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.

The Issue

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. 

Partnering with CMS

To more effectively integrate the Medicare and Medicaid programs, CMS is partnering with states, health care providers, caregivers and beneficiaries to improve quality, reduce costs and improve the dual eligible beneficiary experience. This coordinated effort seeks to transcend boundaries and facilitate a national conversation with stakeholders from around the country to identify opportunities for alignments and improve the two programs. With this initiative from CMS and the directive from House Bill 260, Idaho Medicaid is designing a program to better coordinate care for dual eligible individuals.

To meet CMS requirements, Idaho must develop a detailed model describing how we will structure and implement an integrated program consistent with the following:

• Provide dual eligible individuals full access to the benefits to which such individuals are entitled under the Medicare and Medicaid programs.
• Simplify the processes for dual eligible individuals to access the items and services they are entitled to under the Medicare and Medicaid programs.
• Improve the quality of health care and long-term services for dual eligible individuals.
• Increase dual eligible individuals' understanding of and satisfaction with coverage under the Medicare and Medicaid programs.
• Eliminate regulatory conflicts between rules under the Medicare and Medicaid programs.
• Improve care continuity and ensure safe and effective care transitions for dual eligible individuals
• Eliminate cost-shifting between the Medicare and Medicaid program and among related health care providers.
• Improve the quality of performance of providers of services and supplies under the Medicare and Medicaid programs

April 17th Videoconference

Idaho Medicaid hosted a statewide videoconference to review Idaho’s draft proposal to integrate care for dual eligibles and collect feedback from stakeholders on Tuesday, April 17. Idaho Medicaid will use stakeholder feedback and input to develop the proposal that will be submitted to CMS at the end of May, 2012. To read or download the Draft Proposal, please click here.

If you need any assistance or have questions, please do not hesitate to contact us at: LTCmanagedcare@dhw.idaho.gov. 

Idaho Stakeholder Meeting: October 2011

Developing a managed care program for dual eligible participants is a statewide effort of Medicaid staff, providers, community partners and agencies, participants and families. Idaho Medicaid held a statewide meeting of these stakeholders to gather specific recommendations and priorities on October 26th, 2011. Over 50 people participated in the meeting, which was held at the Boise Medicaid state office and video-conferenced to six other sites throughout the state.

Idaho Medicaid Long Term Care Bureau Chief Natalie Peterson provided background and information for the dual eligible managed care initiative. Following her presentation, a panel of six stakeholders presented their ideas and priorities for the design of a managed care system for dual eligible participants. Members of the panel presented Powerpoint presentations, which are available by clicking the name of each stakeholder.

• Natalie Peterson Bureau Chief, Idaho Medicaid Long Term Care
• Cathy McDougall, Associate State Director - American Assoc. of Retired Persons (AARP)
• Robert VandeMerwe, Executive Director - Idaho Health Care Association (IHCA)
• Dana Gover, Consultant - Access Concepts and Training, and dual eligible participant
• Scott Burpee, CEO and President -  Safe Haven Health Care
• Raul Enriquez, Program Specialist -  Idaho Commission on Aging
• Jason McKinley, President - Idaho Association of Home Care Agencies (IAHCA)

Recommendations from stakeholders will be used to develop the proposal to CMS. A synopsis from the stakeholder meeting panel discussion is available here.