An Essential Guide To Idaho's Medicaid Program

In the world of social programs, Medicaid is one of the hardest to understand.  It’s something of a catch-all program for low-income people, covering broad and divergent needs. Included are healthy children and adults with eligible dependent children, people with disabilities or special health needs, and the elderly. Eligibility is income-based and it varies according the category of qualification for the program.

During the state’s 2011 fiscal year, more than three quarters of the funding allocated to the Department of Health and Welfare’s budget went to Medicaid. The program received about $1.55 billion in federal and state funding, with 74 percent of those dollars coming from the federal government.

Enrollment in Idaho’s Medicaid program has grown substantially in recent years. The average monthly Medicaid enrollment was fairly stable between 2006 and 2008.  It grew by about 3.5 percent.  But in the last three years, the program’s enrollment has grown nearly 21 percent.  Ballooning from about 185,000 in 2008 to 228,897 in 2012.

Kaiser Family Foundation

According to a new Kaiser Family Foundation study, the 29 states that expanded Medicaid since the Affordable Care Act have – not surprisingly – witnessed increased enrollment and spending. Those states brought in new low-income enrollees that were not eligible before. In California alone, 3.4 million people were added to the state-run health insurance program.

Morgan / Flickr Creative Commons

Latinos in Idaho experience barriers that make the process of enrolling in healthcare through the state's  insurance exchange more challenging. That's according to a report released Thursday by a liberal advocacy group, the Idaho Community Action Network (ICAN).

Wally Gobetz / Flickr Creative Commons

The U.S. Supreme Court ruled 5-4 Tuesday in favor of the State of Idaho in a fight over Medicaid payments to providers. The decision could impact Medicaid's low-income patients across the state. 

The case began after a 2009 lawsuit against the state. Officials with Idaho's Department of Health and Welfare had recommended increasing payment rates to private medical providers who serve Medicaid patients.

Zacklur / Flickr Creative Commons

The Supreme Court says private sector health care companies cannot sue to force states to raise their Medicaid reimbursement rates to keep up with rising medical costs.

The justices ruled 5-4 Tuesday that the medical companies have no private right to enforce federal Medicaid funding laws against states if Congress has not created such a right.

Boise State Public Radio

Idaho lawmakers have directed their staff to spend the next nine months studying the state’s contract with Optum Idaho, the company that manages outpatient behavioral health services for Medicaid patients.

Stethescope, Health Care, Doctor, Medical
Emilie Ritter Saunders / Boise State Public Radio

Medicaid expansion supporters began their uphill journey Thursday in attempting to win over Idaho's Republican-controlled Statehouse where most lawmakers consider the idea politically toxic.

Idaho Department of Health and Welfare Director Dick Armstrong tells the House and Senate Health and Welfare Committees that Idaho could save more than $173 million over the next 10 years by loosening its Medicaid eligibility.

An Idaho work group has tweaked its recommendations on expanding Medicaid eligibility in a last-minute effort to make their plan more politically palatable to lawmakers.

Work group facilitator Corey Surber says the 15-member group approved a hybrid model Friday. The group had finalized a proposal to Gov. C.L. "Butch" Otter back in August. However, lawmakers warned the proposal's blanketed support of Medicaid expansion would fail to even be considered when the Republican-controlled Legislature convenes in January.

In Crisis: Idaho Medicaid In Flux Causes A Big Shift In Care

Oct 31, 2014
mental health, in crisis
Katherine Jones / Idaho Statesman

Nine-year-old Kendra sits in one of the private rooms on the second floor of Boise’s Downtown public library with her community-based rehabilitation services worker, Jennifer Beason.

Beason slides a workbook to Kendra. It is what she calls her feelings journal. “Do you know what relieved is?” she asked.

Without missing a beat, Kendra rattles off examples of feeling relieved.

DBKing / Flickr

The Supreme Court will decide whether private sector health care providers can force a state to raise its Medicaid reimbursement rates to keep up with rising costs.

The justices on Thursday agreed to hear an appeal from Idaho.

The state is trying to overturn a lower court decision that ordered the state to increase payments.

Becky diVittorio, Optum
Idaho Statesman

A federal agency is investigating whether the company Idaho hired to manage part of its Medicaid program has violated patient-privacy laws.

Optum Idaho, a unit of United Behavioral Health, took over insurance management for Idaho Medicaid's mental-health and substance-abuse patients last fall.

