Saint Alphonsus Medical Group Strategic Assessment and Creative Recommendations November 30, 2010 Right for Idaho: Medicaid Transformation & Expansion Corey Surber I March 2013

Governor Appoints Workgroup to Study Options June 2012 U.S. Supreme Court decision makes Medicaid expansion under Affordable Care Act (ACA) optional. Gov. Otter appoints 15 member workgroup in July to collect data, analyze and provide recommendations. Workgroup engaged national consultants and experts to collect data. Report/recommendations delivered to Gov. Otter in December.

Current Idaho Medicaid 240,000 participants, with 70% being children from low- income families Also provides coverage for people with disabilities, low- income elderly and low-income women who are pregnant. Federal government pays 70% of program; $1.2 b. of $1.9 b. cost. 96.4% of $1.9 b. budget pays medical claims; less than 3% administration costs.

ACA Impacts Without Optional Expansion Mandatory ACA changes to income and asset calculation for eligibility determination take effect. People currently eligible, but who have not applied, will enroll with mandatory coverage requirement Together, these mandatory requirements will add 46,000 Idahoans to Medicaid w/o optional expansion!

ACA Impacts of Optional Expansion Provides coverage to adults earning <138% of poverty –Family of 4 must have income less than $31,810 64% are working and employed 83% white citizens Most do not have children in household Estimated 104,200 people would become eligible on January 1, 2014.

Expansion Population: Current Healthcare Options 6 Estimated Number of Participants who will be Newly Eligible for Medicaid by State/County Program State Program Estimated Number of Participants Idaho Catastrophic Health Care Cost Program (CAT or Medically Indigent Services) 6,000 Idaho Community Health Centers (CHC) 35,000 Idaho Adult Mental Health Centers4,300 Corrections2,000 Higher rates of obesity, diabetes, and tobacco use. Little preventive care. Access highest cost care through emergency rooms or through state/county medical indigency programs. Prevalent chronic medical conditions, including mental illnesses.

Good for Idaho’s State and County Budgets Net Savings = $84.6 M over 10 years Elimination of county/state indigent program Accepting enhanced federal funding to support expanded Medicaid enrollment

Good for Idahoans’ Health Multiple studies show two major factors in improving health outcomes –Usual source of care –Health care coverage Optional Medicaid expansion provides an opportunity to address both factors Opportunity to redesign the Medicaid program and invest in needed mental health services to promote health and protect public safety –incorporate personal accountability –align incentives to promote value rather than volume –invest in community mental health supports

Good for Idaho’s Economy $9.2 billion in new dollars flowing through Idaho’s economy 16,000 new jobs (all sectors) $717 million in payroll $614 million in tax revenue (sales, income, etc) »Economic Impact Analysis, Idaho Hospital Association 2012

Good for Taxpayers Relieves property tax burden associated with paying for indigent healthcare –County indigent fund –State catastrophic healthcare fund Prevents Idaho taxpayers from bearing the burden for Medicaid expansion in other states without value to Idaho citizens and businesses

Good for Business Eliminates cost shifting from indigent healthcare Prevents employers from facing coverage penalties up to $1.3 B nationwide (Jackson Hewitt) Offsets Medicare reimbursement cuts Idaho hospitals will face (preventing additional cost shift to business) Makes Idaho more competitive for business and prevents job losses to other states

Idaho Has a Choice Status Quo: –Cover 45,500 Idahoans at a cost of $394 million in state funds (not including county) – no offsets OR Expansion: –Cover 150,000 Idahoans with net savings of $84.6 million in state funds

Delay Costs Idahoans Year 1 Loss: $54 M (partial year) Year 2 Loss: $106 M Year 3 Loss: $110 M

The Cost of Inaction If Idaho does not expand Medicaid, there will be a $90.1 M negative impact over 10 years through: –Increased tax burden –High cost coverage for indigent population –Plus, decreased attractiveness to new business

Join the Coalition Supporting Expansion Join the Coalition for regular updates and action alerts For more info, go to

Corey Surber Director, Community Health Initiatives (208)