The Future of Idaho Medicaid is Managed Care

Lewiston Medicaid Member Listening Session Recap 

The recap below is an anonymized summary of the feedback collected during the Medicaid Member Listening Session held in Lewiston on May 28, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the listening session is available in the Lewiston document library. Copies are available in English and Spanish. 

If you would like to share feedback, please fill out the Comments and Concerns Form. 

Session Time: 10:00 a.m. - 12:00 p.m. 

Session Overview

Approximately 30 individuals attended the Medicaid Member Listening Session, including members, community participants, and managed care representatives. Attendees focused primarily on how the transition to comprehensive managed care will be structured, how DHW will preserve accountability for member access and service delivery, and how members and providers can continue to provide input as program design decisions are made. Questions also addressed fraud, waste, and abuse oversight; eligibility redeterminations; rural access to specialty services; local plan presence; and the role of Rural Health Transformation Program funding.

Access to Services

• Attendees raised concerns that Idaho already has challenges with access to care and asked whether those access issues will become the responsibility of managed care organizations (MCOs) after the transition.
• Attendees asked about access to specialty services that may not be available in Idaho. DHW shared that MCOs may contract with out-of-state providers or use single-case agreements when needed to support access to medically necessary services.
• Participants asked whether the use of multiple MCOs is intended to create competition and improve accountability. DHW stated that the current plan is to have three MCOs, with the expectation that competition and public reporting will support member choice and plan accountability.

Local Presence

• Attendees asked whether selected MCOs will be large national organizations without meaningful local ties to Idaho and wondered how DHW will ensure the program reflects Idaho values.
• DHW acknowledged that large national corporations, regional plans, and provider-organized plans may participate in managed care procurements, depending on final program design and procurement requirements.
• Attendees expressed interest in requiring plans to maintain a local Idaho presence. DHW noted that options under consideration may include requirements for local leadership, network teams, offices, call centers, care coordinators, and Idaho-specific investments.

Rural Health Transformation Program

• Attendees asked how MCOs are expected to interact with the Rural Health Transformation Program (RHTP) as Idaho develops and implements managed care.
• DHW stated that Idaho is being careful to use RHTP funds for technology and infrastructure investments that improve systems, rather than funding long-term solutions with short-term dollars. DHW noted that RHTP funding is currently underway and is scheduled to end in 2030, meaning there may be limited overlap between the funding period and full managed care implementation. About the Rural Health Transformation Program Grant | Idaho Department of Health and Welfare.

Eligibility and Member Redeterminations

• Attendees asked whether Medicaid eligibility will be recertified every six months or annually and whether MCOs will be involved in eligibility decisions.
• DHW explained that eligibility redeterminations are currently conducted every 12 months by the Department of Self Reliance. Under HR 1, Medicaid expansion population redeterminations will be required every six months, while traditional Medicaid populations will remain on annual redeterminations. DHW clarified that MCOs will not determine Medicaid eligibility. Eligibility determinations will remain the responsibility of the state.
• DHW also noted that community engagement requirements will apply to the Medicaid expansion population, impacting approximately 85,000 to 90,000 members, while traditional Medicaid members will not be impacted by those requirements.

Accountability and Communication

• Attendees asked how DHW will regulate fraud, waste, and abuse within managed care organizations and what role MCOs will play in identifying and investigating potential issues. DHW explained that MCOs may be expected to have special investigations units as a first line of identification; however, this is still an open program design decision. The Division of Medicaid Program Integrity unit will continue to monitor payments and work with MCOs. Credible allegations of fraud may be referred to the Attorney General’s Medicaid Fraud Control Unit for investigation and enforcement.
• Attendees asked how MCOs will be held accountable for providing the full continuum of care to members, not only for paying claims to providers. DHW described potential contract requirements, federal access reporting, External Quality Review Organization (EQRO) audits, and potential remedies such as liquidated damages, penalties, or interest on unpaid claims as tools for oversight.
• Participants sought assurance that accountability will extend to the member experience, including whether services are actually available and delivered. DHW emphasized that the state remains ultimately responsible for the Medicaid program, while MCOs will be expected to build networks and ensure access for their enrolled members. DHW noted that network adequacy requirements will be included in MCO contracts and that MCOs will be expected to build provider networks capable of serving members. DHW also indicated that Idaho plans to establish provider rate floors while allowing MCOs flexibility to pay above those floors to attract and retain providers.
• Attendees asked whether there is an email address or online pathway for members and community partners to continue asking questions after the listening session. DHW directed attendees to the managed care website and noted that comment and question forms are available through the web portal.
• Participants expressed interest in continued transparency as program design decisions are made, including clear communication about decisions under consideration and opportunities for public input before contracts are finalized. DHW shared that more than 50 high-level program design decisions are still being evaluated in collaboration with the Legislative Medicaid Review Panel. DHW expects to present progress and remaining decisions to the panel in the fall.

Administrative and Payment Issues

• Attendees emphasized the need to reduce provider administrative burden so that smaller community-based providers are not discouraged from participating in managed care networks.
• Participants raised the concept of "standard traditional providers," particularly for long-term services and supports and smaller or atypical providers that may provide niche services but have limited capacity for complex credentialing and contracting processes and noted that providers who have billed Medicaid within a defined recent period may be eligible for consideration under this type of model, which could help smaller providers participate during the managed care transition.

Lewiston Medicaid Provider Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held in Boise on May 28, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 2:00 p.m. - 4:00 p.m.

Session Overview 

Approximately 23 individuals attended the Medicaid Provider Listening Session, including providers and stakeholders. Attendees focused their feedback on how the transition to comprehensive managed care could affect provider reimbursement, administrative burden, credentialing, claims payment, prior authorization, quality oversight, continuity of care, and member plan assignment. Participants asked for clear contractual requirements, timely reporting, and transition protections to reduce disruption for providers and members.

Accountability and Communication

• Providers emphasized the need for clear communication and transition supports as Idaho moves from fee-for-service to comprehensive managed care.
• Attendees asked how current reporting mechanisms would be used for quality oversight and appeals, including how closely reports would be monitored and how timely the data would be. Attendees also heard that some reporting can be affected by claims lag and encounter data timing or quality issues. The discussion noted that MCOs are expected to submit monthly, quarterly, and annual reports.
• Participants asked whether Idaho is mirroring another state in its managed care design, reflecting interest in understanding what lessons or models may inform Idaho’s transition.

Administrative and Payment Issues

• Attendees asked how quality withholds for MCOs could affect providers. The discussion indicated that quality withholds should not impact provider rates.
• Participants asked how capitated rates would affect providers. The discussion clarified that per-member-per-month payments are made from the state to MCOs and are required to be actuarially sound.
• Attendees raised concerns about the accuracy of actuarial projections and how those risks would be addressed in contracts. Medical Loss Ratio (MLR) requirements were discussed as one tool to help mitigate concerns related to rate setting and plan spending.
• The discussion noted that DHW intends to require provider rate floors as part of the managed care program design.
• Providers asked whether every provider would need to be credentialed separately with each insurance company selected for the managed care program.
• Attendees expressed interest in approaches that would reduce provider abrasion during the transition. Centralized credentialing was discussed as a program design option that could help minimize duplicative credentialing requirements.
• Participants emphasized the importance of designing administrative processes that are workable for providers and do not create unnecessary barriers to participation in Medicaid managed care networks.
• Attendees raised concerns about timely claims payment and timely prior authorization processes under MCOs. The discussion indicated that DHW intends to pursue available legal remedies to promote timely payment to providers, including liquidated damages and interest payments for untimely payment of clean claims.
• Attendees expressed concern that duplicative credentialing, delays in prior authorization, and delayed claims payment could create operational and financial strain for providers if not addressed in contract requirements and implementation planning.

Contract Safeguards and Provider Protections

• Participants asked how long the managed care contracts would be in effect. The discussion noted that traditional DHW managed care contracts have been four years with renewal options and that the new contracts are expected to have an initial term of approximately four to five years.
• DHW is also considering market, plan, and member stability when evaluating contract terms and transition timing.

Enrollment, Eligibility and Member Choice

• Attendees asked whether open authorizations would be honored for a period of time during open enrollment and transition to managed care.
• The discussion referenced a continuity of care period, with DHW planning to put protections in place to reduce disruption and support members as they move into the new system.
• Attendees raised concerns that fewer than 25% of beneficiaries typically actively choose a plan, which means the state will need a process to auto-assign members who do not make an active selection. The state may use an enrollment broker to support plan assignment and provide choice counseling. How members will be assigned to plans remains a program design decision under development.
• Participants highlighted the importance of maintaining provider and member stability during implementation, including through continuity of care protections, clear plan assignment processes, and enforceable accountability mechanisms for MCOs.

Coeur d' alene Medicaid Member Listening Session Recap 

The recap below is an anonymized summary of the feedback collected during the Medicaid Member Listening Session held in Boise on May 27, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the listening session is available in the Coeur d' Alene document library. Copies are available in English and Spanish. 

If you would like to share feedback, please fill out the Comments and Concerns Form. 

Session Time: 11:00 a.m. - 1:00 p.m. 

Session Overview

Approximately 35 individuals participated in the Medicaid Member Listening Session, including Medicaid members, family caregivers, insurance brokers, certified family home providers, and managed care plans. Attendees shared both concerns and questions related to Idaho’s transition to comprehensive managed care, with particular focus on provider access in rural communities, reimbursement rates, network adequacy, eligibility processes, and continuity of care for individuals with complex medical needs. Participants also discussed broader concerns related to recent Medicaid budget reductions and provider reimbursement rate cuts.

