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Modernizing Idaho Medicaid
Prevention, Wellness & Responsibility
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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
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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
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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
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Enrollment in Benchmark Plans*
56%
18%
7%
19%Basic
Enhanced
Coordinated
AwaitingAssignment
*July, 2007
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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
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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
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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
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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
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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
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PHA Lessons Learned
Minimal closures for not paying premiums
Rewards healthy behaviors Federal challenges Limited enrollment for behavior
benefits
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Premium Assistance
Premium assistance for individuals who work for small business employers
Premium Assistance for children Expansion challenges
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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
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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