The Idaho Legislature has adjourned for the year. But talk about reforming the state’s Medicaid program has been near continuous since Gov. Butch Otter referenced the idea back in January, and the discussion continues.

“Stay tuned,” Otter press secretary Jon Hanian told IdahoReporter.com Thursday when asked if the governor intends for Medicaid changes to happen this year.

Otter had noted in January that he believes Idaho’s Medicaid program is “broken,” but did not intend to seek expansion of the program in 2013. Despite his expressed intentions, an unsuccessful expansion effort was undertaken in the House of Representatives in March.

While Rep. Tom Loertscher’s, R-Iona, legislation failed to get traction, the task force that Otter assembled in the summer of 2012 to study the issue of Medicaid expansion unanimously recommended that Otter take the federal government’s offer of Medicaid expansion. Members of the task force suggested on March 18 that the state could save anywhere from $44 million to $100 million for each of the first three years of the Medicaid expansion if Medicaid expansion began immediately.

Earlier this month, Otter spoke directly about the need to change people’s behaviors as a means of improving the effectiveness of Medicaid. “The governor has received recommendations (from his Medicaid task force) that have noted the need to improve health care outcomes and to increase personal responsibility (among Medicaid recipients),” Hanian told IdahoReporter.com Thursday. “There are many additional issues we continue to evaluate, including costs to the state.”

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 federal and state tax revenues, the expanding 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 (Obamacare) 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 of the states.

After that Supreme Court ruling, the Obama administration presented the individual states with a revised proposal: Expand Medicaid eligibility during the calendar year 2013 and the federal government will pay the costs of the expansion for the first three years.

That prompted Loerstscher to recommend an expansion of Medicaid as well as favoring shutting down the state’s catastrophic care program, which is funded with state and county tax dollars. “If we’re going to expand Medicaid, this would be an ideal year to do it,” Loertscher said at the time, noting a financial benefit to Idaho with allowing the federal government to take over the health care needs of low income residents.

But the issue of expanding Medicaid became even more complicated when the New England Journal of Medicine (NEJM) published a study of Oregon’s Medicaid expansion, an experimental program that began back in 2008, long before the Obama administration was making a national push for such expansions. According to NEJM, Oregon’s experiment produced mixed results, and simply expanding health care coverage did not necessarily produce greater health care or better treatment outcomes.

Otter would presumably need to call the Legislature to a special session in order for Idaho to act on Medicaid expansion this year, an idea that was discussed and largely dismissed among several legislators back in April. Thursday, when asked about a special session, Hanian declined to comment directly, but noted “the governor will continue to include the Legislature in the process.”