Network Adequacy and access to Care in Rural Areas

• Attendees expressed concern that managed care networks may further limit access to providers in rural communities, particularly for specialty, dental, behavioral health, and transportation services.
• Families shared challenges accessing dental anesthesia services for children with complex medical needs, noting that some providers no longer accept Medicaid and that out-of-pocket costs can be substantial.
• Participants raised concerns that providers may choose to contract with only certain managed care plans, potentially limiting continuity of care and requiring members to change providers.
• Attendees emphasized the importance of maintaining access to out-of-state specialty providers when medically necessary, particularly for families who currently travel to neighboring states for specialty care.
• Questions were raised about how Non-Emergency Medical Transportation (NEMT) access and provider shortages in rural counties would be addressed under comprehensive managed care.
• Participants repeatedly highlighted the unique challenges faced by rural Idaho communities, including provider shortages, long travel distances, and limited specialty care availability.
• Attendees stressed the importance of preserving local provider relationships and ensuring managed care does not further increase barriers to accessing care.
• Attendees expressed concern that ongoing Medicaid budget reductions could destabilize provider networks and reduce service availability, particularly in rural communities.
• Families and providers emphasized the need for sustained investment in community-based supports to maintain access to care.

Administrative and Payment Issues

• Participants expressed concern that recent Medicaid reimbursement rate reductions could further reduce provider participation in Medicaid and negatively impact access to care, emphasizing the need for stable reimbursement rates.
• DHW staff discussed the importance of maintaining actuarially sound rates and described ongoing efforts to collect provider cost and access data to support future rate-setting decisions.
• Providers and advocates emphasized that legislators may not fully understand the operational realities of Medicaid-funded services and encouraged additional education and site visits for policymakers.

Enrollment, Eligibility and Member Choice

• Attendees asked questions about how members will be assigned to managed care plans if they do not actively select a plan.
• Discussion included the possibility of using enrollment brokers and assignment algorithms that consider factors such as family relationships, provider continuity, geographic access, and plan performance.
• Participants asked whether there would be annual open enrollment period or opportunities for members to change plans more frequently if provider networks change.
• Questions were raised about whether eligibility determinations and appeals would continue to be managed by DHW or transition to managed care organizations.
• Attendees shared concerns regarding Medicaid eligibility redeterminations, staffing shortages in local offices, and difficulties navigating the eligibility process.

Care Coordination and Member Experience

• Families expressed appreciation for care coordination support currently provided through insurance case managers and emphasized the importance of maintaining strong care coordination functions under managed care.
• Attendees shared concerns that managed care organizations may prioritize cost savings over patient care and referenced negative experiences with delayed equipment approvals, denials of services, and limited provider expertise in previous managed care arrangements.
• Participants emphasized the importance of protecting continuity of care for individuals with complex medical, behavioral health, and developmental needs.
• Attendees asked how Idaho-specific values and local investment requirements would be incorporated into the managed care procurement and evaluation process.

Coeur d' alene Medicaid Provider Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held in Boise on May 27, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 3:00 p.m. - 5:00 p.m.

Session Overview 

Approximately 40 individuals attended the Medicaid Provider Listening Session, including provider group representatives, pediatricians, developmental disability providers, hospital association representatives, rural hospital and critical access hospital stakeholders, insurance brokers, school-based Medicaid representatives, and other community-based providers. 

Attendees expressed concerns about the comprehensive managed care transition, particularly related to rural access, provider payment, care coordination, administrative burden, plan accountability, and the impact of recent Medicaid program and reimbursement changes. Several attendees also emphasized a willingness to collaborate with DHW and managed care organizations (MCOs) to support a stronger transition and preserve access to services across North Idaho.

Provider Network Adequacy and Access

• Multiple attendees expressed concern that rural areas already have limited provider capacity and that managed care could further strain access if networks are not designed around the realities of rural Idaho.
• Attendees noted that North Idaho lacks certain pediatric subspecialists and emphasized that selected MCOs must be able to contract with providers in Spokane or other out-of-state areas or use single-case agreements when medically necessary.
• Stakeholders raised concerns that low reimbursement, rising costs, and workforce shortages are already limiting provider participation, especially for pediatric therapy, behavioral health, developmental disability, and rural services.
• Attendees raised concerns that years of provider rate pressure, recent reimbursement reductions, and rising costs of living and staffing are making it increasingly difficult for providers to serve Medicaid members.
• Physical therapy and pediatric therapy stakeholders noted that some practices are already at or near their financial limits, with concerns that additional administrative burden or lower effective reimbursement could result in closures or reduced Medicaid participation.
• Hospital and provider association representatives asked how future budget reductions would affect managed care plans and providers, including whether cuts would be passed through to providers and how medical loss ratio or community investment requirements would be structured.

Accountability and Communication

• Participants asked whether DHW will conduct lookbacks after contracts are implemented to evaluate plan performance, identify bad actors, and determine whether a competitive process should be reopened if plans are not operating in good faith.
• Stakeholders asked how much control Idaho will give to MCOs and emphasized that DHW must retain strong oversight authority to ensure plans follow state requirements and contract terms.
• Attendees requested continued listening sessions, advisory structures, or other formal mechanisms for providers, members, families, and communities to provide feedback throughout design, implementation, and ongoing oversight.
• Provider representatives emphasized the need for specialized program design and plan competency related to programs such as Youth Empowerment Services, school-based Medicaid, developmental disability services, and rural pediatric care.
• Attendees asked how DHW will continue collecting access report data and whether dashboards or public-facing reports will be developed to help identify access issues and monitor fiscal responsibility.
• Participants encouraged DHW to benchmark access and provider sustainability using data that reflects the cost of doing business, workforce shortages, rural market conditions, and the ability to attract and retain providers in Idaho.
• Stakeholders requested clear, transparent information about plan performance, access, claims payment, prior authorization, and other metrics so providers and members can understand how plans are performing.

Administrative and Payment Issues

• Providers voiced concern that delayed or disputed payments could destabilize practices, particularly during the transition to managed care. Several attendees referenced current or past issues with claims processing, credentialing, and system glitches affecting reimbursement and provider enrollment.
• Attendees asked whether Idaho will pursue centralized credentialing or other approaches to reduce provider administrative burden, rather than requiring providers to enroll separately with multiple plans.
• Participants highlighted that onboarding to new plans, learning new billing rules, and navigating program-specific requirements can require substantial staff time and create provider fatigue.
• Stakeholders asked how provider education, billing guidance, and operational readiness will be handled so that practices can submit clean claims and avoid disruptions in payment.

Contract Safeguards and Provider Protections

• Attendees raised concerns based on prior managed care and vendor rollouts, including experiences with Magellan and NEMT, and asked how DHW will prevent another unsuccessful implementation.
• Participants emphasized the need for clear, enforceable contracts that reduce ambiguity around clean versus unclean claims, timely payment requirements, prior authorization processes, and provider recourse when plans do not follow contract terms.
• Attendees asked what recourse providers will have if plans reduce rates, change contract terms with limited notice, approve prior authorizations and later deny claims, or otherwise fail to operate in good faith.
• DHW representatives described interest in stronger contract remedies and public accountability, including the possibility of enforcement strategies tied to timely payment, plan performance, external quality review, and access reporting.

Enrollment, Eligibility, and Member Choice

• Attendees asked how Katie Beckett eligibility and services will be handled under managed care and whether Katie Beckett services would change, particularly as private insurance often does not cover needed services. DHW staff confirmed that Katie Beckett services are not impacted by the transition to managed care, as those benefits are defined by a separate waiver program with CMS and that eligibility determinations will continue to be made by the Division of Self Reliance.
• Participants raised concerns about dual-eligible members, including residents who may not understand that their coverage has changed and facilities that may not know when insurance changes occur, creating billing and care coordination challenges.
• Attendees asked how eligibility will be verified under future managed care arrangements and whether retroactive eligibility will be handled through fee-for-service or managed care.

Care Coordination and Member Experience

• Providers stated that embedded care coordination is especially valuable because clinic-based staff know patients and families directly, can work face to face, and can help prevent avoidable emergency department utilization.
• Several stakeholders urged DHW and future MCOs to preserve or recreate funding models that support care coordination in the clinic setting rather than relying solely on centralized plan-based care management.
• Pediatric providers raised concerns about the loss of Healthy Connections and the potential gap in care coordination funding before managed care is implemented, noting that care coordination staff and social workers embedded in clinics help keep children out of emergency departments and improve outcomes.

Access to Services in Rural Areas

• Representatives requested that school-based Medicaid remain carved out of managed care and continue under fee-for-service, citing concerns about administrative burden and the impact of managed care on rural districts.
• Attendees expressed concern that small rural agencies and local providers may be financially strained or unable to continue serving children if reimbursement, authorization, or administrative requirements become more difficult under managed care.
• Participants referenced existing settlement-related requirements and data concerns, noting that rural districts need a Medicaid structure that can support services for children with complex needs.

Boise Medicaid Member Listening Session Recap 

The recap below is an anonymized summary of the feedback collected during the Medicaid Member Listening Session held in Boise on April 7, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the listening session is available in the April information document library. Copies are available in English and Spanish. 

If you would like to share feedback, please fill out the Comments and Concerns Form. 

Session Time: 10:00 a.m. - 12:00 p.m. 

