Hundreds attended Tuesday's 4 1/2-hour hearing on a measure to cut some $39 million in Medicaid funding, with the crowd spilling out into the hallways of the Capitol basement to protest a key part of Idaho's painful push to balance next year's state budget.
The joint House and Senate Health and Welfare committees' session ended without a vote, with the House committee likely to weigh in Thursday. There still could be amendments.
Along with the $39 million in proposed cuts from Idaho's share of Medicaid, the bill would result in the loss of an additional $81 million in federal matching funds. The combined $120 million hit represents 8 percent of the total Idaho Medicaid budget.
Republican Rep. Janice McGeachin of Idaho Falls, the measure's sponsor, says it concentrates on paring Medicaid services for adults -- it mostly spares children's services -- in order to help Idaho make up more than a third of the roughly $92 million gap in Idaho's fiscal year 2012 budget.
"We've done the best we can to work with the limited population of services given to those in the adult Medicaid budget, without having to eliminate whole programs," McGeachin said.
Among its 29 proposed changes: Halting mandatory rate hikes for Medicaid providers; reducing psychosocial rehabilitation services by 20 percent; slashing chiropractic services; adding eight new Medicaid staff to find fraudulent payments; and introducing co-payments for Medicaid services other than for prescription drugs.
Many of those who testified Tuesday criticized a provision that foresees dropping developmentally disabled people from therapeutic services that help them learn or maintain life and employment skills once they reach the age of 45.
Their words were often gut-wrenching, with Sue Gann tearfully describing how the measure would hurt the quality of life for her brother, a 57-year-old who suffered a serious head injury as a youth.
"How many of you are over 45?" Gann asked lawmakers. "I feel that this is totally discrimination against our elderly and disabled."
Those attending included not only Medicaid recipients, but also providers who stand to see their revenue reduced by these changes.
Greg Dickerson, administrator of Human Supports of Idaho that provides mental health services in southwestern Idaho, asked the committee to delay this bill until stakeholders could provide suggestions for changes. Among other criticisms, he targeted a provision that would require a board-certified psychiatrist approve psychosocial rehabilitation services for both adults and children, something he calls unnecessary.
"Currently, there already are several checks and balances in place," Dickerson said. "We feel this is an additional expensive and unrealistic requirement, considering the number of psychiatrists that are available to treat, let alone provide administrative supervision."
Sen. Patti Anne Lodge, R-Huston and chairwoman of the Senate Health and Welfare Committee, helped draft the legislation with McGeachin, as well as industry groups and officials from the Department of Health and Welfare.
Interviewed this week, she expressed frustration with some private Medicaid providers, businesses she believes have become too dependent on taxpayer dollars -- and unwilling to volunteer austerity measures to help the system in times of budget crisis.
"I wish there would be people who find ways to cut their own business," Lodge said. "But if wishes were horses, beggars would ride."
Only a few who testified during Tuesday's session backed the bill.
Steve Millard, lobbyist for the Idaho Hospital Association, praised provisions that seek to enact a managed care system for Medicaid clients and providers.
"I believe it has the opportunity in future years to save dollars for the state," Millard said.
Millard pointed out that the hospitals he represents have chipped in $50 million over two years to help preserve federal Medicaid matching funds. Hospitals, nursing homes and other facilities are contributing another $7.5 million in fiscal year 2012 starting July 1, according to the sweeping 25-page bill.
Legislators who eventually must decide on the cuts, whether in this bill or another one, urged those in the crowd not to demonize them for making tough decisions that affected the lives of the vulnerable. Sen. Denton Darrington, R-Declo, described a 10-year-old relative who suffered a devastating case of spinal meningitis as a baby.
"He'll never put on his own shoes, but he can take them off," Darrington said. "Every member of this committee has an extended family member or an acquaintance or friend with a similar condition. You all need to know that. The only difference between you and us is we're elected to make decisions. And they are hard decisions to make."