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Lawmakers press Health and Welfare on Medicaid costs, behavioral health spending and personal caregiver workforce
Summary
Senate and House Health and Welfare chairs and legislative analysts flagged faster growth in the Medicaid expansion population, debated behavioral-health supplemental appropriations and asked the Department of Health and Welfare for follow-up reporting on direct-care wage increases and Meals on Wheels funding.
Senator Julie VanOrden, chair of the Senate Health and Welfare Committee, told the Joint Finance-Appropriations Committee on Friday that her committee is tracking faster growth in the Medicaid expansion population compared with traditional Medicaid, even as core Medicaid continues to account for the majority of spending.
The senator said committee members suggested medical inflation is a primary driver of recent spending increases and raised questions about specific programs, including whether Meals on Wheels funding appears reduced in the current budget documents.
“I got some feedback from my committee on the budgets… the Medicaid expansion population is growing faster than the regular Medicaid population,” VanOrden said. “She felt like the rise in the spending was because of inflation in medical costs… and how those had increased so much.”
Representative members of the House Health and Welfare delegation told the committee they were broadly supportive of expanded foster-care spending but questioned whether an ombudsman position remains necessary after program restructuring. A House representative also pressed for review of transfers among mental-health budget categories and whether program silos create gaps as people transition from children’s to adult services.
Alex Williamson, budget and policy analyst with the Legislative Services Office, presented a packet of behavioral-health requests that the committee considered as a package. The committee approved a series of budget actions related to the Idaho Behavioral Health Plan (IBHP) and psychiatric hospitalization, and it adopted language exempting certain mental-health transfers from a statutory limit so divisions could move funds across expense classes in accordance with Idaho Code 67-3511.
Notable approvals included a one-time federal appropriation of $6,743,800 for IBHP contract implementation and a one-time general-fund addition of $2,663,500 for civil-commitment expenditures affecting community hospitalization. The committee also approved multiple forecast adjustments and fund shifts for State Hospital West and State Hospital South, moving some costs from federal to dedicated or general funds in response to changing revenue classifications and managed-care arrangements.
Committee members repeatedly asked staff to return follow-up information. Senator VanOrden and multiple members asked for a report on the rate increases enacted for direct-care workers and whether those increases flowed to caregiver wages. “I look forward also to seeing that report and making sure…where’s it going if it’s not going there?” one member said during the discussion.
On foster care, lawmakers said they support planned expansions but expressed concerns about placement stability and whether the new structure reduces the need for an ombudsman role established during earlier system strains.
The committee also discussed LIHEAP (federal low-income home energy assistance) placement within Health and Welfare and whether some programs currently in Health and Welfare would be better located within another agency, such as the energy office.
The committee approved the behavioral-health supplemental and related language by roll call. Votes on the mental-health and psychiatric hospitalization items are recorded in the committee’s actions log and will proceed with the committee’s “due pass” recommendations to the full legislature or the next chamber.
The committee directed staff to gather additional information on the caregiver workforce and the distribution of prior rate increases, and members asked the Department of Health and Welfare to report back on specified transfer authority and federal-fund risk language.
Ending: The committee’s actions on behavioral health were adopted with direction for follow-up reporting; the approved appropriations and language will be included in the committee’s enhancement package and advanced with the committee’s due-pass recommendations.
