H419 - Medicaid Expansion Conditions

This bill requires the submission and implementation of one state plan amendment, one 1132 waiver, and seven 1115 waivers by July 1, 2025, or Medicaid expansion is repealed. These requirements are essentially unachievable. This will effectively repeal Medicaid Expansion.

• Three of the proposed waivers (Medicaid or State Based Marketplace Choice,
Enrollment Caps, Lifetime Benefit Limits) have been never been approved by any
administration (including the Trump administration in the case of Marketplace
Choice.)

• The Biannual redetermination waiver would add significant paperwork burden
and costs to both Idahoans and to the Department of Health & Welfare, and
potentially delay needed health care. Medicaid already requires individuals to
report any monthly income changes.

• 1115 waivers are demonstration waivers designed to enhance programs. The rules
state they must enhance access to services or coverage, not reduce access. It is
difficult to see how these waiver requests improve access to coverage, when they
are specifically designed to remove people from coverage. Additionally, they go
against the central tenet of Medicaid law, which is to provide coverage to eligible
people. This is why they have been overturned in federal court in the past, as they
could not show how these would improve access to coverage.