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Larry E. Tisdale Vice-President of Finance. Medicaid Redesign. Better for Idaho’s taxpayers, businesses, and patients. \=. Where we stand. Community Health Centers. Who are the “medically indigent”?. Working Idahoans Self-employed & Small Business Employees

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Larry E. Tisdale

Vice-President of Finance

medicaid redesign

Medicaid Redesign

Better for Idaho’s taxpayers, businesses, and patients

where we stand
Where we stand
  • Community Health Centers
who are the medically indigent
Who are the “medically indigent”?
  • Working Idahoans
  • Self-employed & Small Business Employees

Idaho’s minimum wage = $15,080/year

Idaho average salary = $38,000/year

Annual Cost of Living *

* U.S. Bureau of Labor Statistics - averages are based on 2.6 person households


Status Quo

High cost



County Indigent Fund – supported entirely by property taxes


Status Quo

High cost



State Catastrophic Fund – supported entirely by income taxes

low value
Low Value
  • Status Quo
financial risk
Financial Risk
  • Status Quo
financial risk1
Financial Risk
  • Status Quo


Eliminate Waste

Over $1 billion

in tax dollars from

2014 - 2024

Half fiscal year


Coverage for Working Idahoans


68% of those who qualify have at least one full-time worker in the household;

16% have one or more part-time workers


Provide Coverage for Working Idahoans

Medicaid Redesign

  • Provides coverage to adults earning <138% of FPL or a family of four must have income less than $32,500
  • Adults age 19-64
  • Must be legal Idaho residents

Idaho minimum wage = $7.25/hr or $15,080/yr


Redesign the System

  • Medicaid Redesign
  • Personal responsibility and accountability
  • Coordinated Care
  • Managed Care for chronic conditions
  • Reduce waste through technology and electronic health records
for idaho s economy

Far Reaching Effects…..

for Idaho’s Economy

  • Status
  • Quo

Medicaid Redesign

$12.3-18.5 million in federal penalties for businesses

Healthier Workforce

Rising taxes or budget cuts to critical programs

16,000 new jobs

Not attractive to new businesses

Bringing Idaho taxes back to Idaho



  • Quo

Medicaid Redesign

$1.5 Billion

$85 Million

only one choice
Only one choice

potential legislative activity
Potential Legislative Activity
  • Medicaid Expansion ?
  • Insurance Exchange
  • Time Sensitive Emergencies
  • Hospital Tax Exemptions
  • Managed Care for Dual Eligibles HB351
  • Battery of Health Care Workers
  • Medically Indigent Statute changes
  • Idaho Physician Shield Act (IMA)
  • Transparency
  • State Health Innovation Plan (SHIP)
medicaid expansion
Medicaid Expansion
  • Not a current initiative for the 2014 Legislative Session
  • Governor Otter “current Medicaid system is broken”
  • Currently exploring 1115 waiver possibilities
insurance exchange
Insurance Exchange
  • Passed by last year’s Legislature
  • Current exchange is federally supported
  • This is mostly a political fight
time sensitive emergencies
Time Sensitive Emergencies
  • TSE is a statewide system for the coordinating and delivering evidence based care
  • Includes trauma, strokes and heart attacks (STEMI)
  • Hospital designation and participation is voluntary
  • Allows billing for trauma team activation
    • Certified by American College of Surgeons
    • Designated by the State
hospital tax exemptions
Hospital Tax Exemptions
  • Largely a political misinformation campaign
    • CEO Compensation
    • Physician Employment
    • Profit Margins
  • Increasing taxes on community hospitals will not lower the cost of health care
managed care for medicaid medicare
Managed Care for Medicaid/Medicare
  • HB351 Manditory or Voluntary enrollment?
  • In response to HB260 from 2011
  • Largest issue may be with nursing facility payments
    • UPL
    • Quality Incentives
battery of health care workers
Battery of Health Care Workers
  • Carryover from last year
  • Makes it a felony to assault hospital workers
  • New version includes non-licensed workers
  • Lesser punishment than first responder assault
  • Tough sell with the Legislature
medically indigent statute changes
Medically Indigent Statute Changes

Two potential Proposals:

  • Eliminate funding over 100% of federal poverty level
  • Remove money to fund “community clinics”
idaho physician shield act
Idaho Physician Shield Act
  • Ensures that no guideline or metrics established by the PPACA shall be used as a basis for establishing community standards of care
  • IHA has no formal position at this time
  • Again?
  • IHA opposes transparency based solely on pricing data
  • States’ websites that have pricing information go largely unused
  • IHA would support transparency of quality data
state health innovation plan ship
State Health Innovation Plan (SHIP)
  • There is potential for a resolution supporting the design model
  • The design grant ended in December 2013
  • The Department of Health and Welfare is in the process of applying for a testing grant