This week’s legislative update delivers an overview of public health issues discussed in the Joint Finance-Appropriations Committee, more information regarding PCAP, and other topics of interest during the week.  

Health and Welfare Week @ JFAC

This week was week is Health & Human Services Week at JFAC. A comprehensive schedule, with links to most of the presentations, can be found here.

Health & Welfare Overview Presentation

Idaho Health & Welfare Director Dick Armstrong began Health and Human Services week at JFAC with an overview of the department’s budget issues. The overall budget proposed by Governor Otter for next year contains a 6.2% increase from this year.

Director Armstrong’s full presentation can be viewed here.

Crisis Center

Ross Edmunds, Administrator of the Division of Behavioral Health for the state Department of Health & Welfare, discussed a third community crisis center during the Division’s presentation to JFAC this week. The third community crisis center that Governor Otter recommended in his State of the State is projected to cost $1.7 million. It was presented that Idaho has been seeing an increase in demand for crisis services. The number of protective holds has grown from 3,745 in 2009 to almost 5,200 in 2015. Edmunds explained that community crisis centers could help.

Health Facilities

Tamara Prisock Health &Welfare Licensing and Certification Division Administrator reported that there is still a backlog at the state agency responsible for inspecting and certifying health care facilities. Health care facilities include hospitals, nursing homes, and assisted living centers. Four new surveyors were hired this year but three teams still have backlogs comprising of overdue surveys and complaint investigations. Positions are vacant and turnover was cited as the barrier preventing teams from being able to tackle backlog issues.

Controversial Water Quality Rule

The Senate Resources Committee voted to approve a DEQ rule that set new water quality standards this week. Betsy Russell’s account of the Committee meeting can be found here.

CAT Fund

As mentioned last week, the CAT Fund has seen quite a significant decrease both case load and state payments. Catastrophic Health Care Fund board Chairman, Roger Christensen, told legislators that the Your Health Idaho insurance exchange has been more successful than anyone anticipated. He added that Idahoans who might have otherwise had to turn to the CAT fund were able to sign up for insurance. 77,00 Idahoans signed up that qualified for subsidies and an additional 10,000 purchased plans on the exchange without subsidies. The numbers continue to grow. Overall, the program has dropped from $51.5 million in 2014 to $36.3 million in 2015. For 2017, the CAT fund’s budget request is $22 million, which proposes a $5 million base reduction in the program. Chairman Christensen mentioned, “Based on the six-month activity and some of the other factors we’ve seen, we feel pretty comfortable suggesting that maybe that base reduction be adjusted from $5 million to $8 million.”

Medicaid Topics

Medicaid had a budget hearing in JFAC on Tuesday. Lisa Hettinger, Medicaid Division Administrator, presented a budget proposal that matched the Governor’s recommendation for a 2.4% increase in state general funds next year. Medicaid comprises 79.7% of the Department of Health & Welfare’s budget.

Catastrophic Health Care Fund board Chairman Roger Christensen told legislators that a small portion of CAT fund applicants qualified for Medicaid last year. Of the 2,593 people who applied for aid from the state’s CAT fund so far this fiscal year, 9% were found to be eligible for Medicaid. In 2010 a law was implemented which established a combined application so CAT fund applicants are assessed for Medicaid eligibility up-front. 

The Idaho Department of Health & Welfare announced that Idaho Medicaid would conduct a cost survey with providers of supported living services before implementing a large reduction in the rates that Medicaid pays in-home care providers. The Department’s announcement can be found here.

Medicaid Expansion Bills

On Friday, Senator Dan Schmidt (D-Moscow) introduced two bills to expand Medicaid in Idaho. The bills were proposed as personal bills and did not require committee votes. One of Senator Schmidt’s bills, Senate Bill No. 1204, would enact the “Healthy Idaho Plan” while the other, Senate Bill No. 1205, would expand Medicaid to the full extent allowed by law. The first bill follows a proposal from the Governor’s latest Medicaid taskforce and the other follows the recommendation of the Governor’s first task force.

