Initial Medicaid Implementation: Idaho initially implemented Medicaid in July 1966, one year after the establishment of the Medicaid program. The state was likely an early adopter of the Medicaid program because it had a more robust existing infrastructure. Prior to the establishment of Medicaid, Idaho paid doctors through “usual and customary” charging structure and this practice continued during the initial establishment of the program. The state’s Medicaid program is divided into three programs- Basic Medicaid Plan which is the MAGI population (pregnant women, adults, and children that qualify based on income), Enhanced Medicaid Plan (people with disabilities or other individuals with special needs), and the Coordinated Medicaid Plan (which serves people who are jointly eligible for Medicare and Medicaid).
Key Medicaid Political Issues: Idaho has a small and largely rural population so issues surrounding coverage for these groups have been key in the program’s development. Like many states, Idaho responded to the growth of the role of the state in providing health coverage by consolidating services (public health, environmental, Medicaid, etc.) into the Board of Health and Welfare.
Medicaid Expansion Implementation: Idaho has not expanded Medicaid and attempts to expand have failed in the legislature. Idaho is one of three states that will have voters decide whether the state should expand Medicaid through an initiative process. The signature gathering campaign has been active over the course of 2017 and 2018. In 2016 governor Butch Otter proposed a plan that would provide primary care services to people that fall in the coverage gap (do not qualify for Medicaid but fall below the 100% poverty level to receive subsidies. This plan ultimately failed to pass and died in committee. The governor is retiring so Otter’s proposal is not currently being discussed. Democratic and Republican legislative leaders have signaled support for the ballot initiative.
General facts about Idaho Medicaid:
Medicaid program name: Medicaid
CHIP Program name: Idaho Health Plan
Separate or combined CHIP: Combination
Medicaid Enrollment: 294,500 (estimate 2017)
Total Medicaid Spending: $1.7 billion (FY 2016 estimate)
Share of total population covered by Medicaid: 18% (2015)
Share of Children covered by Medicaid: 40% (estimate)
Share of Medicaid that is Children and Adults: 77%
Share of Spending on Elderly and people with disabilities: 61%
Share of Nursing Facility Residents covered by Medicaid: 66% (estimate)
Expansion state: No
Number of people in expansion: N/A
Work Requirement: No