A new state law requiring legislative approval of Medicaid waivers could have unintended consequences for Idaho’s assisted living providers, according to Gov. Brad Little (R). One assisted living advocacy group said that the law could result in “the largest cut to the Medicaid program in the history of Idaho,” although that probably was not legislators’ intention.
Little recently signed HB 398, which took effect immediately, but he cautioned that state lawmakers need to clarify how it may — or may not — affect changes already underway.
The new law prohibits the Idaho Department of Health and Welfare from seeking or implementing a Medicaid state plan or waiver without legislative approval. The law affects requested changes under Sections 1115 and 1915 of the Social Security Act — which some assisted living providers use to provide home- and community-based services to Medicaid beneficiaries — that would expand coverage or increase state costs.
The Medicaid program is jointly funded by the federal government and states. Under federal law, states are required to submit plan amendments and waivers to the US Centers for Medicare & Medicaid Services to make changes to their Medicaid programs. Idaho’s Medicaid division is in the process of seeking waivers for some of its programs, including reimbursement rate adjustments for assisted living providers and intermediate care facilities.
Although $65.8 million in state and federal funds were included in the division’s budget for those rate adjustments, the bill’s language has some providers concerned that those changes will be paused until legislators return next year.
In a Monday letter to lawmakers, Little said that he shares the legislature’s goal of Medicaid cost containment, but he added that the new state law contains “vague” language that will “immediately result in harmful disruption to the delivery of services to thousands of Idahoans.”
In a recent letter to the governor, the Idaho Health Care Association called the bill’s language “problematic” and called on Little to support a “trailer bill.” IDHCA Executive Director Robert Vande Merwe stated that the cost of providing long-term care already exceeds Medicaid reimbursement, and without the trailer, providing care to Medicaid recipients will be “unsustainable.”
“If this [trailer] bill does not pass, we think this will be the largest cut to the Medicaid program in the history of Idaho, and we doubt this was the intention of most legislators who voted to pass the bill,” Vande Merwe wrote. “There is no option to wait for a special session. It must be fixed now.”
“Rate increases to assisted living and intermediate care facilities approved by the legislature could be in jeopardy, depending on how the existing statute is interpreted,” Vande Merwe told the Idaho Press. “An increase in federal funds for nursing facilities is also possibly at risk. We urge all legislators to please take the time to pass a trailer bill.”