Session Overview

Approximately 45 individuals participated in the Medicaid Member Listening Session, including Medicaid members, family caregivers, and community advocates. The majority of attendee feedback focused on continuity of care risks for members with complex care needs, access to care, prior authorization hurdles, provider shortages, and communication gaps and confusion during the managed care transition. 

Participants emphasized the need for trust and accountability during the shift from Fee-For-Service (FFS) to managed care by preserving ways to express grievances, service consistency across managed care organizations, and enforcing standards to guarantee care to members. 

Access to Services

• Participants expressed concern about the continuity of care for medically complex members during the transition based on previous experiences with disruptions to care during transition times. 
• Participants described firsthand experiences where the ability to receive essential anti-seizure medications was delayed due to a lack of communication between Medicaid and private insurance. Participants cited that they continue to struggle to receive timely coverage of needed medication. 
• Participants requested clear contingency plans be put in place with guardrails to protect against gaps in service. 
  Participants described challenges obtaining medically necessary custom wheelchairs for their children, citing barriers in the current system and multiple phone calls required to secure approval. 
• Participants reported difficulty receiving continued physical therapy for children with developmental disabilities because of prior authorization requirements. They also noted that some chiropractor providers were no longer accepting Medicaid due to reimbursement challenges, resulting in fewer office visits and worsening health outcomes.
• Stakeholders raised concerns about whether out-of-state specialty services would remain covered under managed care when no providers are available in Idaho. 
• Members raised concerns about maintaining continuity of mental health care and navigating the transition without disruption in services. 
• Participants requested more information about “in lieu of services” authority and consistency, noting that state-level decisions will shape whether these alternatives are available and applied uniformly across MCOs.
  Participants expressed the need for consistency in required services across MCOs, while acknowledging that value-added benefits may differ.

Provider Network Adequacy and Access

• Participants expressed concerns that provider and specialist shortages in Idaho could create access barriers if plan networks differ.
• Participants expressed concerns about providers no longer accepting Medicaid patients when reimbursement issues occur.
• Stakeholders raised concerns about whether provider networks would be shared across MCOs or operate as distinct networks.

Accountability and Communication

• Participants reported difficulty accessing information about listening sessions, citing inconsistences in information shared and challenges finding details online.
• Members requested more direct member outreach through a flyer or postcard to supplement the social media and website forms of communication.
• Participants inquired about how member perspectives and representation will be incorporated into program decision-making.
• Participants requested information on other states’ managed care transitions to understand the benefits and challenges experienced during those transitions.

Administrative & Payment Issues

• Participants voiced concerns about prior authorization requirements creating excessive administrative burden for providers and members, as they are time consuming and erode trust between members and providers.
• Participants described concern about dual-coverage services being coordinated across insurance companies, pharmacies, and providers, noting that ineffective information sharing can lead to delays, out-of-pocket costs, and high caregiver burden.
• Participants expressed concern about payment accuracy and recoupments, questioning how errors will be corrected and how providers will be reimbursed when funds are retracted after services have been delivered. 
• Stakeholders emphasized concern about transition operations, highlighting the need for claims testing, timely and accurate payments (including complex claims), and temporary policies that bridge authorization and care management handoffs during implementation..

Contract Safeguards and Provider Protections

• Members asked what formal grievance and appeal pathways will exist for individuals who do not receive covered benefits, emphasizing the need for a reliable mechanism to challenge denials or gaps in coverage. 
• Stakeholders sought context on the state’s contracting and request for proposals (RFP) approach, noting that contract design decisions and timelines will determine how protections are operationalized. 
• Some participants expressed concern about managed care financial incentives, questioning how MCO profit motives will be balanced against member needs and pointing to the importance of actuarially sound rates and medical loss ratio (MLR) oversight.

Boise Medicaid Provider Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held in Boise on April 7, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 2:00 p.m. - 4:00 p.m.

Session Overview 

Approximately 36 individuals attended the Medicaid Provider Listening Session. Stakeholders acknowledged concerns about preserving continuity of care and specialized care coordination, especially in the provider-scare environment.

Participants focused on maintaining stable care for members while emphasizing the importance of provider financial viability. They emphasized risks around network shortages, care coordination continuity, and access for high-need populations, alongside operational concerns like claims/payment accuracy, prior authorization burden, and rapid rule changes. They also pushed for stronger safeguards and transparency, including insurer financial stability checks, clear contracting/grievance processes, and more consistent, proactive communication about decisions and upcoming sessions.

Access to Services

• Some participants raised concern about preserving care/service coordination through the transition phase, noting that historical knowledge, especially around specialty-focused case management, is extremely valued for member choice and experience.
• Some participants representing individuals with developmental disabilities expressed concern that smaller agencies could be overlooked during the transition and requested support and visibility.
• Stakeholders raised concerns over the pace of change, particularly following prior transitions, noting that repeatedly having to learn and relearn new information could delay care. 
• Participants shared concern about access-to-care performance measures given existing provider scarcity and asked how the state would monitor networks that fall below required provider counts. 

Provider Network Adequacy and Access

• Some participants were concerned about private practice participation requirements, questioning if hospital affiliation is necessary.
• Participants raised questions about how emergency service providers will participate under managed care, how they would contract with MCOs, and the state’s approach for dual eligible individuals. 

Accountability and Communication

• Some participants were concerned that incoming MCOs may lack the appropriate knowledge and preparedness of existing Idaho systems and recommended including informed representation in the contracting phase.
• Multiple participants requested clearer and more proactive communication about listening sessions.
• Participants inquired about the makeup of the Idaho Medicaid Review Panel.

Administrative & Payment Issues

• Providers voiced concern about how reimbursement rate negotiations will work under managed care and how the Medicaid rates would evolve.
• Providers expressed concern over rates changing to keep up with inflation, asking questions about rate floors and the approach for financial structuring and reporting.
• Some participants raised concerns with active billing and claims testing prior to go-live, needing a reorganization for the structure of billing codes. 
• Some participants cited issues under the Molina duals plan, including incorrect payment rates and delayed resolution, and asked how similar issues would be escalated and resolved in the future.
• Participants raised concerns that claims could get lost during contract transitions.
• Providers noted that provider handbook updates were often confusing, emphasizing that it takes too long to learn and adapt to rules before they quickly become outdated. 
• Some participants raised concerns about provider budgeting inconsistencies caused by unclear expense categorization, recommending state training on how to label/categorize expenses (e.g., specialty categories, pay roles) to improve data quality and planning.

Contract Safeguards and Provider Protections

• Participants recommended the procurement process include verification of MCO financial stability and longevity.
• Participants inquired about the grievance process under managed care. 
• Participants discussed the managed care contract term length, reflecting concern about stability in the future.

Gooding Medicaid Member Listening Session Recap 

The recap below is an anonymized summary of the feedback collected during the Medicaid Member Listening Session held in Gooding on March 10, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the listening session is available in the March information document library. Copies are available in English and Spanish. 

If you would like to share feedback, please fill out the Comments and Concerns Form. 

Session Time: 10:00 a.m. - 12:00 p.m. 

Session Overview

Approximately 25 individuals participated in the Medicaid Member Listening Session, including Medicaid members, family caregivers, and community advocates. The majority of attendee feedback focused on language translation services and culturally responsive care, including the need for accurate and accessible interpreters, translated written materials, and services that account for cultural context. 

Participants described communication and language access challenges that occur before, during, and after receiving care. These challenges include difficulty understanding provider questionaries and scheduling services, limited access to qualified interpreters (including Spanish and American Sign Language interpreters), and difficulty understanding follow-up instructions and written materials such as questionaries when they are not translated, written in plain language, or provided in accessible formats. Participants also raised concerns about how managed care and related program changes could further affect access to clear and accessible communication, especially for people with limited technology access, as well as language access, cultural responsiveness, and readability of written materials. 

Access to Services:

• Attendees described challenges understanding what services and programs are currently available and noted that lack of awareness can delay early intervention and access to supports.
• Members shared that navigating Medicaid-related processes can be confusing, particularly when information is primarily online and when families lack support to follow up after appointments or referrals.
• Attendees highlighted that access barriers can be amplified during crises (especially behavioral health crises), where families may avoid seeking help due to fear of law enforcement involvement or negative experiences in emergency or inpatient settings.
• Participants described challenges navigating programs, services, and terminology, even when language is not a barrier, and emphasized the need for hands-on support (e.g., live help, step-by-step guidance, and follow-up after appointments).

Provider Network Adequacy and Access: 

• Participants described difficulty locating appropriate providers, particularly specialty services (e.g., dental care requiring anesthesia and referrals that may involve out-of-state options), and stressed the need for practical guidance on “who to call” and “what to do next.”
• Language access and disability access were described as key components of network adequacy. Attendees noted that it can be difficult to find providers who both accept new patients and can accommodate interpretation services when interpretation is needed.
• Members emphasized that community-based organizations often help families navigate provider access and follow-up when the system is hard to navigate independently.
   

