The Idaho Medicaid program was directed by the Idaho Legislature through HB 260 to develop managed care programs that result in an accountable care system with improved health outcomes. Legislation directed Medicaid to focus on high-cost populations, including dual-eligibiles. The Medicaid program is now seeking input of Idaho stakeholders for transitioning care of adults who are dually eligible for Medicare and Medicaid to an integrated, coordinated care system.
People who are dually eligible are among the nation’s most chronically ill and costliest patients. They account for close to 50 percent of all Medicaid spending and 25 percent of all Medicare spending. As of June 2011, there were 17,172 people in Idaho who were dually eligible for Medicaid and Medicare. Many in this group have opted to enroll in the Idaho Medicare-Medicaid Coordinated plan for dual eligibles and have average monthly expenditures of $1,500. For dual eligibles not enrolled in the plan, their monthly Medicaid expenditures average $1,800.
The majority of the dual eligible beneficiaries receive fragmented and poorly coordinated care. In an effort to make sure dual eligible beneficiaries have full access to seamless, high quality health care and to make the system as cost-effective as possible, the federal Medicare-Medicaid Coordination Office was established pursuant to Section 2602 of the Affordable Care Act.