The Idaho Budget 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.
No program is as large nor is as big a threat to the fiscal health of Idaho as the state’s Medicaid program. Traditional Medicaid provides medical services to low-income children, pregnant women, those who are disabled, and the elderly needing long-term care. There are three Medicaid plans: basic, enhanced, and coordinated. In addition to traditional Medicaid, this budget funds six months of Medicaid expansion to able-bodied adults beginning in January of 2020.
In Fiscal Year 1999, lawmakers appropriated $533 million for Medicaid. In Fiscal Year 2018, the Medicaid appropriation was $2.3 billion and that number climbed to $2.45 billion in Fiscal Year 2019, not including a $53.5 million supplemental for Medicaid to be covered by a separate bill, S1139.
For Fiscal Year 2020, the Medicaid appropriation represents an overall 15.6 percent increase over FY19, for all funds and a General Fund increase of 17.4 percent. To put that in perspective, Medicaid has gone from consuming 17.3 percent of Idaho’s total spending in FY99 to 29.4 percent in FY19 and is headed to more than 30 percent for FY20, based on this $2.83 billion request.
Finally, of the $102 million Medicaid increase from the General Fund, from FY19 to FY20, only $9.3 million is tied to expansion because more than $10 million is being pulled from the Millenium fund for expansion. It must be noted that the Millennium Fund is not sufficient to pay for half of the expansion costs once Medicaid expansion is an ongoing program.
Of the more $90 million increase for traditional Medicaid, only about $20 million is tied to lower federal match rates for Medicaid and Children’s health insurance.
Clearly better management of payments to providers is required to bring this budget under control.