modernizing idaho medicaid: prevention, wellness & responsibility
DESCRIPTION
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Patti CampbellTRANSCRIPT
1
Modernizing Idaho Medicaid
Prevention, Wellness & Responsibility
2
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
3
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
4
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
5
Enrollment in Benchmark Plans*
56%
18%
7%
19%Basic
Enhanced
Coordinated
AwaitingAssignment
*July, 2007
6
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
7
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
8
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
9
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
10
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
11
PHA Lessons Learned
Minimal closures for not paying premiums
Rewards healthy behaviors Federal challenges Limited enrollment for behavior
benefits
12
Premium Assistance
Premium assistance for individuals who work for small business employers
Premium Assistance for children Expansion challenges
13
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
14
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
