Managed LTSS Program
Idaho currently operates an integrated Dual Special Needs Plan (D-SNP) model for dual eligible individuals. This program, known as the Medicare Medicaid Coordination Plan (MMCP) serves almost 30,000 individuals on a voluntary basis and includes LTSS supports in the managed care benefit, despite the state not having an existing MLTSS program outside of the dual eligible initiative. As part of its efforts to expand care coordination for dual eligible individuals, Idaho began rolling out a mandatory Medicaid-only managed care plan, known as Medicaid Plus, for dual eligible individuals who are not enrolled in MMCP. Medicaid Plus will incorporate all Medicaid services, including LTSS, into a managed care model for these individuals. Individuals who receive LTSS but are not eligible for Medicare, members of an American Indian Tribe, Pregnant women, and dual eligible individuals who receive services through the state’s HCBS waiver for intellectual and developmental disabilities, are not required to enroll in Medicaid plus.
Beginning November 1, 2018 dual eligible individuals in Twin Falls County were required to enroll in Medicaid Plus if they were not part of MMCP. The state plans to include additional counties, including Bonneville, Bannock, and Bingham counties on April 1, 2019.
Sources: Idaho Stakeholder Engagement Presentation (11-19-2018); Idaho Medicaid Information Release (12-20-2018); Center for Health Care Strategies (12-12-2018)
Behavioral Health Managed Care
On October 31, 2014, the Idaho Statesman reported that the state’s shift to Medicaid managed care has resulted in behavioral health service cuts for beneficiaries, including cuts to community-based mental health and rehabilitation services. Since September 2013, when Idaho Medicaid implemented the Idaho Behavioral Health Plan (IBHP) and selected Optum to administer the plan using a managed care approach, Optum has cut community-based rehabilitation services by ten percent to focus on the use of more evidence-based practices. The IBHP provides services for children with serious emotional disturbance and adults with serious mental illness or serious and persistent mental illness, as well as any adults or children who manifest symptoms indicative of behavioral health issues. (Idaho Behavioral Health Plan website; Link no longer available, 10/31/2014)
State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)
The state planned to replace its existing voluntary Medicare-Medicaid Coordinated Plan (MMCP) with a Demonstration to Integrate Care for Dual Eligibles, effective January 1, 2014. (Source: Demonstration Proposal)
State Website on Integrating Care for Dual Eligibles
Summary of Idaho Initiative to Integrate Care for Dual Eligibles, 10/2012)
On February 26, 2014, the state announced it will no longer participate in the Dual Eligible Financial Alignment Initiative Demonstration. Instead, Idaho will expand benefits under the existing voluntary Medicare-Medicaid Coordinated Plan (MMCP). (Source: Idaho Department of Health and Welfare website; MLTSS Network Weekly Roundup (link no longer active), 3/6/2014)
The state implemented dual eligible benefits under its MMCP on July 1, 2014. All persons age 21 and over who are eligible for Medicare and Medicaid can enroll in the MMCP. (Source: Idaho Medicaid website)
Medicare-Medicaid Coordinated Plan Stakeholder Update (link no longer active), 6/24/2014)
Section 1915(i) HCBS State Plan Option
As of May 2014, CMS has approved the state’s §1915(i) HCBS State Plan Amendment; and the state is currently participating in the HCBS State Plan Option. (Source: Kaiser HCBS State Plan Option website, 5/2014)
Health Homes
CMS approved the state’s Health Home State Plan Amendment, and Idaho began implementing the SPA in January 2013. The Health Homes target individuals with serious mental illness; diabetes and an additional condition; or asthma and an additional condition. (Source: Demonstration Proposal to Integrate Care for Dual Eligibles; State Health Homes website)
Approved Health Home State Plan Amendment (11/21/2012)