Local health-care providers who treat those patients say Optum has erroneously sent them reports meant for other providers. The reports show patient names and mental-health or substance-abuse services the patients received or were authorized by Optum to receive.

Federal Officials Order Medicaid To Cover Autism Services

Aug 26, 2014

When Yuri Maldonado's 6-year-old son was diagnosed with autism four years ago, she learned that getting him the therapy he needed from California's Medicaid plan for low-income children was going to be tough.

Darin Oswald / Idaho Statesman

The state’s effort to rein in Medicaid costs has created deep friction between small businesses that deliver behavioral-health services to Medicaid patients and a new contractor hired to manage them.

Service providers across Idaho have raised complaints over the last 11 months that the contractor, Optum Idaho, a unit of United Behavioral Health, has created red tape and cut services needed by at-risk patients.

Stethescope, Health Care, Doctor, Medical
Emilie Ritter Saunders / Boise State Public Radio

An Idaho work group says the state should expand its Medicaid eligibility, but committee members voiced concerns that their recommendation will be ignored by both the governor and legislators.

The 15-member group voted Thursday to submit their recommendation to Gov. C.L. "Butch" Otter.

This is the second time this work group has supported expanding Medicaid to provide coverage to the state's working poor. Their 2012 recommendation, however, has been ignored for the past two years.

Lawrence Wasden
Idaho Public Television

Idaho attorneys are requesting that the U.S. Supreme Court consider a state appeal of a lawsuit challenging Medicaid provider reimbursement rates.

Attorney General Lawrence Wasden filed the petition paperwork Wednesday on behalf of the Idaho Department of Health and Welfare.

The state's appeal requests the justices to decide on a 2009 case where five providers alleged that Idaho's Medicaid rates were too low because they were kept at 2006 reimbursement levels.

An Idaho workgroup reconvened Wednesday to reevaluate options on how to offer medical services to low-income adults who don't have health insurance.

Gov. C.L. "Butch" Otter has repeatedly said he does not want to expand the state's current Medicaid program but has appointed a 15-member group to consider other possibilities.

The panel first met in 2012 and recommended expanding the state's Medicaid eligibility requirements.

Some students headed to college this fall will get top-drawer health coverage at little or no cost.

How? Medicaid, it turns out, will pay the premium for the student health plan.

Proponents say students who are eligible for Medicaid, the health insurance program for low-income people, get access to a wider network of doctors and hospitals by getting coverage through the college health plans. These broad networks can be an important consideration for students who travel for internships, international study or who return to homes far from school during the summer.

Transcript

STEVE INSKEEP, HOST:

Many republican governors have taken a stand against Obamacare by refusing to expand Medicaid. Utah, which is one of the most republican states in the nation, remains undecided. But in a state where the majority of the population are Mormons, one bishop from the Church of Jesus Christ of Latter Day Saints says helping the poor is a moral obligation. Andrea Smardon from member station KUER in Salt Lake City has more.

(SOUNDBITE OF CHECKOUT SCANNER)

Butch Otter
Emilie Ritter Saunders / Boise State Public Radio

Idaho Gov. C.L. “Butch” Otter says no matter what, the Affordable Care Act, or Obamacare as it's known, was coming to Idaho.  

“Because if we hadn’t [have] established our own state exchange, we would have had Obamacare in Idaho,” he says. “We didn’t have a choice. We were going to have an exchange in Idaho. We were going to have the Obamacare exchange in Idaho or we were gonna have [an]  Idaho exchange in Idaho.”

Emilie Ritter Saunders / Boise State Public Radio

Russ Fulcher says incumbent Gov. C.L. “Butch” Otter no longer represents the heart of Idaho's Republican Party.  

Fulcher, a state senator from Meridian, has been on the campaign trail since late November spreading that message. He’s the tea party candidate trying to unseat a longtime cowboy politician he says has a political “machine” behind him.

medical, stethoscope
Jasleen_Kaur / Flickr Creative Commons

A U.S. District Court judge issued an injunction Tuesday to halt deep cuts to Medicaid and restore about $16 million in assistance to Idaho's developmentally delayed adults.

The decision lets an American Civil Liberties Union (ACLU) of Idaho lawsuit on behalf of disabled Idahoans proceed as a class-action case.

That opens it up to more people who lost some their Medicaid dollars when the program was slashed in 2011.

Judge B. Lynn Winmill cited cases of severely mentally disabled Idahoans that can no longer afford necessary therapy and other care in his decision.

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