Accountability and Communication:

• Attendees reported that translation and interpretation quality is inconsistent and can lead to misunderstandings during appointments, evaluations, and completion of long questionnaires.
• Participants asked for stronger accountability to confirm:
  • Written materials are translated accurately and in a way that is understandable across dialects and everyday vocabulary.
  • Interpretation services are accurate and reliable (including attention to qualifications).
  • Materials are accessible in format and readability (including the need for plain-language content and accessibility for people who use American Sign Language and other accommodations).
• Members noted that cultural responsiveness should be treated as an accountability issue as well, noting that cultural context (e.g., comfort with provider of the opposite sex during sensitive care, unfamiliarity with U.S. clinical processes) can affect whether members seek care and complete next steps after visits such as scheduling follow-up appointments.
• Advocates asked about tracking outcomes such as “lost to follow-up” as a potential accountability measure tied to communication and navigation barriers.
• Attendees shared that technology-first communication can be a barrier for some members (e.g., older adults, people without reliable internet access, and individuals unfamiliar with online systems).
• Some families reported difficulty finding assistance (e.g., limited availability of Spanish-speaking enrollment support) and noted that community-based organizations often fill gaps when families cannot get timely help elsewhere.

Gooding Medicaid Provider Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held in Gooding on March 10, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 1:30 p.m. - 3:30 p.m.

Session Overview 
Approximately 30 individuals attended the Medicaid Provider Listening Session. Stakeholders acknowledged that the shift toward managed care is expected to move forward and emphasized the importance of meaningful provider engagement early in design, not only during implementation. Participants noted that this was the first time some providers felt they were being asked for input and requested formal mechanisms to confirm operational realities (data, billing, access, and due process) are reflected in contract requirements.

Administrative & Payment Issues:

• Providers raised concerns about delayed payments due to plan system issues (e.g., software glitches), stressing that payment delays create immediate cash flow and payroll risk while care continues uninterrupted.
  Participants suggested contract requirements and enforcement mechanisms to address payment failures, including remedies when delays are not provider-caused.
• Providers requested that contracts preserve provider rights and protections comparable to those available under direct Medicaid fee-for-service (FFS) arrangements, and raised concerns about contract provisions allowing cancellation “without cause.”
• Providers emphasized the need for a common, accurate working database for member attribution and current placement/status to reduce administrative burden and avoid misdirected communications (e.g., notices for patients not seen for years).
• Participants cited prior managed care transitions where plan data inaccuracies contributed to widespread billing/payment disruption, extended delays, and provider financial harm.
   

Contract Safeguards and Provider Protections:

• Providers referenced the “any willing provider” concept and expressed concern that managed care entities may not be held to similar expectations, potentially limiting participation and narrowing networks.
• Participants repeatedly stressed the need for stronger accountability for managed care contractors, including performance standards, monitoring, and meaningful consequences for non-performance.
• Providers cited past failures with non-emergency medical transportation (NEMT) in ride reliability and safety incidents, as well as concerns about spending transparency and contract renewals despite dissatisfaction.
• Providers also noted that because managed care dollars remain public dollars, robust audit tools and fraud detection should be built into oversight, with clarity on who is responsible for monitoring and enforcement.
• Providers urged DHW to better coordinate contracts, reduce overlap, and confirm contract writers incorporate provider operational input.
   

Network Adequacy and Access:

• Attendees described confusion and inefficiency caused by overlapping managed care arrangements and unclear separation of responsibility across different plans and populations (e.g., behavioral health vs. dual-eligible coverage).
• Participants stated that fragmented responsibilities can leave frontline staff (e.g., hospital discharge planners and state navigators) without effective options for high-acuity individuals if the managed care entity lacks practical tools, local presence, or adequate provider capacity.
• Participants reported challenges when members compare benefits across coverage types (e.g., certain value-added benefits available in managed care but not traditional Medicaid), creating friction and placing providers in the position of explaining benefit differences they do not control.
   

Program Design:

• Providers requested a standing provider workgroup that can provide recommendations directly to DHW leadership and help inform policy and contracting decisions with real-world operational input.
• Participants stated there is currently no consistent forum to elevate “what is working and what is not,” and urged DHW to establish ongoing engagement rather than one-time feedback sessions.
• Providers expressed concern that managed care entities can implement changes quickly without processes comparable to public notice and hearing requirements, resulting in abrupt service changes and confusion.
• Participants emphasized that school-based services should be carved out of managed care. Concerns included:
  • Potential requests for student health records raising FERPA (Family Educational Rights and Privacy Act) and HIPAA (Health Insurance Portability and Accountability Act) compliance questions.
  • Risk that school therapists may not be recognized as network providers, potentially worsening provider shortages.
  • Managed care medical necessity determinations and reimbursement changes affecting district operations.
  • Increased billing fragmentation and cash flow risk for school-based service delivery.
     

Tribal Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held virtually on February 3, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the virtual listening session is available in the Virtual Listening Session Library.

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 2:00 - 4:00 p.m.

Tribal Listening Session Recap

In March 2025, the Idaho state legislature passed House Bill 345 (“H345”) directing the state to transition its Medicaid program from a fee-for-service system to a comprehensive managed care model. As a first step in this process, the Idaho Department of Health and Welfare (DHW) is conducting listening sessions to gather input directly from individuals who receive Medicaid services, their families and caregivers, Medicaid providers, and community partners.

The recap below is an anonymized summary of the feedback collected during the Tribal Medicaid Member and Provider Listening Session held in Boise on February 25, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form.

Tribal Medicaid Member and Provider Listening Session Recap

Session Time: 1 PM MT
Format: Hybrid (virtual and in-person)
Attendance: ~4 in person, ~27 online

Session Overview

Participants included tribal and American Indian/Alaska Native (AI/AN) stakeholders and partners, along with providers and community representatives. Attendees raised concerns about how comprehensive managed care could affect behavioral health access (including substance use disorder treatment), administrative burden for tribal providers, payment integrity, and eligibility redeterminations. Participants also emphasized the importance of formal Tribal Consultation, tribal specific contract protections, and clear, early communications to support tribal leaders and communities. 

Tribal Consultation, Communications, and Engagement Expectations

• Participants emphasized that Tribal Consultation is distinct from general listening sessions and should follow appropriate protocols, with engagement centered on tribal leaders and tribal governance structures.
  • A one-pager was requested to explain the transition and impacts for tribes to the tribal leaders in advance of the consultation happening in May.
• Attendees stressed the importance of clear communication about tribal protections during the transition.
• Communications with Oregon, Warm Springs, SC, and NC was suggested to understand their programs for specialty care in remote areas. 

Tribal Protections in Program Design and Contract Requirements

• Participants recommended that AI/AN Medicaid members remain in fee-for-service (FFS) unless they opt-in to managed care and that Idaho should build clear member protections consistent with federal requirements.
• Attendees suggested MCOs should meet requirements of maintaining tribal liaisons on staff, implementing AI/AN-specific performance metrics, and having the proper training and skills to meet AI/AN community needs.
• Participants requested claims-related protections for AI/AN providers, including a 365-day clean claims window since many providers have limited billing capabilities.
• One participant suggested consideration of the 1115 waiver approach (like in AZ and NM) for protecting AI/AN provider stability and mitigation of downstream impacts for service reductions.

Eligibility Redeterminations and Renewal Processes:

• Participants raised concerns about work requirements, eligibility redeterminations, and ex parte renewals where there may be disproportionate impacts on AI/AN members if there are insufficient protections and communications.
• Attendees emphasized needs for close collaboration and timely communication between state and tribes to support tribal entities supporting members through renewal cycles and reducing coverage losses where possible.

Access to Behavioral Health and SUD Treatment:

• Attendees expressed interest in how the transition may impact SUD treatment capacity and access where current in-state options are limited and there are frequent out-of-state referrals for care.
• Attendees highlighted behavioral health and inpatient treatment as high risk for disruption during transitions and requested clarity on how managed care would strengthen access.

Administrative Burden and Transition Risk:

• Participants expressed concerns that moving from one payer to multiple payers can increase administrative complexity, especially for tribal providers with limited billing infrastructure.
• Attendees shared concern that contracts with plans must recognize out-of-state providers to prevent interruption in care.
• Attendees shared examples of referral and acceptance issues tied to managed care coverage where they warned transition could create avoidable care delays.
• Attendees shared concerns about timely payment where payment performance was a primary driver of skepticism and operational risk.
• Participants encouraged planning for transition to support providers with clear workflows, escalation paths, and requirements that minimize preventable denials and delays.

Virtual Medicaid Member Listening Session Recap 

The recap below is an anonymized summary of the feedback collected during the Medicaid Member Listening Session held virtually on February 3, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the virtual listening session is available in the Virtual Listening Session Library. Copies are available in English and Spanish. 

If you would like to share feedback, please fill out the Comments and Concerns Form. 

Session Time: 10:00 a.m. - 12:00 p.m. 

Session Overview

Approximately 153 individuals participated in the Medicaid Member Listening Session, including families/caregivers of Medicaid members, certified family home providers, pediatric and behavioral health providers, community-based providers, advocates, and other interested community members. Participants emphasized concerns about how comprehensive managed care could affect access to specialized and rural care, continuity of established provider relationships, and appeals and denials. Some members offered feedback around the format of the listening session, including questioning why the session wasn’t being recorded and why cameras were disabled. 

Access to Services:

• Attendees expressed concern that managed care could create new barriers to care, particularly for medically complex members and those with developmental disabilities (DD).
• Families highlighted existing gaps in access and worried those gaps could worsen if networks narrow.
  One participant emphasized the importance of maintaining access to specialty care across state lines and asked how managed care will affect reciprocity/out-of-area care.
• Multiple speakers raised concerns about freedom of choice under a 1915(b) waiver structure, noting that “choice” can become limited in practice, especially in rural areas and when specialty care is concentrated in larger urban areas.
• Attendees requested clarity on how specific programs/populations would be impacted, including Katie Beckett participants and children’s access requirements (e.g., early and periodic screening, diagnostic, and treatment (EPSDT)).

