Lawmakers offer budget recommendations to JFAC, urge review of Medicaid pharmacy costs and program transfers

Members of the Idaho House Health & Welfare Committee reviewed areas of the Health and Welfare budget and offered recommendations for the Joint Finance-Appropriations Committee (JFAC), including program transfers, targeted reviews of high-cost areas and greater use of block grants.

Representative Kaler, who said she and Representative Redmond reviewed the Medicaid budget, urged a detailed review of pharmacy spending. “There was over $500,000,000 spent in fiscal year 2022,” she said, and asked the committee to seek information about which drugs and which patients drive that cost.

Kaler and others suggested shifting some low-income energy programs out of the Department of Health and Welfare. Kaler proposed moving the Low Income Home Energy Assistance Program (LIHEAP) and the Weatherization Assistance Program to an energy-focused agency so public-health staff could concentrate on core public-health functions such as disease surveillance and vital statistics.

Representative Levitt likewise encouraged reallocating LIHEAP and winterization funding to agencies more directly tied to energy delivery. Levitt cited figures for those programs discussed in agency meetings, saying LIHEAP was roughly $2,644,006 and winterization costs were approximately $7,540 per person; he urged careful review of those line items.

On foster care, Representative Bieswanger said the department plans to request additional frontline staff to keep children out of higher-cost placements such as group homes; committee members noted that early placement and support can reduce long-term costs.

Representatives Wheeler and Thompson, who reviewed substance-abuse treatment and prevention, recommended JFAC favor greater use of block grants to provide local flexibility. “The flexibility that gives us I think is really on display with the efficiency that the substance abuse treatment prevention folks are managing,” Wheeler said.

Representative Egbert reported that the mental-health budget request is about $51 million and that much of the spending is for the state’s contract with Magellan; she said some services (for example, designated exams tied to involuntary holds) remain state-provided. Egbert also said the department has asked to relax internal transfer restrictions that are stricter than Idaho code currently requires, allowing transfers between program lines (for example children’s to adult mental health) to improve flexibility.

Representative Erickson, speaking from experience with behavioral-health grants, provided state hospital census numbers discussed with the agency: the adolescent west facility had a 16-bed capacity and was at roughly half capacity; the state hospital north census was 28 of 60 beds; south was 98 of 110. Erickson characterized the picture as a tiered system functioning with room in inpatient facilities while outpatient and prevention services continue to operate.

Committee chair thanked members for their line-item suggestions and said he would collect the comments for JFAC consideration. No formal committee votes were taken on budget reassignments during this meeting; members framed these remarks as recommendations and requests for JFAC staff and the Department of Health and Welfare to provide more detailed fiscal information at subsequent hearings.