S1204 full bill text can be found here

S1205 Full bill text can be found here

PCAP Update

Idaho Health & Welfare Director, Dick Armstrong, discussed the PCAP proposal during his overview presentation to JFAC. Director Armstrong explained, “PCAP can help address this disparity in our health care system. It is an all-Idaho initiative, with Idaho controlling the eligibility criteria.” He clarified further, “PCAP is not insurance, and does not provide comprehensive services, such as hospitalization or specialty care. Because of this, the county and state indigent programs are still necessary.” If lawmakers approve PCAP, it’ll be implemented on Jan. 1, 2017. Director Armstrong believes that PCAP can reduce health care costs for all Idahoans and it can also provide Idaho with a more productive workforce, and improve the overall health of Idaho communities.

The PCAP proposal has been split into two separate bills and will need to pass through two different committees in order to succeed. The funding mechanism proposal must be approved in the House Revenue & Taxation Committee and the proposal for the structure of the program will need to be approved in the House Health and Welfare Committee.

The Governor’s Guest Opinion About PCAP

Governor Otter responded to reactions regarding PCAP on Wednesday in a guest opinion sent to Idaho newspapers. He began by saying, “Responses have run the gamut from “It’s not enough – just expand Medicaid” to “We shouldn’t do anything but focus on repealing Obamacare.” The Governor explained that the PCAP option – or a similar option – is all that Idaho can reasonably hope to achieve in its current political environment. He concluded, “PCAP is not the final word on providing Idaho citizens with the opportunities they need to keep themselves and their families healthy. But it could be a great start.” The news release can be read here.

JLOC report on the Idaho Behavioral Health Plan

The Joint Legislative Oversight Committee released a new report this week on the Idaho Behavioral Health Plan. News release, Full report, and Highlights.

Bills/Rules of Note

If there are specific Bills or Rules that you would like Molly to track, please let her know. For full bill text and more information regarding bills this session, please go to the Idaho Legislature Bill Center

Bill No	Description	Last Action
H0331	Alcoholic bevs, powdered alcohol	01/14/2016 House - Reported Printed and Referred to State Affairs
H0332	Residential care, license renewal	01/19/2016 House - Reported Printed and Referred to Health & Welfare
H0333	Optometrists, license renewal	01/19/2016 House - Reported Printed and Referred to Health & Welfare
H0334	Physical therapy license renewal	01/19/2016 House - Reported Printed and Referred to Health & Welfare
H0335	Controlled substances, sched II	01/19/2016 House - Reported Printed and Referred to Health & Welfare
H0336	Pharmacy board terms	01/19/2016 House - Reported Printed and Referred to Health & Welfare
H0337	Prescriptions, med examiners/dbase	01/19/2016 House - Reported Printed and Referred to Health & Welfare
H0338	Legend drug possession	01/19/2016 House - Reported Printed and Referred to Health & Welfare
H0339	Controlled substance storage	01/19/2016 House - Reported Printed and Referred to Health & Welfare
H0340	Pharm brd, contraceptives	01/19/2016 House - Reported Printed and Referred to Health & Welfare
H0341	Patient freedom of info act	01/19/2016 House - Reported Printed and Referred to Health & Welfare
S1196	Sexual orientation, gender identity	01/20/2016 Senate - Reported Printed; referred to State Affairs
S1201	Approp, Catastrophic Health, reduce	01/22/2016 Senate - Reported out of Committee with Do Pass Recommendation; Filed for second reading
S1204	Medicaid, eligibility expansion	01/22/2016 Senate - Introduced; read first time; referred to JR for Printing
S1205	Medical assist/eligibility standard	01/22/2016 Senate - Introduced; read first time; referred to JR for Printing
S1206	Approp, H&W Indirect Support, add'l	01/22/2016 Senate - Introduced; read first time; referred to JR for Printing
S1207	Approp, H&W Psych Hosp, Add'l	01/22/2016 Senate - Introduced; read first time; referred to JR for Printing
S1211	Catastrophic heath care program	01/22/2016 Senate - Introduced; read first time; referred to JR for Printing

This week’s legislative update delivers a summary of public health issues in the Governor's State of the State Address, information about Idaho’s Catastrophic Health Care program, and other topics of interest during the week.  