Provider Network Adequacy and Access:

• Participants emphasized Idaho’s rural provider shortages and questioned how the state will ensure adequate networks in rural/frontier areas under a volume-driven managed care model.
• Family members described the high importance of continuity of care, especially for children with autism/behavioral health needs who have spent years building trusted relationships.
• Certified family home providers and caregivers described system navigation as complex and multi-agency, and advocated for simpler, more coordinated pathways without losing specialized DD expertise.
• Participants raised concerns that provider shortages could worsen if managed care introduces additional administrative burden or if provider participation declines.

Accountability:

• Attendees questioned how MCOs and the broader system will be held accountable, citing concerns about profit incentives, lack of enforcement, and limited ability for families to challenge decisions without legal support.
• Participants asked whether the state would provide meaningful appeals support, including a clear process and assistance for families when denials occur.
• Several participants expressed skepticism about increased involvement of private entities, characterizing the change as “more hands in the pot,” and worried about administrative complexity and coverage loss over time.

Rollout Timeline and Program Design:

• Families requested clearer guidance on what Medicaid benefits and services will stay the same under comprehensive managed care and what will change, especially for certified family home models and care coordination models.
• Participants raised concerns about auto-assignment if members do not choose a plan, especially for people who may not receive mail, and suggested extensions or exceptions for extenuating circumstances.
• Some speakers inquired how caregivers and providers will have an ongoing role in shaping DD services, so policies reflect real-life navigation, not just program theory.
   

Payment Models and Capitation:

• Participants expressed concern that capitated payments could incentivize MCOs to reduce utilization or restrict higher-cost, essential support services, potentially impacting home- and community-based service stability.
• Families and providers questioned whether that managed care could increase prior authorization requirements and denials, impacting time-sensitive services and durable medical equipment access, as well as increasing caregiver administrative burden.

Virtual Medicaid Provider Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held virtually on February 3, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the virtual listening session is available in the Virtual Listening Session Library.

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 2:00 - 4:00 p.m.

Session Overview
Approximately 224 individuals attended the Medicaid Provider Listening Session, including Medicaid members and families/caregivers, family home operators, therapy and behavioral health/substance use disorder (SUD) providers, independent child/developmental disability (DD) providers, special education leaders and school-based Medicaid billers, and physicians/primary care representatives. Attendees largely conveyed that services and supports are already under strain, and they expressed concern that comprehensive managed care could exacerbate provider shortages, reduce reimbursements, increase prior authorization/denials, and destabilize small and rural providers. Some attendees requested more open and transparent communication from the state around the upcoming transition. 

Administrative & Payment Issues:

• Many small and rural providers described limited administrative capacity and warned that managed care could introduce an “astronomical” increase in paperwork, contracting, training, and prior authorization workload.
• Certified family home operators and home and community-based services (HCBS) providers emphasized that added administrative steps could reduce time available for care and increase caregiver and provider burnout, especially when layered on top of existing documentation requirements.
• Attendees repeatedly raised concerns about payment delays, difficulty reaching a live representative to resolve billing issues, and limited avenues to escalate or appeal operational problems, issues that could threaten provider solvency and continuity of services.
• Providers and families raised concerns that managed care could increase prior authorizations, denials, visit limits, and added documentation requirements that could delay medically necessary care. 

Contract Safeguards and Provider Protections:

• Attendees advocated for strong contract guardrails to protect members and providers from adverse managed care practices, including clear requirements for continuity of care, timely and transparent communications, and limits on disruptive mid-year policy changes.
• Multiple providers referenced prior experience in other states where MCOs reduced reimbursement rates with little notice. They requested contractual protections, such as advance notice requirements, defined change windows, and stakeholder engagement before material policy or rate changes.
• Participants requested safeguards to ensure utilization management uses appropriately qualified clinicians, especially for pediatrics and specialty therapies, to reduce inappropriate denials.
• Attendees stressed that rural and small providers must be treated as essential partners and that contracts should include enforceable network adequacy standards that reflect Idaho’s geography and provider shortage realities, with accountability when networks deteriorate.
• Providers and families raised concerns that managed care could increase prior authorizations, denials, visit limits, and added documentation requirements that delay medically necessary care.

Program Design:

• School district and charter school participants strongly emphasized that school-based Medicaid operates differently from traditional Medicaid provider types due to requirements under the Individuals with Disabilities Education Act (IDEA) and Individualized Education Programs (IEPs). As schools already have significant administrative burden and specific funding mechanisms and service requirements under federal law, multiple attendees advocated for a school-based services carve-out from comprehensive managed care.
• Participants asked operational questions about whether districts would need to contract with multiple MCOs, how federal match would work, how students moving across plans and/or school districts would be supported, and how quality and provider shortages would be addressed without adding additional administrative burden.
  General Feedback Related to the Medicaid Program

Access to Services:

• Attendees emphasized that HCBS and waiver services enable people with complex needs to remain safely at home and in their communities. Multiple speakers highlighted that Medicaid services directly affect health stability, family safety, and long-term independence goals for children and adults with disabilities.
• Participants expressed concern that reduced access to early intervention and pediatric therapies may increase downstream need for more intensive and costly services later, potentially worsening outcomes.

Provider Rate Cuts and Financial Sustainability:

• Across therapy, behavioral health, HCBS, and certified family home providers, participants stated that reimbursement is already at or beyond a threshold they can tolerate, with recent cuts leading to staff losses, reduced services, and risk of clinic closure, particularly in rural areas with provider shortages.
• Several providers expressed concern that managed care historically reimburses below fee-for-service and may impose additional uncompensated administrative work, making participation in managed care financially nonviable for small practices and independent providers.
• Participants expressed that further rate compression could accelerate workforce attrition, reduce access for Medicaid members, and create spillover impacts on the broader healthcare ecosystem.
   

Caldwell Medicaid Member Listening Session Recap 

The recap below is an anonymized summary of the feedback collected during the Medicaid Member Listening Session held in Caldwell on January 6, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the listening session is available in the Caldwell Information document library. Copies are available in English and Spanish. 

If you would like to share feedback, please fill out the Comments and Concerns Form. 

Session Time: 10:00 a.m. - 12:00 p.m. 

Session Overview

Approximately 25 individuals attended the Medicaid Member Listening Session, including families of Medicaid members, member advocacy association members, assisted living providers, developmental disability (DD) providers, community-based providers, Idaho state agency representatives, and managed care organizations (MCOs). Providers in the session spoke on behalf of the individuals they serve who were unable to participate in the session. Attendees voiced concerns about ongoing DD waiver access and navigation challenges, advocacy for strong contract language and oversight of MCOs, and worries about ongoing provider financial solvency challenges due to timely payment issues. They also expressed excitement about the prospect of streamlining care coordination and system navigation under comprehensive managed care.

Access to Services:

• Attendees expressed that the DD waiver can be overwhelming and challenging for many families to access and navigate. It offers crucial support that families need, but it also can create frequent situations where families face subjectivity in waiver approvals, leading to confusion, extra advocacy work, and perceived unfairness.
• Attendees asked questions regarding how funding for services and MCO reimbursement will work as it relates to members’ access to care and services.
• Attendees asked clarifying questions and expressed concerns about the potential for comprehensive managed care to create waiting lists for members to access needed services.

Provider Network Adequacy and Access: 

• Provider attendees explained that it is challenging to find and retain County Support Workers (CSWs) and support brokers due to low wages and workforce challenges, which in turn can create additional burden for families attempting to access services they need.
• Attendees emphasized the importance of maintaining DD service coordinators with strong DD system expertise. Moving coordination solely to MCOs could risk loss of local expertise and individualized support.
• Participants highlighted that provider networks must remain strong and comprehensive, especially in rural areas, so that families have uninterrupted, proximate access to the care they need.

Accountability:

• Attendees expressed significant frustrations and concerns with the inconsistent and lack of timely payments that occur with current Idaho managed care organizations. Payment delays create significant financial solvency issues and risks, especially for small and independent providers.
• Attendees suggested including language in the contracts that contains more stringent penalties, interest, and/or liquidated damages for late payments to providers, improves monitoring and oversight of MCOs, and requires robust technical assistance for providers to promote clean claims submission. One attendee suggested requiring MCOs to have a certain ratio of staff dedicated to claims submission and issues technical assistance, rather than a set number, to help balance workloads and wait times.
• Attendees suggested strengthening provider network adequacy requirements in the contract, including provider relationship strength performance incentives and measures for monitoring provider network churn or loss.

Rollout Timeline and Program Design:

• Attendees expressed concerns with families’ abilities to navigate their options and choose the managed care plan that best fits their needs as this process can be overwhelming for many. Attendees emphasized the importance of providing a neutral, third-party resource such as an enrollment broker or a user-friendly online portal to assist members with these processes and decisions.
• Participants expressed concerns with, and asked clarifying questions about, MCOs’ abilities to restructure services based on how they conduct programs in other states and markets.
• Provider participants strongly emphasized the benefits of the contract language development process including input from providers to best understand what requirements are needed.

Payment Models and Capitation: 

• Participants expressed concerns that managed care monthly capitation payments might incentivize MCOs to limit access to higher cost but essential services, like supported living, to maximize their profits.
• Participants asked clarifying questions about how the State may implement risk-adjusted payments for MCOs to manage financial unpredictability, particularly during the transition period.

Caldwell Medicaid Provider Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held in Caldwell on January 6, 2026. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 2:00 - 5:00 p.m.

