The Future of Idaho Medicaid is Managed Care

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 Rexburg 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 Pocatello 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.