Disability advocates worried about Medicaid caps

BOISE - Disability advocates have concerns about a health care bill introduced by Rep. Bryan Zollinger, R-Idaho Falls, that will be heard Monday. But Zollinger said Friday he will ensure the disabled aren't subject to lifetime Medicaid caps proposed under the bill.

Gov. C.L. "Butch" Otter, along with the Department of Insurance and the Department of Health and Welfare, are pushing for the Idaho Health Care Plan this year. That plan, also called a "dual waiver" proposal, aims to offer low-cost private insurance to those in the Medicaid gap by extending subsidies to help them purchase plans on Your Health Idaho. It would also move 2,500 to 3,500 Idahoans with very high-cost conditions onto Medicaid in order to push down skyrocketing premiums and stabilize Idaho's individual health insurance market.

That bill is due to be debated next week, but in a town hall meeting in Idaho Falls last week, Zollinger claimed there aren't enough votes in the Republican platform for it to pass.

Zollinger has produced an alternative bill that will be heard Monday. Unlike the Idaho Health Care Plan, which provides mechanisms to make ACA plans available to those in the Medicaid gap, Zollinger's bill focuses on shifting the state to non-compliant plans with lower guaranteed benefit levels and reducing the number of people covered by Medicaid.

The bill has three primary parts. One basically codifies in law the non-ACA-compliant health care plans that were established in an executive order signed earlier this year. One directs the Department of Health and Welfare "to the extent practicable" to establish a direct primary care program, while specifying few details about what such a program would look like. A final piece would impose unspecified work requirements for Medicaid recipients, and mandate that some Medicaid recipients would be limited to only five years of benefits across their lifetimes.

Zollinger said he thinks five years of benefits is enough for an able-bodied person to find employment and get out of poverty several times, if necessary. Currently, an individual has to make less than 26 percent of the poverty level (about $3,160 per year for a single person) in order to qualify for Medicaid in Idaho on the basis of economic need.

The benefit cap contains exceptions for pregnant women and single parents of children under 6. It wouldn't count the time children under 18 spend in the program toward their lifetime caps.

Because nearly all Medicaid recipients fall into one of those categories, the lifetime caps are expected to affect only a few hundred current recipients. But Jim Baugh, director of Disability Rights Idaho, said Friday the current draft could subject a large, unintended group of people to the caps: the "dual eligible population."

Dual eligibles are people who are eligible for both Medicare and Medicaid. The group consists primarily of elderly people in nursing homes and those with severe disabilities, many of whom require round-the-clock care.

Baugh said his son, who was born with severe mental disabilities and is paraplegic, is such a dual eligible. His son breathes through a tracheotomy, and his breathing tube has to be cleared regularly (sometimes every 20 minutes) in order to keep him from suffocating. Baugh said the bill for such services can run $200,000 per year, so if his son hit a lifetime cap, he would have no practical options to stay alive.

Zollinger said in an interview Friday that he intends for dual eligibles to be covered under his bill. He said the House Health and Welfare Committee will examine it in detail to make sure dual eligibles' Medicaid coverage isn't subject to a lifetime cap. If the bill as currently drafted includes them in the cap, Zollinger said he would amend the bill to take them out of it.

"The only ones I want to be affected are those who are physically able to work and don't have minor children at home," Zollinger said.

The bill is scheduled for a hearing Monday morning.