Gov. Otter unveils proposal for establishing a primary care access program

Gov. C.L. “Butch” Otter announced a new proposal today to connect uninsured Idaho adults living in poverty with primary healthcare and preventive services to help keep them healthy.

Subject to approval by the Legislature, the Primary Care Access Program (PCAP) is a public-private partnership that would benefit adults 19-64 years of age who have no access to health insurance coverage.

PCAP providers would assess the health of each participant and develop treatment plans to manage chronic conditions and coordinate their care through a patient-centered medical home model.

“This is an all-Idaho initiative that can improve the health and lives of 78,000 adults who have been going without basic healthcare and suffering because of it,” Gov. Otter said. “We have been struggling to find a solution for more than three years, and it has become apparent Medicaid expansion is not what Idaho wants. This is an achievable alternative that gives us total control, with no federal strings or mandates.”

The proposal for closing a gap in healthcare access programs would utilize $30 million from annual cigarette and tobacco tax receipts at existing rates. It would pay $32 per month to qualified providers who develop preventive and chronic condition treatment plans for each participant while also providing regular primary care services. Participants would be required to cover a share of their healthcare costs through an income-based, sliding-scale fee.

“We all know tragic stories of people who delayed medical care because they could not afford it and suffered heartbreaking consequences,” said Richard Armstrong, director of the Idaho Department of Health and Welfare.

“This plan connects our lowest income citizens to coordinated primary care that can help them improve their health and quality of life,” Armstrong added. “It is an Idaho solution that can help prevent disease, disability and premature death, while improving the productivity and well-being of our communities.”

Any qualified primary care provider who adopts the patient-centered medical home model of care and agrees to collect a sliding-scale fee based on patient income could enroll in the PCAP provider network. The Idaho Community Health Centers (CHCs) already has expressed interest in its 60 healthcare clinics statewide being PCAP providers. Examples of CHCs in Idaho are the Terry Reilly clinics in southwestern Idaho, Health West or Community Family clinics in eastern Idaho, and Heritage Health in the Panhandle.

Providers would be required to report aggregate utilization and outcome data so the state can track the success and viability of the program. The proposal includes a five-year sunset clause to dissolve the program if it is not successful or lawmakers want to replace it with a different program.

Additional information about the proposal is available here. A  PCAP Summary also is available.

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