Solutions for Medicaid Spending

Concerning: Medicaid and other entitlement spending

Fellow Legislators:

The question that is before us is how to provide social services to the needy at reduced costs. Medicaid spending consumes most of the DHW budget and is growing every year. The reason is simple. It is an open-ended program with no limits. If a person qualifies, then the state taxpayer must pay.

There are two main budget items in the state budget that consume 85 percent of all spending: education (65 percent with k-12 taking up 50 percent) and DHW (20 percent). Public education, under the direction of Tom Luna, is developing a strategy so that better outcomes can be achieved at less cost. This is being done through the use of technology, flexibility, and allowing students to learn at accelerated rates. Public education is well positioned to move into the future even with reduced funding. This is not the case for the DHW.

While it is necessary to address this year's budget problems which will require fairly small changes to or eliminations of current programs, this ‘tinkering-around-the-edges' approach will not solve the underlying problem. If we do not develop a long-term strategy, we will be back next year simply trying to get through another year.

It is my hope that we consider and develop a long-term strategy to improve DHW services while reducing and controlling costs this legislative session. A long-term strategy would place us in a proactive position allowing the legislature to improve the quality of services. I would offer several suggestions for your consideration.

1. Caps and limits: Medicaid and other social programs were designed to help the neediest of the needy. They were not designed to provide services to a large percentage of the population. We learned during the Clinton years that lifetime limits on programs like Aid to Families to Dependent Families could actually work. In Idaho, AFDF or TANF has a two year limit. This program is not growing and is working as intended. I propose two types of limits; first, lifetime limits, and second, limits to a percent of the population. For example, 13 percent of the population of Idaho is now on Food Stamps. Limiting this program to 10 percent or 8 percent of the population could be achieved by changing eligibility requirements. This could also be done for Medicaid and other programs while still helping the neediest of the needy.

2. Each person should, especially for the working poor, have an Individual Improvement Plan (IIP). The purpose of the IIP would be to help them achieve independence and self-sufficiency through skill development and personal growth. This could be best accomplished through a non-paid mentor.

3. The state of Idaho needs flexibility in order to use the resources we have in more reasonable ways. The regulations of the federal government drive up costs without significant regard to the actual needs of the people or common sense.

The adoption of these three principles (and others) would change the DHW discussion and place Idaho on firm footing for future changes and improvements. Without these changes, I don't see any real change taking place. I recognize that some of these changes are not now possible under current federal rules. Rules can and should change.

 #Medicaid  #Long-term  #solutions  #for  #Idaho
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