Modernizing Idaho Medicaid Prevention, Wellness & Responsibility
Approach to Modernization <ul><li>Simplify eligibility  </li></ul><ul><li>Need to balance access, quality and cost contain...
State / Federal Approval <ul><li>2006 State Statute Changes </li></ul><ul><ul><li>Legislator input </li></ul></ul><ul><ul>...
Three Benchmark Plans <ul><li>Basic Plan: Individuals with average health needs; </li></ul><ul><li>Enhanced Plan: Individu...
Enrollment in Benchmark Plans* *July, 2007
Benchmark Lessons Learned <ul><li>Coordination and communication with external and internal stakeholders </li></ul><ul><li...
Streamlining Enrollment   <ul><li>Eligibility categories simplified </li></ul><ul><li>Identification of health needs at ti...
Enrollment Lessons Learned <ul><li>Medical home established early without additional paperwork </li></ul><ul><li>Eligibili...
Cost Sharing <ul><li>Basic Plan:  Tiered premiums for individuals > 133% FPL </li></ul><ul><li>Enhanced Plan:  Tiered prem...
Preventive Health Assistance <ul><li>Behavior accounts:  Points for weight loss & tobacco cessation </li></ul><ul><ul><li>...
PHA Lessons Learned <ul><li>Minimal closures for not paying premiums  </li></ul><ul><li>Rewards healthy behaviors  </li></...
Premium Assistance <ul><li>Premium assistance for individuals who work for small business employers </li></ul><ul><li>Prem...
Dental Outsourcing <ul><li>Dental for Basic Plan participants outsourced to improve access for preventative & restorative ...
Other Reforms <ul><li>Increased rates for well child exams </li></ul><ul><li>Adult routine annual wellness exams  </li></u...
Questions <ul><li>Patti Campbell </li></ul><ul><li>[email_address] </li></ul>
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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

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Modernizing Idaho Medicaid: Prevention, Wellness & Responsibility

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

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