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Idaho Simplifies Medicaid Benefit Packages

Former Governor Dirk Kempthorne signed the Idaho Medicaid Simplification Act (HB 776) in late March 2006. Submitted to the federal government as a state plan amendment through the new provisions of the Deficit Reduction Act, it was approved on May 25, 2006, and implemented July 1.

The bill takes over 50 Medicaid eligibility categories and reduces them to three separate programs with their own distinct benefit packages, which are intended to serve the groups' needs:

  • The Benchmark Basic program, for low-income healthy children and adults, will cover most traditional Medicaid benefits except long-term care, organ transplants, and intensive mental health treatment. Children under 19 can still receive all of these services through Early Periodic Screening Diagnostic and Treatment.
  • The Enhanced Benchmark program, for the elderly and individuals with disabilities or special health needs, will cover all traditional Medicaid benefits, including long-term and institutional care.
  • The Coordinated Benchmark program, for dual-eligible elderly (those eligible for both Medicare and Medicaid), will cover all benefits in the state's traditional Medicaid program for dual eligibles. Enrollees will be required to register for both Medicare Part B (outpatient coverage) and Part D (the new prescription drug benefit).
To determine the appropriate program and take a baseline measure of a beneficiary's health, the state will conduct comprehensive health risk assessments of all program enrollees.

The governor's plan also institutes copayments for Medicaid recipients, implements a pilot pay-for-performance program in community health centers, advocates private financing options for long-term care through a variety of methods (including reverse mortgages and tax deductions), and establishes personal health accounts that offer credits for good health behavior. The state plans on removing asset tests for all eligible children with family incomes below 185 percent of poverty.

Advocates of the bill say the previous "one-size-fits-all" Medicaid package is inefficient, and the new benefit packages will better meet the needs of participants. Critics claim the new plan will achieve cost savings largely by limiting benefits and fear that the increased cost-sharing will cause low-income Medicaid recipients to forgo needed care.

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