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Senate Bill 1331 - Health and Welfare Department: Medicaid FY22 supplemental appropriation

Senate Bill 1331 - Health and Welfare Department: Medicaid FY22 supplemental appropriation

Fred Birnbaum
February 18, 2022

The Idaho Spending Index examines appropriation bills on several fronts to add important context to lawmakers’ discussions as they are considered on the floor of the House and Senate. Among the issues we look at in drawing a conclusion about a budget:

Does the agency requesting these funds serve a proper role of government? Has wasteful or duplicative spending been identified within the agency, and if so, has that spending been eliminated or corrected? Does the budget examine existing spending to look for opportunities to contain spending, e.g., through a base reduction? If there is a maintenance budget, is that maintenance budget appropriate? Are the line items appropriate in type and size, and are they absolutely necessary for serving the public? Does the budget contemplate the addition of new employees or programs? Does the appropriation increase dependency on the federal government?

Our analysis is intended to provide lawmakers and their constituents with a frame of reference for conservative budgeting, by summarizing whether appropriation measures contain items that are sincerely objectionable or sincerely supportable.

Rating -1

Bill description: To provide a $6.4 million increase to the Idaho Medicaid budget.


Another session, another Medicaid supplemental. It never ends. This supplemental brings into clear focus the extent to which the federal government is using federal funds to plug gaps in Idaho’s exploding Medicaid budget. 

The bill has a net appropriation increase of $6.4 million, which might seem small in comparison to a $4 billion Medicaid budget, but there is more to this story.

The background is that under the coronavirus health emergency the federal government increased its federal match rate by 10 percentage points and required that Idaho let any Medicaid participant stay in the program until the end of the health emergency. Meaning that nobody is disenrolled – including someone who doesn’t meet the requirements of enrollment. This federal string has now expanded Medicaid to over 100,000 people who didn’t formerly qualify for it, under the rules before the health emergency.

This supplemental uses $93.8 million of federal money to fund the rescission portion of this bill. In addition the bill contains a line item of $38 million. This includes funds to pay $34 million in obligations as part of a retrospective settlement - for prior costs incurred that exceeded projections. This is based on actual utilization, costs, and membership mix. A major problem is that in recent years, actual costs have consistently been overshooting estimates, and there appears to be no credible solution. 

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