By Times-News, magicvalley.com - GRETEL KAUFFMAN and JULIE WOOTTON-GREENER
TWIN FALLS — The Magic Valley’s rural hospitals say they don’t expect Medicaid expansion to have much impact on their patient numbers or staffing levels.
Hospital officials say expanding Medicaid, even with a mandatory work requirement and other conditions attached by the Legislature, will help people get primary care services and keep more people out of the emergency room for non-emergent conditions, which is costly for hospitals when patients can’t afford to pay their bills.
But critics of the work requirement have expressed concern that it could create a “secondary gap” of uninsured people who cannot prove they are working 20 hours a week — making it possible that hospitals won’t see the same savings they would under a “clean” Medicaid expansion as approved by 61 percent of voters last year.
An estimated 60,000 low-income Idahoans fall into the “Medicaid gap,” meaning they make too much money to qualify for Medicaid, but not enough to get federal subsidies through the Your Health Idaho insurance exchange. A ballot initiative passed in November would have made Idaho residents between 100 and 138 percent of the poverty line eligible for Medicaid.
But a fight in the Legislature this year resulted in state officials agreeing to ask the federal government for a waiver that would let Idaho require able-bodied adult Medicaid recipients to prove they are working, volunteering or training at least 20 hours a week; people who do not meet the work requirement would be removed from Medicaid for two months, after which they may reapply.
At this point, it’s unknown whether the work requirement will be implemented at all: a federal judge in March struck down similar requirements in Arkansas and Kentucky. In an interview with the Times-News last week, Gov. Brad Little said he believed there was “a fair possibility” that the federal government wouldn’t approve the requested waivers.
But if the work requirement does go into effect, its impact would likely be felt most in rural areas, said Brian Whitlock, president and CEO of the Idaho Hospital Association. Rural Idahoans, even those who are already working 20 hours a week, may face additional challenges when it comes to proving to the state with correct documentation that they are working, Whitlock noted. While Whitlock said he certainly expects rural hospitals to see savings under a Medicaid expansion that includes work requirements, it’s likely that hospitals won’t save as much as they would under a “clean” expansion — and at a time when 20 of the state’s 27 rural critical access hospitals are operating at a negative margin, every dollar counts.