Idaho lawmakers last year directed the Idaho Department of Health and Welfare (DHW) to find ways to save money in the state's Medicaid program.  The department developed a policy that includes cost-sharing for the parents of special needs children on Medicaid, which lawmakers approved earlier this year.  On May 1, those changes go into effect, and some parents will be required to spend more for the care of their children.

The fee increases will affect children are involved in the Katie Beckett program, initiated during the Reagan administration, which allows children who have severe disabilities to remain in their home and receive in-home health services at Medicaid's expense.  Idaho has about 2,150 children on the program.  Each child receives about $1,424 in aid, for a total cost of $37 million per year to the state.

Unlike many Medicaid programs, the Katie Beckett program has no cap on how much money participants, or their parents, make before being disqualified.  The new rules proposed won’t change eligibility of the program, but will charge higher income parents a monthly payment to help offset the cost of the program.

The department decided that families making up to 150 percent of the federal poverty level will not pay anything into the program.  Above that level, the department created a sliding fee in which the percentage paid to the state will increase as income increases.

For example, a family of four earning $2,750 a month, or 150 percent of poverty level, will not have to contribute to the program.  A family of four making $10,000 a month, however, will be forced to pay $300 a month.  The cap for required payments from parents will be set at 5 percent of family income.   High-income families who pay into an insurance policy would receive a 25 percent discount on that payment required by Medicaid.

With the changes, the state could see as much as $200,000 a year in additional revenue for the program, according to Rep. Fred Wood, R-Burley.

Families making between 150 to 185 percent of poverty levels who have more than one child enrolled in the program will pay a maximum of $30 a month into the program.  Similar families making over 185 percent of federal poverty levels will pay a monthly family fee and will not be charged per child.

The department will not be able to force parents to pay and will also not be able to drop children from the program for non-payments.  Rep. Pete Nielsen, R-Mountain Home, made it clear during the final hearing on the changes that though DHW could strongly encourage parents to contribute their monthly premiums, the department could not negatively affect someone's credit score if they choose not to pay.  Paul Leary, an administrator with DHW, assured Nielsen and other committee members that the department has no mechanism to force parents to pay.  Tom Shanahan, the spokesman for the department, also confirmed, in an email to IdahoReporter.com, that DHW is unable send a person to collections for non-payment.

Some on the committee that approved the fee hike, including Rep. Branden Durst, D-Boise, were skeptical that the change would actually help the Medicaid program overall.  He said, during the final hearing, that those who are forced to pay the additional fee might not be wealthy enough to do so, and may be forced to use other social services offered by the state, which, he said, would end up costing the state more money in the end.

(Note: For more information on the changes, view the department's list of Frequently Asked Questions here.)