Medicaid Expansion Update - 1/20/20

Medicaid Expansion Implementation - Top 10 Things to Know

As of January 16th, 57,794 Idahoans have enrolled and Idahoans continue to sign up for expanded Medicaid!

Here are the top 10 things health center staff need to know:

  1. 91,000 Idahoans are estimated to be eligible. However, this is an intentionally high estimate made by the Dept. of Health & Welfare (DHW) to ensure that state lawmakers weren’t caught off guard by a higher level of sign-ups than expected. The reality could be much less than the estimated 91,000.

  2. Expanded Medicaid is still Medicaid! Expanded Medicaid provides coverage to a new adult population. The benefits mirror Idaho’s Basic Plan and include primary care, specialty care, hospitalization, outpatient surgery, emergency room & ambulance, maternity and newborn care, mental health, substance use disorder services, prescription drugs, rehabilitation, labs, preventive/wellness visits, pediatric, optometry, podiatry, chiropractic, and dental care. Check the 2020 Idaho Medicaid Health Plan Booklet for more information.

  3. It’s Healthy Connections. Expanded Medicaid is part of the Healthy Connections program, just like traditional Medicaid. Healthy Connections is sending this letter to Idahoans as they sign up for Medicaid. It outlines how to choose a primary care provider (PCP), how a person may change PCPs, and details about fixed enrollment.

  4. Assisting patients with enrollment is a two-step process:
    A person can apply for Medicaid through Idalink (which O&E counselors already use), at a local DHW office, or by phone (1-877-456-1233); AND
    a person can choose a Healthy Connections PCP through the Live Better Idaho website. An eligible person may sign up for Medicaid at any time during the year.

  5. Changing Healthy Connections PCP can be done annually.
    DHW implemented fixed enrollment in July 2019, requiring Medicaid recipients to choose a PCP (clinic).  People are enrolled with their Healthy Connections provider on an annual basis. They may request a change in PCP for any reason during the annual enrollment period of January and February; the rest of the year, it can be only for special circumstances as outlined by DHW in their fixed enrollment policy.

  6. PCP selection must occur within 90 days of enrollment or DHW will assign a PCP. People who enrolled in expanded Medicaid in November and December 2019 will be attributed to clinics in January 2020. If they did not choose their PCP at the time of application (the two-step process), these new Medicaid patients will have until 3/31/20 to do so. From January 2020 on, newly enrolled Medicaid patients will have a 90-day grace period to select a PCP. If a person fails to select their PCP, Medicaid will assign them a PCP based on their zip code and available providers.

  7. Health centers must be proactive in assisting patients with their PCP selection. Health centers must be proactive in asking patients to choose them as their PCP. To retain or attract patients, health centers can communicate using research-tested messages for enrollment. Read more in “Messaging for Successful Medicaid Expansion Enrollment” in the Cube (IPCA's internal website for health centers). If a patient has not chosen your health center as their Healthy Connections PCP, you may not be reimbursed for the services your health center provides.

  8. Patients in PDAP vs Healthy Connections. DHW started pre-enrolling eligible adults in Medicaid in 2019. These individuals were flagged in the PDAP system (a view-only portal for Medicaid program eligibility), as “PMA” or Presumptive Medicaid Adult. Recently, some health centers have reported patients flagged PMA in PDAP who have chosen them as their PCP are not showing up on the Healthy Connections report for the health center. DHW is aware of this problem and is working to ensure that both systems are synced. The PDAP information is correct, so please consult this system if in doubt.

  9. Medicaid has a 90-day lookback period. Starting in January, enrollment for expanded Medicaid will be on a rolling basis–not an open enrollment period like Your Health Idaho. When a person applies and is eligible, coverage starts at the beginning of that month. A person may be able to access Medicaid coverage for past healthcare costs through Idaho’s 90-day lookback period. However, this look-back cannot pre-date when the expanded Medicaid program started (January 2020).

  10. Approximately 18,000 people lost their APTC and have the option to move to expanded Medicaid.
    People moving off the advanced premium tax credit (APTC) on the exchange received notices from Your Health Idaho, DHW, and insurance carriers prior to the start of open enrollment for the Affordable Care Act. This will likely be confusing for your patients and you may receive questions. For details, see “Highlights from Your Health Idaho Board Meeting” blog in the Cube. 

The Department of Health & Welfare created a website for information on Medicaid expansion. Check here for updates directly from the Department. For more information, contact Lee Flinn or Moriah Nelson at IPCA.

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