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Paying the Bills

Disability advocates want Medicaid buy-in program

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Bobby Ball wants a raise. The disability advocate pulls full-time hours, earns part-time pay and isn't the type to ask for the world on a silver platter. Ball spends her time doing on behalf of others, navigating disability laws, lobbying against discrimination and maneuvering her power wheelchair through tight squeezes at the Statehouse for a little one-on-one time with lawmakers. She didn't even mention that she could use a little income boost until after she spoke of the scores of other Idahoans trapped between paying their medical bills and earning a decent living.

"They're really in a Catch-22," says Kelly Buckland, Idaho State Independent Living Council executive director.

That Catch-22 comes in the form of state Medicaid laws Buckland and Ball hope lawmakers reform before the legislative session's fast-approaching end. Under current Medicaid laws, if you make too much money, you could loose your medical coverage. At the same time, many Medicaid recipients don't earn enough money to cover the costly gaps in their coverage.

"It keeps people with disabilities in poverty," Ball says of current laws.

Ball and Buckland are asking lawmakers to change the Catch-22 by creating a Medicaid "buy-in" program that would allow disabled folks to go to work and still retain their benefits. For Ball, the program could mean a pay raise. And a bigger paycheck could help her feel less of a pinch when she lays down that $1,200 monthly Medicaid co-pay to cover her attendant care.

"It's a huge monthly bill," Ball says of the personal services she and others depend upon, but insurance plans and Medicaid often don't cover.

As executive director of the Idaho Task Force on the ADA (Americans with Disabilities Act), you would think Ball could have some say on what kind of wage she takes home. And she does. She consistently refuses pay raises. She has no choice, she says. If she earns even one dollar too much, she looses her Medicaid benefits. And as Buckland puts it, "Bobby couldn't buy insurance for any price."

The buy-in proposal aims to keep folks' medical needs covered and transition them into employment by allowing them to pay a premium based on a sliding scale, earn 250 percent of the Federal Poverty Guidelines and still retain their Medicaid benefits.

For Ball and the bill's backers, a buy-in paves the path to independence.

The legislation notes that many people on Medicaid want to work or work more and recognizes that employment helps end dependence. A buy-in program, authors wrote, "encourages self-sufficiency and independence instead of trapping people in dependence and poverty."

Ball tells story after story about folks who do work and would like to work longer hours or take a pay raise but can't because of Medicaid's current income limits. She says those limits are especially difficult on people who also pay high Medicaid co-payments and out-of-pocket medical costs. It's not unusual for some people to need 20 some hours per week of attendant care and those costs are often not paid by the Medicare program. That care costs around $15 an hour. Some pay an attendant care bill that easily exceeds the median Boise mortgage.

A buy-in program could ease the burden of those medical bills and also enable folks to contribute more as tax paying citizens, Ball says.

"This really does what the Legislature has been saying they've wanted for years, and that's (help) people who are on public benefits to get off and go to work and work themselves off. But you can't do that unless you have something like this that allows them to do that," Buckland says.

That logic earned the bill support from Sen. Denton Darrington (R-Declo), who says the measure makes fiscal sense under tight budget forecasts and could ease the demands put on public assistance. Darrington's sentiment echoes a 1996 recommendation from Gov. Phil Batt's Medicaid Reform Advisory Council. In 2001, the Legislature again called for a program to transition people back into the work force while receiving needed health care coverage on a sliding scale. And in 2003, Gov. Dirk Kempthorne's Blue Ribbon 2020 Task Force also recommended that the state implement a Medicaid buy-in program. The Senate put those recommendations into action, passing the buy-in measure with a 19 to 15 non-partisan vote earlier this month.

The entirely Republican dissent came from opponents such as Sen. Dean Cameron (R-Rupert), who asked lawmakers if they were willing to take home prisoners in exchange for passage of the proposal. Lawmakers on both sides of the coin say their votes came down to the fiscal impact that Ball says is still difficult to gauge.

"I have not had a single lawmaker tell me that they do not approve of the direction, of the policy direction, but it's the fiscal impact-they don't want to spend money in this kind of fiscal year," Buckland says. He admits that while a buy-in program could save the state money in the long run, the bill could put more people on Medicaid enrollment. The measure could also save federal dollars as people lose benefits such as housing assistance when they go to work or earn more money.

At presstime, the bill sat in the House Ways and Means committee and was not slated for a hearing on the upcoming agenda. At this point in the legislative session, dollars and cents often govern what does and doesn't move through the legislative pipeline, and lawmakers are eyeing a slim Health and Welfare budget. That could mean another year without a raise for Ball.

"We're hopeful it will come out of (committee)," Buckland says. "But right now, we don't know."