State of the State

On January 11, 2016 Governor Otter began the legislative session with his State of the State and Budget Address, during which he touched on a few public health initiatives.

The Governor recommended that Idaho follow through on its plan to provide more physician training by adding five more seats to our medical school partnership with the University of Washington. He acknowledged that there are quicker ways to address the shortage of primary care physicians in the state and encouraged legislators to continue providing medical loan reimbursement incentives for primary care doctors who agree to serve in Idaho communities. The Governor also asked that the Board of Education work with the medical community and higher education institutions to develop a new plan for addressing future healthcare provider demands.

The Governor recognized and commended Health and Welfare Director Dick Armstrong and his team, as well as legislative leaders Representative Fred Wood and Senator Lee Heider, who have worked to develop an “Idaho-based alternative” to Medicaid expansion under the Affordable Care Act. The Governor noted that he looks forward to discussing the plan (PCAP) that he unveiled last week.

Last year, Governor Otter recommended a second behavioral health crisis center for the state. Idaho now has two centers, one in Idaho Falls and one in Coeur d’Alene. This session, the Governor’s budget request includes funding for a third crisis center in southern Idaho. The Governor reported that, “during the first nine months that the Idaho Falls center was open, it had more than 1,100 admissions and diverted 47 people from more expensive in-patient psychiatric care – all while saving an estimated 860 hours of law enforcement officers’ time.” He expressed his appreciation for the Legislature’s continued support of efforts to improve local access to care while reducing costs to the community.

The Governor’s State of the State and Budget Address can be read here. 

The physician shortage may hinder Governor Otter’s proposed PCAP

The CEO of Kootenai Health, John Ness, told the Economic Outlook and Revenue Assessment Committee last Friday that Idaho does not currently have enough doctors to provide care to the 78,000 people in the “gap” through the proposed program. Full article.

Close the Gap Press Conference

Close the Gap held a press conference following the State of the State on Monday in response to Governor Otter’s proposed Primary Care Access Program (PCAP). Dr. Ted Epperly, CEO of the Family Medicine Residency of Idaho, expressed that PCAP is not a “total solution”. He explained that the Medicaid expansion plan, dubbed the Healthy Idaho Plan, recommended by the governor’s Medicaid redesign task force should be implemented to close the health coverage gap. The Healthy Idaho Plan would use federal funds to purchase private health insurance for folks who fall in the gap. Neva Santos, executive director of the Idaho Academy of Family Physicians, explained that PCAP is not health insurance coverage. It is a good idea to provide additional access to primary care for those in the gap, but the solution to the dilemma is to implement full coverage through the Healthy Idaho Plan. 

• Betsy Russel’s account of the press conference can be found here
  
• Information regarding Close the Gap
  
• More information about the Healthy Idaho Plan
  

Tobacco Tax

There have been many questions regarding the tobacco tax following the proposal of PCAP. A couple news articles from the Idaho Statesman sought to clear up the confusion.

• "Legislative Day 2: A closer look at ‘Ottercare’" 
  
• "Legislative Day 3: Support for health plan; question on tobacco tax"
  

The Joint Finance-Appropriations Committee

JFAC held special hearings on Wednesday, January 13. Byron Welch, Principal Evaluator from the Office of Performance Evaluations, presented “The General Fund Distribution Formula for Public Health Districts.

On Friday Jared Tatro, Principal Analyst from the Department of Health and Human Services, presented the Catastrophic Health Care Program – Reduce Excess OT Funding, Psychiatric Hospitalization – Personnel Funding Shortfall SHS, Indirect Support Services - Federal Earned Revenue Rate, and Independent Councils - Victims of Crime Act- Additional Oversight.

