In the wake of what they called "dramatic" reductions or elimination of services to Idaho's most-vulnerable citizens, the Consortium for Idahoans with Disabilities plans to have a very tangible impact on the 2012 Idaho Legislature this Friday with its Disability Advocacy Day.

“It's about getting out there and letting legislators hear our stories,” said Medicaid Matters in Idaho representative Richelle Tierney. “We're looking to restore, rebuild and renew some of the budget cuts that were made in House Bill 260.”

The 2011 Legislature passed H.B. 260, cutting $35 million from the Medicaid budget, resulting in the loss of almost double that amount when matching federal funds evaporated.

“H.B. 260 came from recommendations that different organizations had made as temporary fixes in the state budget as a result of the bad economy.” Tierney explained. “These cuts were never meant to be permanent; however, there is a possibility of that happening.”

A unique roundtable this morning featured members of law enforcement, health care providers and advocates for the disabled. But the discussion also included the voices and faces of Medicaid.

Krystal, who asked that her last name not be used at the roundtable, is a 22-year-old who has struggled her entire life with an intellectual disability and bipolar disorder. She also has a diagnosis of fetal alcohol syndrome.

For two years, she said, she was doing well, living in her own apartment and holding down a job. But she needed her therapy along with psychosocial rehabilitation counseling. Her PSR services were threatened last year, in the wake of the Idaho Legislature's decision to cut tens of millions of dollars from Medicaid and other services.

"When I was told that I had to choose between my fundamental therapy and my PSR services, I cried a lot," said Krystal. "How am I supposed to deal with my life? It makes me feel I can't be a civilized person in Idaho."

• Medicaid Matters roundtable at JRW State Building.

Boise's first significant snowfall hampered a good many plans today, but when mental health advocates know that Medicaid funding once again hangs in the balance at the Idaho Legislature, they come out in force.

The keyword was "organization" at a unique roundtable this morning, considering the impact of Medicaid in Idaho, which saw nearly $34 million in cuts in state funding last year. Matched with federal funds, Idahoans lost about $70 million in services.

The discussion included input from Medicaid recipients, their service providers, law enforcement and advocates for the disabled and infirmed.

"Our community has begged to have Medicaid back," said Retta Green from Caldwell. "Because people are really suffering."

Mike Ferguson, Idaho's recently retired chief economist and the new director for the Idaho Center for Fiscal Policy, outlined how the 2010 and 2011 Idaho legislatures continued to "take money off the table," resulting in significant cuts to Medicaid and other services.

"And now the governor is recommending that we put $60 million into a rainy day fund for future reserves," said Ferguson. "But rainy day funds are supposed to be replenished when the weather is better. But the current economy tells us it's still raining."

"Our elected officials should protect the Medicaid program," said Veronica Solis of Boise. "It makes a huge difference in the health of my children and family."

Medicaid provides comprehensive health coverage to more than 210,000 Idahoans—more than 150,000 of them children.

"Four of them are mine," said Terri Sterling of Culdesac.

Five Idaho corporations providing basic life skills such as bathing, eating and laundry to disabled children and adults have won a summary judgment from U.S. District Court Chief Judge Lynn Winmill against Idaho's Department of Health and Welfare and its Division of Medicaid.

"The law is clear that budgetary concerns cannot form the sole basis for reimbursement rates," wrote Winmill in a ruling that has wide-ranging implications for Medicaid-reimbursed service providers throughout Idaho.

The plaintiffs, in their complaint, challenged Health and Welfare's "inaction, or failure to amend existing reimbursement rates," which had been set in July 2006. But according to today's ruling, subsequent studies "reveal that actual provider costs exceed the 2006 rates." Health and Welfare had argued that insufficient funding from the Idaho Legislature kept it from properly adjusting the rates.

But Winmill wrote that Idaho's budget constraints aren't an excuse to deny appropriate reimbursement. Winmill wrote that it "may in fact force the Idaho Department of Health and Welfare to reallocate funds from other programs," to properly pay the providers but "the Court need not wait for evidence of low quality care or insufficient access to services before intervention is warranted."

You can read the full decision and order here mediciad_ruling.pdf.

It has been nearly a year-and-a-half since Idaho's Medicaid debacle, which resulted in hundreds of caregivers not being reimbursed for their services and other caregivers being paid too much.

On Tuesday, Medicaid administrator Leslie Clement told lawmakers that the state has begun recovering double payments to providers, but was still $6.6 million short. The mess began when Idaho's Health and Welfare Department contracted with Molina to process the state's Medicaid systems.

Clement said Idaho has docked Molina's compensation by $3 million for its errors. Clement also told members of the Interim Health and Welfare Committee that Molina would be expected to cover any losses if federal regulators don't fully certify the state's claims processing system.

The Associated Press reports that the Idaho Dept. of Health and Welfare is holding back funds from Molina Medicaid Solutions in the wake of last year's debacle, which tangled the state's Medicaid systems, putting clients and providers at financial risk.

In a new agreement with Molina, Health and Welfare will now pay no more than $15 million but penalties will be assessed if Molina doesn't meet operational standards. For example, the first payment sent to Molina under the new arrangement will be $12 million.

A series of headaches erupted shortly after Molina took over Idaho's Medicaid claims processing in May 2010. Thousands of payments were delayed, resulting in scores of Idaho caregivers being in a position of not being able to pay their bills.

To make matters worse, Idaho decided to accelerate payments to a number of providers but many of the checks were for services that had already been paid, resulting in double funding. As a result, the AP reports that Idaho is now trying to recover nearly $10 million in double payments.

The debate over the possibility of a significant bump in the cigarette tax moves to the front burner today. The Idaho Council on Indian Affairs is expected to take up the discussion, which includes a plan to increase the tax on a pack of smokes from 57 cents to $1.25. Such an increase would be expected to generate nearly $50 million, the proposed shortfall for Health and Welfare's Medicaid programs.

Idaho's Native American reservations are not required to uphold the tax but lawmakers are eager to get the tribes on board, because a bump in price could cause a dramatic disparity between the price of cigarettes sold on and off reservations.

According to the American Lung Association, Idaho's current cigarette tax generates approximately $47 million in revenue.

So why wouldn't a 73-cent 68-cent bump raise more than $50 million? Because the increase is also expected to cut down the amount of cigarettes sold in Idaho.

CORRECTION: The above revenue figure of $47 million is from fiscal year 2008. In fiscal year 2010, Idaho's current cigarette tax rate of 57 cents per pack generated $39.7.
According to the American Lung Association: "a $1.25 increase would bring in an additional $48.2 million in revenue, with an added $2.9 million generated by a proposed tax increase on all other tobacco products, even accounting for an expected reduction smoking rates, particularly among youth."

An emotional yet peaceful protest filled the steps of Idaho's statehouse today. It was one of 17 rallies across the Gem State railing against possible cuts to Medicaid services.

Nearly 500 men, women and children made their way to the Capitol at noon, many using wheelchairs or walkers. Their message: Medicaid matters, which was the theme of each of the rallies.

"I want to go to college," said 14-year-old Elizabeth. "I want to go into medicine someday." The student requires several Medicaid-funded services in order to attend public school and achieve her short-term and long-term goals.

Thirty-year-old Shirleane Abbott told the gathering of her struggles with mental illness, including being homeless and incarcerated. Abbott said her Medicaid-funded psychosocial rehabilitation services led her to a path toward full-time employment, independent living and motherhood.

"There's no place like home," said Abbott, lifting her voice to the crowd. "Say it with me. There's no place like home."