The Idaho Department of Health and Welfare is enrolling eligible Idaho adults in Medicaid who earn up to 138 percent of the Federal Poverty Limit. Benefits for those folks will begin on Jan. 1, 2020.
So if someone applies in December and is determined to be eligible, will they be able to access their benefits on Jan. 1?
Medicaid expansion will be effective January 1. However, depending on when the application and all verifications were submitted, they may not have a final decision about eligibility on January 1. Medicaid operates under what is called month-effective eligibility. That means if a person applies and is eligible on Jan. 6, they will be eligible for all of January.
Open enrollment for buying insurance on Your Health Idaho ends on Dec. 16. Does that same deadline apply to Medicaid?
There really is no deadline to apply for Medicaid. People who think they may be eligible can apply at any time. If you’re not sure, you should start that process now, so if you’re not eligible for Medicaid but you are eligible for a tax credit, there is still time to purchase insurance on the state-based health insurance exchange. Continue reading
Like many department employees, Wendy Walther Davis, medical program specialist, sits in an unassuming office in the belly of an office building where the public does not tread. Also like so many employees, Wendy quietly goes about doing an enormously valuable job. She arranges medical transportation for Medicaid participants with urgent needs.
When we think of medical transportation, the conjured image is a van or ambulance picking someone up, dropping them off, and it’s done. But in Wendy’s world, figuring out how to transport someone is far more complicated, and sometimes life and death. “I don’t just work with transport companies,” she says. “I work with doctors, long-term care providers, government entities, participants, and the participants’ families. I genuinely care about these people. In fact, many of them feel like friends.”
Wendy Walther Davis is a medical program specialist in the Division of Medicaid.
Much of Wendy’s job entails working around obstacles to ensure patients get what they need within the timeframe they need it. On the day we caught up with her she was working to get a terminal patient out of state back to Idaho so they could spend their last days with their family. To accomplish this, she worked with the family to ensure hospice was in place when the patient arrived, worked with the out-of-state provider’s transportation team to make sure they were aware of the patient’s situation and ready in case he passed away during the trip. Although this is not a situation that would normally be attempt by Wendy and her team of providers, they were determined to try because it is “the right thing to do. No one should have to die in a hospital hundreds of miles from their family.” she says. Continue reading
Meet Jane. Jane lives in Idaho. She has diabetes and high blood pressure, and she recently broke her wrist when she slipped on an icy sidewalk. Jane is a Medicaid participant. When she sees her primary healthcare provider for her wrist, the provider is aware of the diabetes and blood pressure conditions, even though that’s not why she’s in the office. That’s because the doctor has agreed to designate his practice as a patient-centered medical home. This means he will coordinate ALL of Jane’s care to make sure she’s receiving the right treatment to maintain or improve her health, at the right time, and at the right cost.
This is the future the Department of Health and Welfare sees as it works to ensure all Idahoans have affordable, available healthcare that works. A milestone will be marked on Jan. 1, 2020, with the start of the Healthy Connection Value Care Program for Medicaid participants.
The Evolution of Healthy Connections
The Healthy Connections Program in the Division of Medicaid started several years ago. In 2013, Healthy Connections introduced a nationally-recognized model of healthcare delivery called the patient-centered medical home. This model emphasizes three goals:
- Improved patient satisfaction
- Improved clinic staff satisfaction
- Increased clinic efficiencies
In the patient-centered medical home model, a primary care provider or healthcare team works with the patient to provide comprehensive and continuous medical care. The goal is to keep the patient healthy or improve their health, if possible. Continue reading
The Department of Insurance submitted the Section 1332 Coverage Choice Waiver application to the Centers for Medicare and Medicaid Services (CMS) on Monday, July 15, seeking federal approval to allow individuals between 100-138% of the federal poverty limit the option to receive tax credits to remain on the state-based private marketplace or enroll in Medicaid.
Recent discussions with CMS late last week suggested necessary changes to the dual-track 1115 Coverage Choice waiver, and the possibility that an 1115 waiver may not be necessary in addition to the 1332 waiver. Based on this feedback, IDHW has ended the public comment period for the Section 1115 Coverage Choice waiver application, which began on July 3, while seeking further guidance from CMS and the Center for Consumer Information and Insurance Oversight. The department will initiate a new comment period if needed. Continue reading
BOISE – The Idaho Department of Health and Welfare (IDHW) is requesting public comment through public hearings, email, or traditional mail regarding a draft Section 1115 Waiver application. Public comments will be accepted until August 9th, and the department plans to submit the waiver application to the Centers for Medicare and Medicaid Services (CMS) as soon as possible after that date.
The purpose of the waiver, titled the Idaho Coverage Choice Waiver, is to allow Idahoans with incomes from 100% to 138% of the Federal Poverty Level the choice to continue receiving tax credits to reduce premiums for private health insurance, or to enroll in Medicaid. The Idaho Coverage Choice Waiver is being requested in response to changes in Idaho law during the 2019 legislative session. The proposed effective date for the waiver is January 1, 2020. Without the waiver, individuals who are currently eligible for a tax credit and enrolled in private insurance coverage will be required to enroll in Medicaid. Continue reading
Idaho Medicaid has announced that it has chosen National Vision Administrators (NVA) and Classic Optical Laboratories to administer eyeglasses and contact lens vision supplies for Idaho Medicaid members starting Oct. 1, 2018.
NVA has been in business for more than 30 years and provides services to over 7.5 million members across the country. NVA also has expertise in administering the vision benefits for Medicaid participants, currently managing those benefits for more than 200,000 people.
Classic Optical will continue to manufacture the lenses, but all lab orders and requests for prior approvals will be administered by NVA. NVA will be sending additional information out to optical providers in the coming weeks.
In the meantime, please direct questions to Cody Cockrum, program specialist with the Idaho Department of Health and Welfare, at Cody.Cockrum@dhw.idaho.gov or 208.334.5747.
The Department of Health and Welfare has released a new report titled “Financial Impacts from Medicaid Expansion in Idaho,” from Milliman Inc. The actuarial firm analyzed the cost impact of expanding Medicaid in the event a voter-initiated ballot measure passes.
The report indicates that Medicaid expansion in a single year (using the second-year costs because it represents the first year of full implementation) would cost the state about $45 million but will also generate about $40 million in state and local fund offsets. The single year net cost to the state will vary year over year, but the net total 10-year cost estimate from state fiscal year 2020-2030 in state funds is $105.1 million, once costs and savings are accounted for. Continue reading