Panel OKs Medicaid spending plan

Budget is higher than governor's by $10 million

The House-Senate budget committee on Friday approved a spending blueprint for Medicaid that's $10 million higher than Gov. Dirk Kempthorne had asked for — on the basis that the governor is overly optimistic about forthcoming federal reforms to the health care program for the poor and disabled.

But no one criticized the Joint Finance-Appropriations Committee's action, which also instructed the Department of Health and Welfare to end the practice of subsidizing infant circumcisions (for a savings of $173,000) and to find ways to streamline sprawling mental health services.

"It's a thoughtful budget," Kempthorne's Health and Welfare adviser, David Lehman, said after the vote. "We are very delighted, very pleased with the actions of the committee," Health and Welfare director Karl Kurtz told legislative budget writers.

The committee's proposal weighs in at $331 million, an increase of 15 percent over the $288 million in state taxpayer support that lawmakers set a year ago.

Kempthorne's budget was $321 million. He was hopeful that the federal government would give relief to the states, which are almost universally struggling with annual double-digit increases in Medicaid spending.

Kempthorne told lawmakers in his State of the State speech that his budget "anticipates that we'll find additional ways to contain rising costs."

But he added, "Absent federal reforms in the Medicaid system, or drastic or even devastating reductions in vital services, we will have to revisit this year's Medicaid budget next session."

Senate Finance Chairman Dean Cameron of Rupert said he wasn't comfortable with the prospect of waiting and then having to inject another $20 million into the budget next year.

"We all recognize that the governor's number is well under what the actual cost will be," Cameron said. "It is far more responsible for us to put a reasonable number out there."

"I feel like this is as honest a budget as we can come up with," said Rep. Margaret Henbest, a Boise Democrat who worked up the budget with Republican Sen. John McGee of Caldwell.

The budget remains more than $8 million less than the agency had requested, but lawmakers were confident that the agency would find ways to keep costs in check.

Part of that effort was the joint committee's clear directive that the agency end state-supported infant circumcisions unless they are medically necessary.

And the committee instructed the department to review mental health services for possible overuse. Mental health care is one of Medicaid's more rapidly growing expenses.

The panel said the department should look at limiting hours and requiring prior approval for psychosocial rehabilitation services — a popular set of services provided to help kids and adults with serve emotional problems function in the community and at home.

Henbest said the intent is not to limit the availability of the service, but to better match the services to clients.