Session Overview 
Approximately 50 individuals attended the Medicaid Provider Listening Session, including school district representatives, community-based providers, dentists, developmental disability (DD) providers, nursing facility providers, assisted living providers, Idaho member and provider advocacy associations, targeted service coordinators, and managed care organizations. Attendees expressed concerns regarding the transition to comprehensive managed care. They shared worries that the transition will make existing timely payment and rate reduction issues worse and that insufficient contractual requirements, data sharing, and oversight could make it challenging for providers to successfully work with managed care organizations.

Rollout Timeline and Program Design:

• Multiple participants strongly advocated for school-based services to be carved out of comprehensive managed care, citing federal education laws, unique administrative structures, budget scarcity and predictability needs, and school districts paying the non-federal share for these school-based services costs. Schools already face challenges with low reimbursement rates, limited staff, and burdensome billing and administrative processes. School-based services representatives requested timely communication about program design decisions so that they may adapt their advocacy and activities as needed.
• Attendees requested that the State implement the transition slowly to avoid administrative errors, payment interruptions, and service gaps and use a program design approach that reflects the nuance of smaller providers, rural communities, and individualized DD supports.
• Participants expressed concerns with comprehensive managed care limiting members’ choices. 
  Attendees highlighted that MCOs should be required to have at least a rudimentary knowledge of Idaho’s culture and systems.

Payment Models and Capitation:

• Providers, especially rural and small business providers, expressed concerns with the transition to comprehensive managed care amplifying the significant timely payment and rate reduction issues they are already experiencing with the current MCOs. They emphasized the threat to their financial stability caused by this payment unpredictability causes.
• Attendees communicated that other states have documented rate reductions, reimbursement delays, staff retention challenges, and access issues after transitioning to managed care and requested that the State carve out DD provider facilities and independent providers to reduce their risks, protect service access, and support workforce stability.

Contract Safeguards and Provider Protections:

• Provider participants requested the ability to review and provide inputs on the contract language before the Request for Proposals (RFP) is released.
• Attendees requested establishment of active advisory committees, robust and high-quality data sharing requirements, and strong performance accountability directly tied to payment, access, and care outcomes. Improved data quality, transparency, and use could allow providers and MCOs to work together to create better care for the State.
• Participants expressed concerns about inappropriate claw-backs, denied claims, and unclear appeals processes they experience with the current MCOs becoming more prevalent under comprehensive managed care. 
  Participants stressed the importance of including strong contract language to hold MCOs accountable for timely payment and member care decisions.
• Attendees expressed frustrations and challenges with the lack of transparency and unexpected costs and financial burdens they’ve experienced with the current MCOs. Providers requested that the contract require MCOs to include actual costs in their request for changes that they make of providers. 
  Participants emphasized that providers need better training, support, and education resources so that providers and MCOs may learn to work together more effectively.  

Network Adequacy and Access:

• Attendees expressed concerns that care coordination under comprehensive managed care could be duplicative of the services that Targeted Service Coordinators (TSCs) currently provide for individuals receiving DD services. Families and providers value the longstanding relationships and deep expertise of TSCs, and attendees worry that MCO-driven care coordination could be impersonal, overburdened, and/or lack DD- and system-specific knowledge.
• Attendees expressed concerns that decreased access to care and providers in rural areas under comprehensive managed care could leave highly vulnerable individuals with few options.
  Participants expressed frustration that Medicaid dental access is currently very limited for adults, particularly adults in nursing home and assisted living settings, and requested additional monitoring and measures for adult dental care access and provision. Decreased adult dental care access will lead to higher levels of care being accessed more frequently and increased costs over time.

Rexburg Medicaid Member Listening Session Recap 

The recap below is an anonymized summary of the feedback collected during the Medicaid Member Listening Session held in Rexburg on December 15, 2025. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the listening session is available in the Rexburg Information document library. Copies are available in English and Spanish. 

If you would like to share feedback, please fill out the Comments and Concerns Form. 

Session Time: 12:00 - 2:00 p.m. 

Session Overview

Approximately 60 individuals attended the Medicaid Member Listening Session/Testimony, including members and families of Medicaid members. In addition to feedback related to the transition to comprehensive managed care, attendees also voiced a desire for DHW to maintain transparent communication by regularly updating stakeholders on transition progress, decisions, and impacts.

Feedback Related to Managed CareTransition

Access to Services:

• Attendees explained that dental services in Medicaid fee-for-service have been hard to access and poor in quality. One member has had a positive experience with dental service access and quality with the Medicaid and Medicare duals plan and expressed the importance of quality dental service access across Idaho as an important factor for physical and mental health.
• One member stated that access to some mental health medications has not always been available, as restrictions and lack of communication across different provider types can cause barriers. Some individuals take years to find medication(s) that work well for them, and losing access can be catastrophic.
• Attendees expressed concerns about being able to access Katie Beckett services and levels of care consistent with children’s needs as part of the transition.
• Attendees explained that they have missed out on earlier opportunities to access services for themselves or their family members due to lack of awareness. They stressed that early intervention, access to services, and adequate provider support are essential to long-term outcomes.
• Attendees expressed how confusing and frustrating it can be to navigate Medicaid and Medicare enrollment platforms and processes. Enrollment brokers and accessible information, education materials, and guidance have been helpful resources when navigating the systems and understanding what services are available. 

Network Adequacy and Access:

• Attendees underscored the value and importance of relationships and continuity with providers, particularly for intellectual and developmental disabilities (ID/DD) and behavioral health services. There are concerns about providers leaving the network and losing access to services after the transition to managed care.
• Attendees expressed concern with ID/DD and behavioral health managed care rolling out as a phase 2 of the comprehensive managed care transition and whether their access to waivers and services in those spaces will be disrupted.

Accountability:

• Members expressed that they sometimes receive conflicting information across health plans, providers, and the state due to lack of comprehensive and uniform provider education. Strong accountability is needed to make sure accurate information is being shared across stakeholder groups.
• Members reported confusion, frustration, and gaps due to not having a uniform definition or supporting contract standards and enforcement mechanisms for care coordination, which has led to fragmented care and wasted resources.
• Attendees expressed a desire for strong MCO monitoring and accountability mechanisms during and after the transition via the contract. Contracts must sharply define key responsibilities so nothing critical is left to plan interpretation.

Rexburg Medicaid Provider Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held in Rexburg on December 15, 2025. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 2:00 - 5:00 p.m.

Session Overview 

Approximately 65 individuals attended the Medicaid Provider Listening Session/Testimony, including physicians, pediatricians, mental health specialists, community-based providers, certified family home providers, physical therapists, speech therapists, occupational therapists, federally qualified health center (FQHC) providers, and developmental disability providers. Attendees expressed significant concerns regarding the comprehensive managed care transition, sharing worries that the transition will leave vulnerable populations at risk and will require strong contractual protections for providers. In addition to feedback related to the transition to comprehensive managed care, attendees also voiced concerns about the interrelatedness and downstream impacts that recent Medicaid program cuts and provider reimbursement rate cuts have on the transition to comprehensive managed care. 

Feedback Related to the Managed Care Transition

Rollout Timeline and Program Design:

• Attendees expressed concerns about the phased comprehensive managed care program roll-out and asked for assurances that they will continue to have a voice in shaping program design.
• Attendees expressed concerns about potential policy authority shifts from the legislature to the agency level without full legislative process or input. Providers explained that this lack of oversight increases risks for members, providers, and system stability.
• Attendees discussed that some degree of regional understanding and program design elements are important to include because services and needs (e.g., crisis services) look different region-by-region.
• Providers requested the ability to review and provide input on the managed care RFP and contracts before finalization.
• Attendees expressed widespread concern that out-of-state MCOs may lack understanding of Idaho’s population, unique needs, rural landscape, and region-specific challenges.
• Attendees expressed concerns with spending Idaho taxpayer dollars on out-of-state plans instead of reinvesting locally.
• Attendees advocated for Idaho-specific program fidelity models and contract requirements, including accountability for delivering on Idaho First values and requirements.

Payment Models and Capitation:

• Attendees provided strong feedback about the need to set realistic, data-driven capitation rates for the MCOs to avoid provider network erosion and coverage gaps.
• Attendees expressed that rate cuts, fee changes, and service cuts threaten small providers’ financial sustainability.
• Attendees stressed the need for robust, Idaho-specific data to inform rate setting, provider network adequacy, and ongoing evaluation and monitoring of the MCOs.
• Attendees reported challenges with managed care, including unclear and cumbersome billing systems, lack of real “live” claims testing, and lack of transparency. Robust claims testing is critical before the new program and systems can roll out.

General Feedback Related to the Medicaid Program 

Provider Network Adequacy and Access:

• Attendees expressed concerns that MCOs may create provider access limits and network constraints, particularly for rural and specialized services, causing coverage gaps, threats to continuity, and loss of choice for Medicaid beneficiaries.
• Members raised worries about recredentialing requirements, changing network requirements, and provider network erosion risks as patients change plans.
• Attendees stressed the importance of establishing stable rates, network adequacy requirements, medical necessity definitions, and safeguards against unnecessary interruptions to service delivery.
• Attendees explained that burdensome administrative requirements and processes and inconsistent service decisions (e.g., Non-Emergency Medical Transportation (NEMT), coverage denials, appeal complexity, etc.) threaten equity and access.
• Attendees requested streamlined navigation, additional supports, and attention to language barriers and socioeconomic factors when helping members navigate plan networks and choice.

