Medicaid, the government-run health program, which is split in cost about 30-70 between the state and the federal government, continues to grow, adding millions of dollars to taxpayers’ backs each year. The program is a social health care safety net for families and individuals with low income and limited resources.

For 2015, lawmakers approved $492 million in state general fund dollars for Medicaid, a 3.1 percent increase from fiscal year 2014. The program’s overall budget, with state and federal dollars included, checks in at $2.03 billion.

To put that figure in perspective, take a walk back about a decade. For fiscal year 2005, lawmakers decided to spend $2.08 billion in state funds on all functions of government—education, public safety and Idaho’s portion of health programs. In short, 2015’s total Medicaid spending will nearly surpass all state spending of 2005.

Due to the economic doldrums of the economic recession, Idaho’s seen large jumps in Medicaid spending. In 2010, the state spent $298 million on Medicaid, or $194 million less than what’s expected to go out the door for the program in fiscal year 2015.

In 1990, Idaho’s Medicaid program made up a mere 5 percent of state spending. In 2005, that figure jumped to about 15 percent. In 2015, about 16.7 percent of state spending is dedicated to Medicaid.

Enrollment in the program has grown significantly through the last decade. In fiscal year 2004, Medicaid served just more than 162,000 Idahoans. This year, the program boats 246,000 participants, an increase of more than 80,000.

Based on those enrollment figures, dependency on Medicaid is growing at a slightly higher rate than Idaho’s population. In 2004, about one in every 8.5 Idahoans needed Medicaid to get by; this year, it’s one in 6.4.

That said, the numbers could have been much, much worse. This year, Idaho legislators declined to take up Medicaid expansion, an option under the Affordable Care Act. Expanding the program under Obamacare would have added at least 70,000 new Idahoans to the Medicaid program.

It is important to note, of course, that the new enrollees, created by raising some of the program’s income guidelines, would have their costs covered completely by the federal government for a few years, instead of coming into Medicaid under the tradition 30-70 state-federal split. Then, by 2019, the federal government would lower its funding of those new enrollees to 90 percent, with the state picking up the rest.

Still, simply adding more money to a government program year after year doesn’t appease some critics. Josh Archambault, a senior analyst with the Foundation for Government Accountability is among those who believe lawmakers can do better by taxpayers by working to improve Medicaid.

“Idaho should reform the old broken Medicaid model by injecting competition into the program by granting beneficiaries more choice,” Archambault wrote to IdahoReporter.com. “Reforms in Florida, Louisiana, Kansas and some being debated right now in North Carolina show a path forward that is both pro-patient and pro-taxpayer.”

He suggested that Idaho focus on the Florida reforms, which the state kicked off in 2006. Under the plan, Medicaid enrollees have their choice of several different private plans with customizable benefits. The state funds the private insurance plans instead of paying for open-ended health coverage.

Archambault believes Idaho could save hundreds of millions of dollars annually by injecting some choice and free market principles into the state’s Medicaid program.

Additionally, he suggested that the state conduct a comprehensive audit to ensure Medicaid integrity. The Illinois state government conducted just such a review and delivered stunning results. “So far this year, the company (the private auditor) has reviewed 465,076 cases, and recommended that 228,965 people—about half—be dropped from the Medicaid rolls,” wrote Watchdog.org’s Ben Yount about the examination.

Illinois dropped at least 114,000 people from the Medicaid program, which will save taxpayers millions and millions of dollars each year.

“Idaho should immediately conduct a similar comprehensive audit of its program,” Archambault urged.