A controversial plan to raise fees on parents of disabled children finally received committee approval Wednesday after a month-long wait for a decision on the issue.  Members of the House Health and Welfare Committee voted to approve the measure because the fee increases are only temporary and are not technically enforceable by the state.

The changes proposed by the Idaho Department of Health and Welfare (DHW) deal with 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, which are typically paid for by the Medicaid programs.  Idaho has 2,150 children on the program, with each child receiving 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 participants, or their parents, can make before being disqualified.  The new fee rules proposed will not change eligibility of the program, but will force higher income parents to begin paying a monthly payment to help offset the cost of the program.

The department determined that families making up to 150 percent of the federal poverty level will not be required to pay anything into the program.   From there, 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 making $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.

This is seen as a cost cutting measure for the state in a year with looming budget shortfalls.  According to Rep. Fred Wood, R-Burley, a staunch advocate of the changes, this move by the department could save $200,000 a year.  The department itself recognizes that Medicaid is struggling and states must make changes to ensure the sustainability of the programs.

The issue was the subject of rather intense debate in the committee.  Wood was joined by Rep. Janice McGeachin, R-Idaho Falls, as he stormed out of previous hearing on the fee increase over "hypocrisy" he said he sensed in some committee members.

Wednesday’s hearing was much less intense than previous meetings, but still included some interesting material.  There was no public testimony because committee members previously heard debate on the issue, but Paul Leary, representing DHW, was called by Rep. Pete Nielsen, R-Mountain Home, to answer some questions about the financial impact of the program of families in Idaho.  Nielsen asked Leary if the plan would negatively affect a family's credit score if it couldn't pay the co-pay, to which Leary replied that it would not.  Nielsen then asked Leary if the state would have some manner of forcing families to pay, to which he again replied that it did not.

With those answers, Nielsen urged his fellow lawmakers to support the fee hike, stating that a voluntary fee increase is the avenue legislators should take to save money.  He said that the program would operate in a similar manner to private health insurance, which already asks people to share the costs of health care.

Rep. Lynn Luker, R-Boise, wasn't comfortable with Nielsen encouraging citizens to "flaunt the law," but said that because the changes to the program would be temporary, next year's Legislature can revisit the issue to see if changes need to be made and adjust accordingly.

Some legislators, including Rep. Branden Durst, D-Boise, still weren't convinced to vote for the fee hike.  Durst said that despite the voluntary nature of the program, "that is not going to change the fact that the department is still going to purse the money."  He added that he feels the fee hike might not save the state as much money as anticipated because those who currently utilize services might, because of the increased cost, seek help from other state-funded sources.