Accountability:

• Attendees requested strong contract terms such as clear standards for Idaho-based operations and community reinvestments, liquidated damages, effective live-support call centers based in Idaho, and oversights and restrictions on plans’ ability to enact provider fees on operational requirements.
• Attendees underscored the importance of establishing effective and transparent contract monitoring mechanisms to enforce contract accountability, prevent “box-checking”, and ensure MCOs align with Idaho First values.

Pocatello Medicaid Member Listening Session Recap 

The recap below is an anonymized summary of the feedback collected during the Medicaid Member Listening Session held in Pocatello on November 10, 2025. This feedback will inform DHW as it develops a comprehensive managed care program. A copy of the presentation from the listening session is available in the Pocatello Information document library. Copies are available in English and Spanish. 

If you would like to share feedback, please fill out the Comments and Concerns Form. 

Session Time: 2:00 - 4:00 p.m. 

Session Overview 

Approximately 100 individuals attended the Medicaid Member Listening Session, including peer support specialists, families of Medicaid members, licensed social workers, and community-based providers. Providers in the session spoke on behalf of the individuals they serve who were unable to participate in the session. In addition to feedback related to the transition to comprehensive managed care, attendees also voiced concerns about recent Medicaid program cuts and provider reimbursement rate cuts. Multiple attendees referenced the recent announcement of upcoming cuts to the Peer Support and Assertive Community Treatment (ACT) programs.  

Feedback Related to the Managed Care Transition 

Access to Services: 

• Attendees raised concerns about the risk that managed care would limit choice by dictating which services members can access and from which providers.
• There was concern around the potential loss of benefits for individuals currently receiving waiver services, including through the Katie Beckett program.
• Attendees raised that having to work with multiple insurance departments could cause confusion and expressed a desire for a more streamlined and member-centered system.

 Accountability: 

• Attendees asked questions about whether there will be adequate checks and balances within managed care to prevent service cuts and promote advocacy in the best interest of the members.
• Attendees mentioned that some individuals cannot advocate for themselves due to severe mental illness and/or disabilities, raising concerns about how “translation” and advocacy for these members will be protected in the new system.
• Attendees asked for assurance that their concerns would be genuinely considered in the program redesign and that feedback shared during these sessions will influence decisions. The discussion included a question on how current program cuts would be addressed during the managed care transition.

General Feedback Related to the Medicaid Program  

 Program Cuts: 

• Several participants described how peer support programs have saved lives, built hope, and provided essential bridges between clients and mental health treatment.
• Community members and individuals viewed the termination of peer support programs as a loss, both individually and for the community, with concerns about increased hospitalizations, incarcerations, and loss of hope for recovery.
• Attendees voiced concerns that services will be fragmented (e.g., peer support services split into smaller, less comprehensive units rather than integrated support systems), impacting continuity of care and reducing the effectiveness of support for individuals with complex behavioral health needs.
• People expressed general anxiety over losing behavioral health services, long wait times for authorizations, and difficulties navigating the Medicaid program. Attendees shared a strong sentiment of uncertainty and frustration regarding the decision to cut certain services. 

 Provider Rate Cuts: 

• Attendees noted that lower Medicaid reimbursement rates, which are already seen as a barrier to service access and availability, may force providers to decline Medicaid patients completely.
• Attendees emphasized that maintaining options, member choice, and community-based supports are crucial for member well-being.

Pocatello Medicaid Provider Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held in Pocatello on November 10, 2025. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 5:30-7:30 p.m.

Session Overview 

Approximately 130 individuals attended the Medicaid Provider Listening Session, including physicians, mental health specialists, community-based providers, dentists, representatives of tribal communities, hospital executives and developmental disability providers. Attendees expressed both hope and substantial concerns regarding the comprehensive managed care transition. They shared worries that the transition will leave vulnerable populations at risk and will require strong contractual protections for providers but also expressed a willingness to work collaboratively with DHW and share expertise to help navigate this complex transition.

Feedback Related to the Managed Care Transition

Rollout Timeline and Program Design

• There was concern that Idaho’s current managed care transition timeline is too short and that other states have rolled out managed care over 7-10 years and even then encountered setbacks due to condensed timelines.
• Several stakeholders advocated for piloting managed care in regions before statewide expansion, allowing for real-world testing and iterative improvement.
• Attendees urged DHW to avoid a “one size fits all” approach to managed care and called for more tailored approaches to incorporate the diverse needs of Idahoans, such as program customization for different demographics and population needs.
• Participants emphasized that federal requirements, including tribal consultation, must inform program design. 

Payment Models and Capitation 

• Attendees raised that is difficult to establish “realistic” capitation rates and Idaho is already struggling with rate setting under the fee-for-service model. There were concerns that capitation could exacerbate financial risk for providers, especially during the transition period.
• Attendees expressed anxieties around the managed care transition and contracting processes resulting in delayed or inconsistent payments and cited past negative experiences with Non-Emergency Medical Transportation service payment delays under a managed care model.

Contract Safeguards and Provider Protections

• Attendees voiced skepticism about whether managed care contracts would sufficiently protect providers and guarantee members’ access to essential services.
• Participants requested contracts that prevent arbitrary service cuts and ensure recourse for payment or authorization disputes.
• There was concern about the use of Artificial Intelligence (AI) in the prior authorization processes and requests to have insight into the relevant algorithm or ruleset.
• Feedback highlighted the need for transparent, meaningful managed care program outcome metrics, especially for hospitals and rural clinics, where current reporting requirements are seen as either unfair or unmanageable.
• Attendees expressed fear that managed care will displace established local programs and career pathways, citing the recent loss of the Assertive Community Treatment (ACT) Team and peer support jobs as examples.

Network Adequacy and Access

• Stakeholders expressed worry that managed care network requirements may further limit provider availability, especially in rural areas where there are already gaps.
• Attendees voiced concerns that low reimbursement rates will make dental and behavioral health services harder to access under managed care.
• Concerns were raised about the planned discontinuation of the Healthy Connections program and its impact on pediatric care coordination before the transition to managed care.

General Feedback Related to the Medicaid Program 

Network Adequacy and Provider Experience 

• Attendees shared that both primary and sub-specialty physician shortages persist due to low reimbursement rates and heavy administrative requirements. The program’s complexity discourages provider participation, especially for new or rural providers.
• Providers stated that the process to join and operate within Medicaid is overly cumbersome and reported that it discourages expansion of the provider network.
• Attendees noted that rural communities already experience gaps in access to behavioral and physical health services. Although state-run facilities and hospitals provide valuable training and services, many practitioners move to private practice for better compensation.

Twin Falls Medicaid Member Listening Session Recap 

The recap below is an anonymized summary of the feedback collected during the Medicaid Member Listening Session held in Twin Falls on September 3, 2025. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form. 

Session Time: 10:00 am - 12:00 p.m. 

Session Overview

Approximately 35 individuals attended the Medicaid Member Listening Session, including Medicaid members, family members, caregivers, and several providers. Participants shared candid feedback regarding the transition to comprehensive managed care, as well as ongoing challenges relating to service disruptions, difficulty finding in-network and local providers, and challenges accessing timely, consistent information. Participants underscored the need for meaningful engagement, clearer communication, and more reliable, person-centered coordination throughout the Medicaid program.

Feedback Related to the Managed Care Transition

Access to Services:

• Attendees raised concerns that the transition could result in more administrative layers without cost savings or efficiency.
• Families and caregivers described challenges in maintaining longstanding relationships with trusted providers, with some forced to persuade providers to join new networks or switch insurance plans entirely (especially with UnitedHealthcare (UHC)). Some participants noted that the current system allows families to access community-based services, which they want to preserve.
• Attendees underscored the need for both preparedness and qualified, live human contacts (i.e., not call centers staffed outside of Idaho) to help families navigate services, paperwork, and transitions. Many emphasized the importance of local knowledge and personal support, especially for children with complex behavioral or medical needs.

Network Adequacy and Access:

• Members expressed anxiety that care might increasingly be managed out of state or by those unfamiliar with Idaho’s needs, leading to reduced access and responsiveness for residents.
• Members recounted that prior managed care transitions, including to UHC and Molina, resulted in authorization gaps and service delays at critical moments, undermining access for vulnerable members.

Managed Care Stakeholder Engagement:

• Attendees shared that previous engagement efforts, including QR codes and digital outreach, have not successfully reached people with disabilities, making it difficult to get their voices involved.
• Members advocated for more accessible, inclusive outreach, including the use of American Sign Language (ASL) interpreters in virtual sessions and proactive contact with disability and advocacy organizations to ensure that all perspectives are included.

General Feedback Related to the Medicaid Program

Provider Rate Cuts:

• Attendees voiced concern about the 4% rate reduction for Medicaid providers, noting that many providers already operate on tight margins. Several are worried that these cuts would result in providers leaving Medicaid entirely and shrink access as a result, especially in rural, hard-to-serve areas and for specialized programs.

Network Adequacy and Provider Experience:

• Attendees noted that they are already noticing provider network erosion, especially following new legislative changes (including HB 345), causing service loss for children with special needs.
• Families reported rising out-of-pocket costs for travel, copays, deductibles, and other indirect expenses, and highlighted the administrative complexity and burden facing both families and providers.

Access to Services:

• Attendees shared that funding obstacles and inconsistent or incomplete communication from the state and its managed care partners have forced them to take extreme measures to get their children the care they need.
• Attendees noted significant gaps where both Medicaid and private insurance fail to provide sufficient coverage, leading to high costs, duplicative requirements, and reliance on “natural supports” at home without sufficient external support.