Idaho’s Catastrophic Health Care (CAT) program has been spending less than projected. The CAT fund is the state share of Idaho’s arrangement for paying the catastrophic medical bills of residents who can’t afford them. Counties cover a portion of each bill from local property taxes and amounts beyond that are paid for by the CAT fund. As more Idaho residents have obtained health insurance, the CAT program has been spending less. During the JFAC meeting on Friday morning, Senator Dan Schmidt (D- Moscow) proposed a transfer of $28,892,700 from the CAT fund back to the state general fund. Betsy Russel’s account of the committee meeting can be found here.  

House Health & Welfare Presentations

This week, the Board of Pharmacy and the Bureau of Occupational Licenses presented to the House Health & Welfare Committee. Committee minutes can be found here.

Senate Health & Welfare Presentations

The Board of Pharmacy also presented to the Senate Health & Welfare Committee. Committee minutes are not online yet.

National News

President Obama made headlines this week when he proposed to boost federal funding for states that choose to expand Medicaid. Full article.

What to look forward to next week

Next week is Health & Human Services Week at JFAC. A full schedule of the presentations can be found here.

Welcome back!

Hi everyone! It’s been a while. I hope you all have had a great year and I hope you are as excited as I am about the upcoming legislative session! This past week, Governor Otter provided us with a preview of what’s to come this legislative session.

PCAP overview

On Thursday, Governor Otter revealed his $30 million plan to provide preventive, primary medical care to the estimated 78,000 Idaho residents that fall in the “gap” population. The Primary Care Access Program (PCAP) is a public-private partnership that would benefit Idahoans who have no access to health insurance. The proposal attempts to connect uninsured Idaho adults living in poverty with primary health care and preventive services to help keep them healthy. For the past few years, the Governor’s Medicaid Redesign Task Force has been recommending Medicaid expansion but legislators have not seemed to budge. Otter called PCAP an “Idaho solution”.

Here are the materials posted on Governor Otter’s website:

Press release: http://www.gov.idaho.gov/mediacenter/press/pr2016/1_Jan/pr_01.html

PCAP Summary: http://www.gov.idaho.gov/pdf/2016/PCAP_Summary.pdf

PCAP FAQs:

http://healthandwelfare.idaho.gov/portals/0/aboutus/newsroom/faqs_pcap.pdf

Betsy Russell of The Spokesman-Review reports that the House and Senate Health and Welfare chairs applaud Otter’s plan. Link to full article.

What to look forward to this week

• Governor Otter will be making his State of the State address on Monday
• Close the Gap Idaho will be holding a press conference in response to PCAP after the State of the State on Monday at 2:30 PM

What to look forward to this session

Last session, IPHA’s very own Dr. Sarah Toevs and the Idaho Caregiver Alliance formed a Task Force to examine policies, resources and programs available for caregivers in Idaho and other states. The Task Force also studied innovative ways to support unpaid family caregivers. The Task Force found that:

• Family caregiving impacts all aspects of a family’s economic, physical, cultural, and social wellbeing.
• Most caregivers are juggling paid work and caregiving.
• Caregiver stress has costs.
• Assistance is fragmented and mostly focused on the care recipient.
• Demographics are changing; 23 % of Idaho’s population will be over age 60 by the year 2030, an increase of 33 % from 2012 (US Census Bureau, 2009 Projections).
• Non-profit organizations have not been a sustainable source of support for caregivers.
• Respite care is inadequate.

We look forward to the recommendations that the Idaho Caregiver Alliance will be making this session. The group’s final report can be accessed here.

Mark your calendars!

Just a reminder that registration is available for the Idaho Public Health Association Annual Meeting.  Attendance is free but we ask that you register in advance.  Refreshments and light appetizers will be provided.  Agenda topics include introduction of new IPHA Board members, IPHA updates, and announcement of the annual award and student scholarship recipients.  Online registration available on the IPHA website.

Event details:

Idaho Public Health Association Annual Meeting

Location:  Hampton Inn & Suites-Boise Spectrum

Date: January 13, 2016

Time: 4:30-6:30 PM MST 

More information and online registration: Idaho Public Health Association Annual Meeting