As the Idaho Legislature considers Medicaid Expansion this week, we’ve been called to answer a lot of questions about this complex program.
As a reminder, the Division of Medicaid provides healthcare services for low-income people and families in Idaho. This includes adults and children, pregnant women, people over the age of 65, and people with disabilities who meet eligibility requirements.
If you currently receive Medicaid, please take action to make sure you receive notices about your benefits and re-evaluations. Report any changes in your household information, including your phone number and address.
If your contact information has changed, or you want to confirm your current information, call DHW at 877-456-1233 or email MyBenefits@dhw.idaho.gov. You can also report changes by visiting idalink.idaho.gov
Who is served by Medicaid Expansion?
As of January 2023, around 145,000 Idaho residents are enrolled in Medicaid Expansion. These are individuals who have a monthly income of $1,563 or less, or a family of four with a monthly income of $3,192 or less.
Most of them, over 80%, have reportable income.
Some of them, 24%, have a primary diagnosis of Serious Mental Illness. Medicaid Expansion allowed them access to a wider range of behavioral health services so they could get more comprehensive treatment. The state was paying for some services before expansion. Now for every dollar spent in Medicaid, the state pays 10 cents and the federal government pays 90 cents. The cost of Medicaid Expansion is split with 90% paid for by the federal government and 10% paid for by the state.
By comparison, for every dollar spent for traditional Medicaid, the federal government pays for about 70 cents, while the state pays for around 30 cents.
On average, people with a Serious Mental Illness live about 20 years less than others because they often have untreated physical health issues. Medicaid Expansion allows for more comprehensive treatment of both physical and behavioral health issues, which might help people live longer.
Did Medicaid Expansion reduce costs for healthcare providers?
Yes -- hospitals report spending $42 million less on charity care and had $61 million less bad debt from 2019-2021.
What is Medicaid Protection or continuous Medicaid enrollment?
During the COVID-19 public health emergency, states were not allowed to remove anyone from Medicaid enrollment unless they moved out of the state, asked to be removed, or died. This was called continuous Medicaid enrollment or continuous Medicaid coverage. It was also called Medicaid Protection.
As people’s situations or incomes changed, some of the people enrolled in Medicaid and Medicaid Expansion are no longer qualified to get benefits. Recent federal statute allows the department to remove Idahoans who no longer qualify for Medicaid starting April 1. Notices will be sent to those people starting Feb. 1, and those re-evaluations are expected to be finished by September. If they are found to be ineligible, they will no longer receive Medicaid or Medicaid Expansion benefits.
Does this mean people enrolled in Medicaid Expansion will be removed from the program?
We expect that some Medicaid Expansion participants will no longer be eligible and will be removed from the program.
Of nearly 450,000 Idahoans enrolled in Medicaid (including Expansion), we know that 300,000 are eligible because DHW staff have completed their re-evaluations.
There are about 150,000 people currently enrolled in Medicaid who we know either don't qualify or have not been in contact with the department during the public health emergency. Of these, 67,000 are enrolled in Medicaid Expansion.
In the re-evaluation process, those who no longer qualify for Medicaid may be eligible for the Advance Premium Tax Credit (APTC). That credit can be used to buy health insurance on the state-based health insurance market, called Your Health Idaho. The department has worked closely with Your Health Idaho to create transitions for those who may need to switch from one kind of coverage to the other.
Will the department send out all 150,000 notices on Feb. 1?
The department will send the notices out in batches of about 30,000 each month for the next six months. The federal Centers for Medicare and Medicaid Services requires that we complete the full re-evaluation process for all participants in Medicaid Protection. This means that once we send the notices, customers have up to 60 days to respond. If they don’t respond at all, they can be removed from the program. If they do respond, that starts a process to determine if they are eligible.
Healthcare costs and Medicaid costs seem to increase each year. Does the department have a plan to keep costs in check?
Containing Medicaid costs is very important to us. Since the pandemic began at the same time Medicaid Expansion was rolling out in Idaho, we don’t yet have a clear picture of the true costs of Expansion. As we move through this next year or two and hopefully away from the pandemic, we expect to get a more accurate idea of what the costs will be.
In the meantime, the Healthy Connection Value Care Program focuses on paying healthcare providers for value, rather than volume. Medicaid participants are connected with a primary care provider who can help them make healthier decisions and get treatment for issues before they become chronic and more expensive.
Here’s how that works. The vast majority of healthcare providers across the state participate in at least one of the 11 value care organizations. These agreements set cost targets for healthcare providers for their Medicaid patients. If the annual cost comes in above the target, the healthcare providers pay Medicaid for a portion of the higher cost. If the annual cost comes in below the target, the healthcare providers share in some of the savings.
To make sure that cost savings are not achieved by reducing access or quality, healthcare providers must also achieve quality targets, which means their patients are achieving better health.
I hope you have a safe and healthy weekend.
The Idaho Department of Health and Welfare is dedicated to strengthening the health, safety, and independence of Idahoans. Learn more at healthandwelfare.idaho.gov.
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