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Slide 1: Modernizing Idaho Medicaid Prevention, Wellness & Responsibility 1
Slide 2: Approach to Modernization      Simplify eligibility Need to balance access, quality and cost containment Establish goals by target population Structure benefits to meet health needs Phased Implementation 2
Slide 3: State / Federal Approval  2006 State Statute Changes   Legislator input Legislator champions  Federal approval of 13 State Plan Amendments  Frequent meetings with CMS prior to submission 3
Slide 4: Three Benchmark Plans    Basic Plan: Individuals with average health needs; Enhanced Plan: Individuals with disabilities or special health needs; and Medicare/Medicaid Coordinated Plan: Dual eligibles 4
Slide 5: Enrollment in Benchmark Plans* 19% Basic Enhanced 56% Coordinated Awaiting Assignment 7% 18% *July, 2007 5
Slide 6: Benchmark Lessons Learned     Coordination and communication with external and internal stakeholders Gradual transition to new plans Qualifications for Enhanced Plan of Mental health services Medicare Coordinated Plan choice 6
Slide 7: Streamlining Enrollment      Eligibility categories simplified Identification of health needs at time of application Identification of PCP at application Elimination of asset test for children Consolidated unit for application processing 7
Slide 8: Enrollment Lessons Learned     Medical home established early without additional paperwork Eligibility simplification helped staff and participants Ambitious implementation timeline Identification of health needs pose challenges 8
Slide 9: Cost Sharing    Basic Plan: Tiered premiums for individuals > 133% FPL Enhanced Plan: Tiered premiums for workers with disabilities (Buy-In) Co-Pays for selected services  Co-Pay challenges 9
Slide 10: Preventive Health Assistance  Behavior accounts: Points for weight loss & tobacco cessation  Points used for weight management and smoking cessation  Wellness accounts: Points for well child exams & immunizations for individuals paying premiums  Points used for premium payments 10
Slide 11: PHA Lessons Learned     Minimal closures for not paying premiums Rewards healthy behaviors Federal challenges Limited enrollment for behavior benefits 11
Slide 12: Premium Assistance    Premium assistance for individuals who work for small business employers Premium Assistance for children Expansion challenges 12
Slide 13: Dental Outsourcing    Dental for Basic Plan participants outsourced to improve access for preventative & restorative dental care Implemented 9/1/2007 Challenges to date  Provider enrollment 13
Slide 14: Other Reforms          Increased rates for well child exams Adult routine annual wellness exams Healthy Schools initiative Best price negotiated for incontinent supplies Multi-State purchasing pool for pharmacy pricing Pay for performance Pilot: Diabetes Transportation Brokerage LTC Partnership / Estate recovery Medicare enrollment as a condition of eligibility 14
Slide 15: Questions  Patti Campbell campbell@dhw.idaho.gov 15