Moscow-Pullman Daily News May 27-28, 2006
By Judith L. Brown
The dust has settled, more or less, from the 2006 Idaho legislative session — presuming that the crazy idea of calling a special session for “more property tax relief” dries up and blows away. But that’s a topic for another day perhaps, if need be.
Today I want to talk about the Medicaid for Workers with Disabilities Act of 2006. Embedded now in the legislative history of the 2006 Idaho session, and in danger of disappearing into obscurity, is the story of HB 664. This piece of legislation seemingly slid through the session without a hitch. It received very little press attention. You may not recall hearing of it. Behind this bill, however, is a story that deserves to be told, celebrated, and gleaned for lessons.
HB 664’s path through the Legislature went like this: Feb. 28, HB 664 passed out of the House Health and Welfare Committee with a unanimous vote. March 6, HB 664 passed the House unanimously. March 8, HB 664 passed out of the Senate Health and Welfare Committee with a unanimous vote. March 14, HB 664 passed the Senate unanimously. Almost simultaneously, the Joint Finance-Appropriations Committee authorized, unanimously, $234,000 to fund HB 664 for fiscal 2007. March 23, the governor signed HB 664 into law and it became the Medicaid for Workers with Disabilities Act of 2006.
Unanimous. Unanimous. Unanimous. Sounds like a shoo-in, doesn’t it? But it wasn’t. Anything but. The story behind HB 664 is a legislative victory for people with disabilities and advocates for better, more sane health care policy that was more than 10 years in the making.
First, what does the Medicaid for Workers with Disabilities Act of 2006 do?
It allows workers with disabilities to maintain their eligibility for Medicaid by paying premiums based on a sliding scale. Premiums increase as income increases. This idea of allowing people with disabilities to transition into work and transition off Medicaid is sometimes called “Medicaid Buy-In.”
One feature of Medicaid is that it is generally an all-or-nothing program, with eligibility based on income. If your income is below a certain level, you are eligible for all Medicaid services. If your income rises above that level, even by one dollar, you are ineligible for Medicaid.
Idaho’s income eligibility requirements are among the strictest in the nation, so a person who works, even part time for low wages, quickly becomes ineligible for Medicaid.
Individuals with disabilities are often able to work, and would like to work. Many possess valuable skills. Many, however, also have steep medical expenses for services and supports related to their disability. All too often, accepting a job means losing Medicaid eligibility and losing vital medical services. Financial reality dictates against going to work.
The Medicaid for Workers with Disabilities Act of 2006 is a common-sense fix for this problem.
Why did it take so long to pass? The idea of Medicaid buy-in through a sliding scale premium program was first recommended by then-Governor Phil Batt’s Medicaid Reform Advisory Council in 1996. Since then, the idea has moved forward a little each year, but only a little. It had no real opposition, yet year after year it stalled.
Why did it finally pass this year? Two reasons, at least.
One, there was money available to fund it. In 2000 and 2001, the last years when the state had revenue available for better funding state services, the Legislature opted to hand out a lot of tax cuts instead. This year, the Legislature opted to provide more adequate funding for essential state services, including Medicaid for workers with disabilities.
Two, the issue had come to be seen as a win-win proposition. It’s a win for people with disabilities, who now have better options for pursuing meaningful and rewarding work. It’s also a win for employers because it minimizes the risk of increased group insurance rates as a result of hiring individuals with disabilities. As a winning proposition, HB 664 was supported by 33 organizations this year.
Actually — and this is one of those surprising things about Idaho — Idaho has worked as hard as any state to make it possible for people with disabilities to live in their homes and communities rather than in institutions. Not so long ago there were nearly 1,000 Idahoans living in the Idaho State School and Hospital in Nampa because of disability-related factors. Today there are between 30 and 40, and eventually the institution may be closed altogether.
Today an array of services from personal assistants to accessible housing and transportation, some funded by the state and some by the federal government, empower people with disabilities to live with dignity in their own homes and communities. As a result of the Medicaid for Workers with Disabilities with Act of 2006, more of them will be working in their communities too.
* Judith L. Brown is an economist and director of the Idaho Center on Budget and Tax Policy. She lives in Moscow with her family and can be reached at jlbrown@turbonet.com.