Twin Falls Medicaid Provider Listening Session Recap

The recap below is an anonymized summary of the feedback collected during the Medicaid Provider Listening Session held in Twin Falls on September 3, 2025. This feedback will inform DHW as it develops a comprehensive managed care program. 

If you would like to share feedback, please fill out the Comments and Concerns Form.

Session Time: 6:00-7:30 p.m.

Session Overview 

Approximately 50 individuals attended the Medicaid Provider Listening Session, including physicians, pediatricians, dental providers, behavioral health providers, and direct care organizations. While some participants acknowledged potential modernization benefits, many attendees emphasized concerns over service reductions, administrative burdens, and the impact of recent rate cuts, especially for community-based clinics and medically complex patients. Loss of the Healthy Connections program, the threat to care coordination roles, and increased financial strain on providers were repeatedly cited as threats to care access and quality for Idaho’s most vulnerable populations.

 Feedback Related to the Managed Care Transition

 Rollout Timeline and Program Design:

• Some providers acknowledged managed care as an opportunity for process improvement but cautioned that successful implementation typically takes several years and demands direct provider engagement in program design and public contract review.
• Participants recommended regular public review of MCO contracts and inclusion of providers in all design and evaluation stages.
• Attendees expressed the need for transparent, ongoing evaluation of MCO contracts and outcomes. Providers urged that spending on administration and care coordination should ultimately benefit patients and practitioners, not just MCOs.
• Concerns were raised that managed care transitions often result in reduction of services over time, financial disorganization, and major administrative delays, especially during go-live periods and episodes like the Magellan transition.

Payment Models and Capitation:

• Attendees flagged the difficulty of accurate capitation rate setting and the risk of delays/inconsistencies. Participants advocated for rates that consider member complexity, citing examples of other states customizing payment for children with high needs. 

Accountability:

• Attendees discussed increased administrative workload from duplicative audits, billing with multiple payers, and complex authorization requirements, especially in transitions involving MCOs like Molina and Magellan.
• Many attendees expressed frustration over billing delays and paperwork that disrupt timely payment and care delivery.

Administrative & Payment Issues:

• Participants expressed the need to keep assessment and progress tools like the Child and Adolescent Needs and Strengths (CANS) system accessible to both providers and managed care organizations.

Contract Safeguards and Provider Protections:

• Participants expressed the need to keep assessment and progress tools like the Child and Adolescent Needs and Strengths (CANS) system accessible to both providers and managed care organizations.

Network Adequacy and Access:

• Participants urged the preservation of adult dental benefits and recommended integrating preventive dental health into primary care to better support whole-person care.
• Attendees noted that centralized, out-of-state call centers are seen as unresponsive and create barriers for families needing assistance with authorizations or care navigation.
• Several attendees called for the preservation of existing community-based programs like supported housing and the Katie Beckett waiver after the transition and objected to changes that would force more paperwork or jeopardize these services.
• Participants recommended targeted service coordination and live service navigation, not just paper eligibility or call center scripts.

 General Feedback Related to the Medicaid Program

 Program Cuts:

• Attendees expressed broad concern about the potential elimination of the Healthy Connections program, which funds local care coordinators and supports the medical home model, viewed as the gold standard for medically complex children and adults.
• Providers noted that Healthy Connections has enabled their clinics to deliver higher-quality, more cost-effective care, especially for Medicaid’s high-need and rural members, and that funding from the program directly supports hiring care teams and keeping people out of higher-cost hospital or ER care.
• Attendees stressed that ending Healthy Connections harms small practices, reduces care continuity, reduces access to specialists, and undermines incentives for providers to serve Medicaid members.

Provider Rate Cuts:

• Participants stated that low reimbursement rates, especially the recent 4% cut, are unsustainable for many practices, especially in rural, behavioral health, dental, and specialty care.
• Attendees stated that workforce retention is an urgent challenge and that caregivers and clinical staff are leaving due to inadequate pay and high risk.
• Providers noted that that H345 and the recent rate cuts threaten coverage continuity and could destabilize small businesses and local clinics.

There will be three managed care plans.

The managed care plans will be statewide. 

Idaho will allow multiple governance types (non-profit, for-profit, provider affiliated plans etc.). The state will require Idaho-based leadership, advisory boards, and local accountability structures as explicit contract obligations. 

The state aims to have delegation with strong guard rails. Idaho will delegate most operations but embed standardized statewide requirements and explicit approval over key functions to maintain consistency.

State law directs comprehensive managed care. The state intends to include all services in managed care, with few, if any, exceptions. Services supporting people with intellectual and developmental disabilities will transition to managed care two years after all other services. 

State law directs comprehensive managed care. All populations will be covered with managed care except where the federal law requires exemptions. For example, tribal members may opt out of managed care. 

The state will have a tiered approach to plan assignment. 
(1) All members will be able to choose their managed care plan.
(2) Among members who do not choose, the state will prioritize family unity and existing provider relationships.
(3) Remaining members will be assigned in a manner that helps support an even distribution of members across plans. When plans are not meeting contractual obligations, the state may also withhold new membership until plans are in compliance.

The state will approve all member materials and prescribe timelines for distribution of key materials.

Eligibility determinations are made exclusively by the state. Managed care plans will support work and community engagement requirements by sharing information about the requirements, and leveraging their provider networks to connect members to employment services or job training. The state is still exploring the extent to which managed care organizations may be able to help members gather documentation, screen for exemptions, or provide other support. 

State law requires cost sharing at the highest level approved by any state. Managed care will not impact cost sharing.

Similar to employer-sponsored insurance or Medicare, Idahoans on Medicaid will be able to choose their initial plan upon enrollment and then once annually during open enrollment after that. Members may also change plans at any time for specific reasons such as lack of access to providers.

Idaho will define key expectations with transitions of care, such as notification expectations, follow up and medication continuity.

State law directs comprehensive managed care. The state intends to include all services in managed care, with few, if any, exceptions. Services supporting people with intellectual and developmental disabilities will transition to managed care two years after all other services.

The Rural Health Transformation Program is underway now and ends FY 2030. Managed care timelines do not support significant integration with the program.

The state will have a Single Pharmacy Benefit Manager, which is a specialized contractor overseeing pharmacy benefits independent of the managed care organizations. Data will be shared with the managed care organizations to support care management. 

The state will identify quality domains and minimum performance improvement plan requirements while allowing managed care organizations discretion in designing specific interventions, project methodologies and additional improvement initiatives. 

Managed care plans will be required to be licensed with the Idaho Department of Insurance before contract signature.

As a general approach, Idaho will have enhanced provider protections with escalation mechanisms to support a stable transition. We are exploring contract language that has explicit financial remedies, interest on late payments, and expedited state mediation processes.

Idaho will require providers to at least match the fee-for-service rate for a period following the transition. The state will reassess to what extent flexibility in rate setting is appropriate for certain or all services following stabilization.

Idaho will pursue provisions for interest or penalties for appropriately submitted claims that are not paid timely. The state will also continue to have liquidated damages for systemic late payment.

The state will have a matrix of liquidated damages for high impact contract failures, such as noticing requirements, provider directory accuracy, and call center performance.

The state will have a medical loss ratio and likely have risk sharing toward the beginning of the contract to account for unknowns during transition. Reinsurance pools and reconciliations will be avoided and only used if necessary for actuarial soundness. 

Medical loss ratios will accompany incentives (such as performance withholds) and remedies (such as liquidated damages) embedded in the contract.

By having clear performance withholds for managed care organizations that build upon provider-level alternative payment model requirements, the state aims to capitalize on creativity of managed care organizations while driving efforts toward the state's goals of improve outcomes and cost containment. 

Idaho's contract will require standardized engagement with bidirectional feedback loops. Managed care organizations will have dedicated provider relations staff in Idaho, training and education, provider manuals, and expectations in relation to training cadence, advisory committees with state attendance, and frequency of communication in some situations.

Idaho will have moderate prescriptiveness in the way managed care organizations report on provider performance. Federal rule requires the development of an external facing provider scorecard to better inform participants selecting a provider. The state will standardize some components of the scorecard to decrease reporting burden on providers who may be enrolled with multiple managed care plans.

Encounter data and other reporting are critical requirements. The state will establish core expectations in the contract and require compliance with a systems manual defining encounter data, reporting formats, validation rules, and correction processes. Idaho will also need to develop feedback loops with managed care organizations before implementing changes. 

The state aims to have a state operated publicly posted dashboard with information about managed care plan performance, such as prior authorization approval rates and denial reasons, timely payment metrics, and network adequacy measures. The purpose of sharing information publicly is to give participants more information when selecting a plan and providers more information when contracting with plans. 

Participants always have the right to choose their primary care provider. If the participant does not make an active selection, their managed care organization will assign a primary care provider and take into consideration whether the participant previously has been supported by a primary care provider in the network.

Some managed care organizations may elect to offer a qualified health plan and a Medicaid managed care plan. These plans will have different coverage and eligibility criteria; however, member choice may be influenced by which plan they previously had when moving to or from Medicaid when their income changes. Managed care plans will be required to support continuity of care in transitioning to any new health coverage, including on the insurance marketplace.

While some more populous states have variation in NEMT administration across managed care plans, Idaho intends to pursue more prescriptive contractual expectations and maintain a detailed information flow concerning NEMT performance due to its importance in such a remote state