The Idaho Medicaid program will delay a rate adjustment for supported living services from January to February 2016 to allow providers more time to adjust to the change and provide accurate information to participants about service options. The state had told providers last week that the rate adjustment would occur in January but realized more time would be necessary for many of them.

The rate adjustment is the result of a U.S. Supreme Court ruling in April of this year that upheld the state’s ability to set reimbursement rates for Medicaid services. A specific group of Medicaid providers had filed suit against Idaho in 2011 to force the state to pay higher rates. During the three years it took the lawsuit to work its way through the courts, the state paid providers the higher, court-ordered rates. With the Supreme Court victory, Idaho will reinstate the previous rates for Medicaid supported living services beginning February 1. 

Private Medicaid providers deliver supported living services. These services allow adults with developmental disabilities who choose to live in their own homes up to 24-hour support for personal care, supervision, and to receive help building skills needed to become more independent. Medicaid participants receiving supported living services are still eligible for the same amount of services, however, the reimbursement rates paid to providers will return to the previously approved amounts.

How much will the reimbursement rates change? It depends on each participant’s needs.  For the largest group of participants, a little over 600 enrollees, providers are paid a daily rate. For the last three years, that rate was $248/day; on February 1 it will reduce to $225/day. The largest change is for providers who support participants with intense needs, which includes almost 200 participants. The lawsuit had increased the rate for intense needs to $496/day; come February it will reinstate the rate of $268/day.

The Medicaid program continuously monitors the program for problems with quality or participant access to services. We also have an obligation to be good stewards of taxpayer money and ensure that we are only paying the rate needed by the most efficient providers. If the state sees any adverse impact on participants and their ability to receive quality services, we will re-evaluate the reimbursement rates and raise them if necessary. If the rates appear to be sufficient with no access or quality problems, rates may remain status quo. The free market will help determine if rates need to be adjusted.

Back in 2012, the Medicaid program objected to the court-ordered rate increase because there were plenty of providers offering quality services at the rates that were being paid. The Supreme Court reversal came out eight months ago, but the state could not change the rates until Idaho Medicaid obtained federal approval. The program received that approval last week, and in turn, contacted providers with the intent to implement in January. The reasoning for the quick implementation was that each month’s delay costs taxpayers over $1 million. However, the state Medicaid program has since realized more time was necessary so participants are not negatively impacted.