IDAHO STATE PLAN AMENDMENT
Idaho is joining a small group of states that are taking advantage of new federal flexibility (afforded by the Deficit Reduction Act of 2005) that allows states to modify their Medicaid program. The Centers for Medicare and Medicaid Services approved Idaho’s groundbreaking reform plan in May 2006, and gave the state approval to target specific package of benefits to specific categories of enrollees—resulting in different benefits for children, people with disabilities and dual-eligible beneficiaries. Among the state’s goals for the reformed Medicaid program:
Encourage prevention and wellness to improve enrollee’s health and reduce future costs;
Promote responsible use of the healthcare system to reduce unnecessary services that are often costly;
Use limited resources wisely and invest carefully in targeted services to achieve long-term savings
To accomplish these goals, the Idaho Department of Health and Welfare will deliver targeted benefit packages to people based upon their similar health care needs. Enrollment in one of the targeted plans is voluntary, and enrollees can opt-out of one of the plans at any time and return to standard Medicaid. The three targeted plans include:
Benchmark Basic Plan: Serves healthy children and adults and will cover the cost of standard Medicaid benefits, except long-term care, organ transplants and intensive mental health treatment. Children under 19 will continue to receive all of these and other benefits through the mandatory EPSDT feature of the Medicaid program. The goal of this program is to achieve wellness by “emphasizing prevention and proactively managing health.” One feature of this program includes incentives for healthy behaviors, including an option to set up a personal health account.
Enhanced Benchmark Plan: Serves individuals with more complex health care needs, such as the elderly and disabled. This plan will cover all the traditional Medicaid benefits, including long-term or institutional care. Individuals covered in the Basic Plan who need benefits that are not covered under the Basic Plan will be transferred to the Enhanced plan.
Coordinated Benchmark Plan: Serves Medicaid enrollees who are also eligible for Medicare. This group will be required to enroll in the Medicare outpatient coverage plan, or Part B, as well as the new prescription drug benefit, Medicare Part D. The goal for this program is to finance and deliver “cost-effective individualized services integrated with Medicare coverage.”
Under the State Plan Amendment, certain individuals will be responsible for premiums and co-payments, depending on family income. All of the new benefit packages listed above will include some new benefits, including preventive and nutrition services and “preventive health assistance” to help certain individuals—for example, the obese and smokers—adopt healthier lifestyles. The programs seek to achieve long-term savings by enhancing prevention and wellness and encouraging enrollees to adopt healthy behaviors.
Source: Idaho Department of Health and Welfare
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