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
Liberty Healthcare is now providing mental health assessments for children and young adults up to the age of 18, as part of the Youth Empowerment Services (YES) program and the settlement agreement for the Jeff D. lawsuit.
The YES program was created and tasked with transforming mental health for children in Idaho as part of the settlement. As part of that transformation, families of children with serious emotional disturbances and functional impairments may now (as of Jan. 1) be eligible for Medicaid coverage if their income is up to 300 percent of the federal poverty limit. Liberty will provide the necessary initial assessments at no cost to the family seeking YES program eligibility.
If you know of a child who needs mental health services, including respite, please contact Liberty Healthcare at 1-877-305-3469. Learn more here and here.
The State of Idaho has chosen a contractor from among four bidders to handle the non-emergency medical transportation needs of Medicaid patients.
Medical Transportation Management, Inc. (MTM) will take over the program March 6, 2018. The existing contractor, Veyo, exercised an early-out provision in its $70 million, three-year contract, citing expensive, unexpected restrictions on its business model that uses independent drivers.
“The Department of Health and Welfare will work with the existing broker, MTM and stakeholders to ensure a smooth transition for our Idaho Medicaid participants and providers,” said Matt Wimmer, administrator of Health and Welfare’s Division of Medicaid. Continue reading