idaho.

Q: What happens to Medicaid expansion if the Affordable Care Act is repealed?

A: If the Affordable Care Act (ACA) is repealed after Medicaid expansion is enacted, eligibility for Medicaid in Idaho would most likely return to what it was before the expansion (see “Medicaid expansion basics”). This depends on whether there is a replacement plan passed and what it includes. When Congress tried to repeal the ACA in 2017, replacement plans differed with how they treated Medicaid. Some kept expansion in states that had expanded it, while others changed the way the federal government pays for Medicaid. These latter plans, often referred to as “block grants” for Medicaid, pay less money to states and reduce the number of people able to get Medicaid coverage.

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