The Idaho State Capitol Building in Boise shines in the sunlight on Jan. 7, 2025. (Pat Sutphin for the Idaho Capital Sun)
A bill to reduce the maximum income refugees can earn to still access a federal medical assistance program is headed to Idaho Gov. Brad Little for final consideration.
House Bill 199, cosponsored by Rep. John Vander Woude, R-Nampa, would decrease the maximum income refugees in Idaho can earn to remain eligible for the Refugee Medical Assistance program to 133% of the federal poverty level, down from its higher current cap of 150% of the federal poverty level.
Under the bill, the new income cutoff for refugee medical assistance for a single person would be about $20,814 in annual income, down from the $23,475 it is under the existing income cap, based on annually updated federal poverty guidelines.
The Refugee Medical Assistance program is a federally funded program that provides short-term medical coverage for refugees who aren’t eligible for Medicaid, according to the federal Office of Refugee Resettlement.
In the last fiscal year, Idaho spent about $1 million on the Refugee Medical Assistance program, Idaho Reports reported. The bill is not anticipated to change state revenue, or increase state or local government spending, the bill’s fiscal note says.
The Idaho Senate passed the bill on a 29-6 vote on Monday. All six Senate Democrats opposed it.
When the bill is transmitted to the governor’s desk, he has five days — excluding Sundays — to decide how to act on it. He has three options: He can sign the bill into law, allow it to become law without his signature, or veto it.
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In committee, lawmakers focused on creating same eligibility cap. But bill would set lower program cap than for Medicaid expansion.
In the Senate Health and Welfare Committee’s hearing on the bill nearly two weeks ago, Sen. Josh Keyser, R-Meridian, who is cosponsoring the bill in the Senate, pitched the bill as a way to “match every other Idaho federal poverty guideline of 133%.”
But Idaho Medicaid expansion has a slightly higher income eligibility cap, of 138% of the federal poverty level, according to the Department of Health and Welfare’s website. The new bill would set the Refugee Medical Assistance’s income eligibility cap at 133% of the federal poverty level.
Effectively, the bill would create a lower income eligibility cap for the Refugee Medical Assistance gap than for Medicaid expansion — which is part of the broader Medicaid program that the Refugee Medical Assistance Program is an alternative to.
The income cap difference — of five percentage points in the federal poverty level — is a gap of about $782 for a single-person household. But the gap grows as family size increases.
Only 19 people’s eligibility would be affected by the reduced income eligibility cap, Keyser told the committee on March 6.
Several Republican senators on the committee said they supported the bill because it set uniform public health assistance standards.
“I don’t want to be callous to the fact that 19 people are going to be affected by the vote that we’re about to cast,” Sen. Camille Blaylock, R-Caldwell, told the committee. “That being said, it doesn’t sit well with me either to have Idahoans at a different, at a lower rate — understanding even the traumatic situations that they’re coming from.”
Asked about how the bill would set a lower income eligibility cap for the refugee aid program than for Idaho Medicaid expansion, Vander Woude, a House lawmaker cosponsoring the bill, told the Sun on Monday “If it’s if it’s an alternative to Medicaid, then it doesn’t have to deal with the Medicaid (expansion population) that’s at 138 (percent of the federal poverty level). Because this is not part of Medicaid. It’s part of the refugee program, and so their benefits are the same as the U.S. citizens are.”
Keyser, the Senate cosponsor, declined to comment.
An Idaho Department of Health and Welfare spokesperson declined to answer questions about if the bill could create a health care program assistance gap, saying the agency does not comment on pending legislation.
‘It’s not a ton of money … but it matters a lot to those people,’ Sen. Wintrow says
Senate Minority Leader Melissa Wintrow, D-Boise, opposed the bill in the Senate Health and Welfare Committee and on the Senate floor.
“Maybe it is a special treatment. But to say, in our heart of hearts, ‘If you have watched a loved one murdered in front of you and had to leave your country for your own well being and safety, that we should give you an extra boost.’ And I’m willing to do it — because it’s not that much,” Wintrow said in committee on March 6. “It’s not — it’s not a ton of money that we’re doing, but it matters a lot to those people.”
That echoed what some members of the public testified in the Senate committee.
“The numbers are not astronomical, but for the lives that it will make a difference in, it will make a difference. And it could access the kind of health care they can get based on what private insurance they’re able to get,” said Holly Beech, communications manager for the Idaho Office of Refugees.
Hannah Habineza, a refugee medical case manager who said she was testifying for herself in opposition of the bill, said she’s seen many refugees who have had to choose between work and their health.
“If they lose this assistance, then they’re having to either stay home and not go to the hospital … and then continue to work. And maybe they’re not even able to continue to work because of those … conditions that they have,” she testified.
Bill is largely an effort to convert agency rules into law
The program’s higher eligibility cap was created through an agency administrative rule by the Idaho Department of Health and Welfare. The bill would shift much of that administrative rule on the program into state law, but would reduce the program’s income eligibility cap.
Administrative rules are policies adopted by agencies, subject to legislative approval. But agency rules are generally easier to change than state laws.
If the bill becomes law, it would take effect July 1.
The Idaho House passed the bill last month. Only eight Democrats voted against the bill, compared to all 61 House Republican lawmakers who backed the bill. One Democrat, Rep. Brooke Green, D-Boise, was absent for the House floor vote.
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