Just as he did last year, Gov. Butch Otter has said he does not intend to legislatively expand the state’s Medicaid program. However, despite his declaration, the governor’s new budget proposal for fiscal year 2015 calls for an expansion of Medicaid spending as his administration is planning for thousands of new Medicaid recipients within the next few years.

“We are doing the right thing by continuing to carefully study and learn from the experience of other states when it comes to Medicaid expansion,” Otter announced during his State of the State address opening the legislative session.

“I appreciate the passion with which advocates both public and private seek our approval for expanding this program,” said the governor. “I also appreciate the gravity of what some consider ‘leaving money on the table’ for early financial support of expansion. My concerns continue to be with the stability and sustainability of that federal support and the risk of leaving Idaho taxpayers holding the bag for growing an entitlement that we simply can’t afford as it’s now structured.”

Begun in 1965, the Medicaid program provides certain health care services to individuals and families with low incomes and limited resources. Financed with a combination of both federal and state tax revenues, the increasing costs of Medicaid have in recent years become a topic of growing concern among the individual states, despite the eligibility of the program being based on a variety of means testing processes.

A key element of President Barack Obama’s Affordable Care Act law was to have mandated that the individual states reduce eligibility requirements for Medicaid and expand the number of participants in their respective programs. However, the United States Supreme Court overturned that component of the Obamacare law, so expansion of Medicaid is now left as an elective choice for each individual state.

As a means of incentivizing individual state governments to expand the federal welfare program, the Obama administration has offered to pay states for the first few years of the increased administrative costs entailed in expanding their Medicaid rosters.

Last spring Otter’s Medicaid task force unanimously recommended that he seek Medicaid expansion under the financial incentives offered by the Obama administration, with one task force member, Susie Pouliot of the Idaho Medical Association, suggesting that legislators who might disagree with expanding the welfare program were inadequately informed and needed to be better educated. “They need to know what we know,” Pouliot said on March 18.

For the second year, however, Otter has said no to the Obama administration’s desire that Idaho relax eligibility requirements for the Medicaid program. Yet despite the governor’s present disinterest in the official Medicaid expansion offer from Washington, D.C., within Otter’s proposed state budget is a request for increased spending both of federal and state tax dollars to accommodate more Medicaid welfare recipients who qualify under current eligibility requirements.

Noting that the governor anticipates 35,000 more Medicaid recipients within the next few years, members of his budget staff are calling for an initial additional $5 million to spend as a means of accommodating a first wave of 15,000 new Medicaid recipients.

Otter’s administration refers to the anticipated spike in Medicaid demand as the “woodwork effect,” a phenomena that is expected to result from people applying for health insurance benefits through Obamacare health insurance exchanges and discovering in the process that they actually qualify for the welfare benefit.

Otter’s staff assumes that there are many Idahoans who already qualify for Medicaid under current eligibility standards, but are unaware that they qualify. Such people are said to come “out of the woodwork” when they first become aware that they qualify for the welfare benefit through the Obamacare program.

“It appears we are doing Medicaid expansion without calling it Medicaid expansion,” Sen. Steven Thayn, R-Emmett, told IdahoReporter.com. Thayn sits on the powerful Joint Finance-Appropriations Committee, which oversees state budgetary items. After seeing Otter’s budget request noted that “it appears that this is what is happening, whether it is intended or not.”

However, Sen. Lee Heider, R-Twin Falls, chairman of the Senate Health and Welfare Committee, sees it differently. “I have total confidence in the Department of Health and Welfare (the department that administrates Medicaid) and in Director Armstrong (IDHW Director Richard Armstrong). I do not believe he is intentionally trying to expand Medicaid.”

Heider added that “if the governor is seeking additional funds for Medicaid, then I believe he is doing that because he believes people will need help, not because he wishes there to be more welfare recipients.”

“We have a choice this legislative session,” Thayn commented. “We can continue to go down this road of increasing Medicaid and government welfare, or we can go toward private charity health care. That is Idaho's choice to make, and I'm trying to get through to people with the idea of making better choices.”