The Future of Idaho Medicaid is Managed Care

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. 

If you would like to share feedback, please fill out the Compliment, Comment, Concern 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 Compliment, Comment, Concern 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.