Medicaid cuts improved by public input

As the vice-chairman of the Senate Health and Welfare Committee and a member of the Joint Appropriations-Finance Committee, I am familiar with both the fiscal hardship facing our state and the impact it has on our most vulnerable citizens.

Early in this year’s legislative session it became clear that Medicaid cuts would be necessary to fulfill our constitutional obligation to balance the budget. How it would be done, however, was anything but clear. One proposal would have slashed entire programs, leaving some of our neediest citizens without the basic services they require and, over the long-term, likely increasing the cost to taxpayers.

I was relieved when legislation came forward in the House Health and Welfare committee with a set of more focused, thoughtful cuts that preserved fundamental programs. For example, the proposal made some reductions to adult dental services while preserving preventive and emergency care. It cuts back on the number of chiropractor visits the state would pay for from 24 to six. Additional savings were found by freezing automatic payment rate increases to some providers and a second year of voluntary assessments on hospitals and nursing homes.

Still, after listening to almost five hours of public hearings on the proposed $39 million of Medicaid cuts it was clear that I could not support the legislation as it was written. There were several reductions that seemed imprudent. I had three major concerns that emerged from listening to the public hearings and constituents back home.

First, the bill called for eliminating developmental therapy services at the age of 45. This was an unacceptably harsh cut which would have greatly diminished the quality of life for our citizens with disabilities as they aged. It was also unclear how much this cut would have saved the state as other costs would have likely increased from the cut. The proposal would have moved them from the DD Waiver to the Aged and Disabled waiver for which many of these folks could not qualify.

Second, it was proposed that services be cut entirely for disabled adults that were capable of living on their own. These developmental delayed folks have the cognitive ability of at least 9 years old but often less than a teenager. This was unreasonable as it was exactly the services proposed to be cut which enable many of these citizens to live on their own at a huge cost savings to the taxpayers.

Lastly the legislation required all PSR – psycho social rehabilitation referrals to be made by a psychiatrist. This sounds good on the surface but there are only 40 board certified Psychiatrists in the state so it is not feasible.

At their first meeting following the public hearing the House Health and Welfare Committee unanimously removed all three of the proposed cuts above from the legislation, demonstrating that they too had listened to the public.

While improvements to the bill may still be possible, the now $34 million in proposed general fund cuts is a dramatic improvement from the initial suggestion of taking a sledgehammer to Idaho’s Medicaid program. The legislature is now considering a set of thoughtful, focused cuts preserving basic services while delivering the necessary reductions.

If you have thoughts or questions about the proposed Medicaid cuts or any other issue before the Idaho Legislature please don’t hesitate to call me at 1 (800) 626-0471 or email me at jbroadsword@senate.idaho.gov.