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Modernizing Idaho Medicaid: Prevention, Wellness & Responsibility
 

Modernizing Idaho Medicaid: Prevention, Wellness & Responsibility

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Patti Campbell

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Patti Campbell

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    Modernizing Idaho Medicaid: Prevention, Wellness & Responsibility Modernizing Idaho Medicaid: Prevention, Wellness & Responsibility Presentation Transcript

    • Modernizing Idaho Medicaid Prevention, Wellness & Responsibility
    • Approach to Modernization
      • Simplify eligibility
      • Need to balance access, quality and cost containment
      • Establish goals by target population
      • Structure benefits to meet health needs
      • Phased Implementation
    • State / Federal Approval
      • 2006 State Statute Changes
        • Legislator input
        • Legislator champions
      • Federal approval of 13 State Plan Amendments
        • Frequent meetings with CMS prior to submission
    • Three Benchmark Plans
      • Basic Plan: Individuals with average health needs;
      • Enhanced Plan: Individuals with disabilities or special health needs; and
      • Medicare/Medicaid Coordinated Plan: Dual eligibles
    • Enrollment in Benchmark Plans* *July, 2007
    • Benchmark Lessons Learned
      • Coordination and communication with external and internal stakeholders
      • Gradual transition to new plans
      • Qualifications for Enhanced Plan of Mental health services
      • Medicare Coordinated Plan choice
    • Streamlining Enrollment
      • Eligibility categories simplified
      • Identification of health needs at time of application
      • Identification of PCP at application
      • Elimination of asset test for children
      • Consolidated unit for application processing
    • Enrollment Lessons Learned
      • Medical home established early without additional paperwork
      • Eligibility simplification helped staff and participants
      • Ambitious implementation timeline
      • Identification of health needs pose challenges
    • Cost Sharing
      • Basic Plan: Tiered premiums for individuals > 133% FPL
      • Enhanced Plan: Tiered premiums for workers with disabilities (Buy-In)
      • Co-Pays for selected services
        • Co-Pay challenges
    • Preventive Health Assistance
      • Behavior accounts: Points for weight loss & tobacco cessation
        • Points used for weight management and smoking cessation
      • Wellness accounts: Points for well child exams & immunizations for individuals paying premiums
        • Points used for premium payments
    • PHA Lessons Learned
      • Minimal closures for not paying premiums
      • Rewards healthy behaviors
      • Federal challenges
      • Limited enrollment for behavior benefits
    • Premium Assistance
      • Premium assistance for individuals who work for small business employers
      • Premium Assistance for children
      • Expansion challenges
    • Dental Outsourcing
      • Dental for Basic Plan participants outsourced to improve access for preventative & restorative dental care
      • Implemented 9/1/2007
      • Challenges to date
        • Provider enrollment
    • Other Reforms
      • Increased rates for well child exams
      • Adult routine annual wellness exams
      • Healthy Schools initiative
      • Best price negotiated for incontinent supplies
      • Multi-State purchasing pool for pharmacy pricing
      • Pay for performance Pilot: Diabetes
      • Transportation Brokerage
      • LTC Partnership / Estate recovery
      • Medicare enrollment as a condition of eligibility
    • Questions
      • Patti Campbell
      • [email_address]