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
Informational, question-and-answer sessions are planned for Pocatello on Dec. 7 and Coeur d’Alene Dec. 11 to discuss the Idaho Health Care Plan, aimed at delivering better health care for Idahoans. Continue reading
Medicaid’s cost survey of providers for supported living services will begin soon. This survey is for providers who offer up to 24-hour support to qualified participants with developmental disabilities so they can live in their communities rather than in an institution.
We have received a number of questions about the survey and how it will be conducted. The framework of the study is set by Idaho state regulations, which you can find here (page 27, section 037). Continue reading
Idaho Medicaid announced today that it will work with providers to conduct a cost survey to evaluate the rates paid to providers of supported living services. During the survey period, Medicaid will pay temporary rates that will go into effect Feb. 1.
These changes do not affect all Medicaid providers, only those who provide community-based supported living services to qualified participants with developmental disabilities.
Supported Living 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 had originally announced reinstatement of an approved rate schedule after a U.S. Supreme Court ruling in 2015 that upheld the state’s ability to set reimbursement rates for Medicaid services. Service providers objected and said those rates would be too low, with several suggesting they would no longer participate in the program. Continue reading
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.” Continue reading
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. Continue reading
For a person enrolled in both Medicaid and Medicare, navigating those systems simultaneously can be a nightmare. But that is changing. Idaho Medicaid is learning from other states and implementing innovative solutions to better coordinate benefits and manage costs for people in those programs.
People who are eligible for benefits in both programs typically have more than four times the healthcare expenses than Medicare-only beneficiaries. They also have a higher prevalence of complex and chronic health conditions than the general population and must navigate two benefit systems that were not designed to work together.
Idaho Medicaid is proud to offer a coordinated health plan for most Idaho residents who are eligible and enrolled in Medicare Part A and B and full Medicaid coverage. This program, the Medicare-Medicaid Coordinated Plan (MMCP), offers one set of comprehensive benefits, one accountable entity to coordinate the navigation and delivery of services, and one care management team to develop care plans and coordinate benefits. Continue reading