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Published:May 27th, 2006 06:50 EST
HHS Approves Historic Medicaid Reform Plans in Idaho

HHS Approves Historic Medicaid Reform Plans in Idaho

By SOP newswire

Medicaid beneficiaries in Idaho will be among the first in the nation to have benefits designed to meet their needs based on age and health status -- changes allowed by the Deficit Reduction Act of 2005 (DRA), HHS Secretary Mike Leavitt announced today. Prior to enactment of the DRA states could not target benefits to one certain group of enrollees.

The DRA, signed into law February 8, granted states sweeping new options for designing their Medicaid programs -- the first major revision to the program since its inception.

"Idaho is on the cutting edge in crafting Medicaid benefit packages to the needs of its residents and I commend Governor Kempthorne for this innovative work," Secretary Leavitt said. "These changes make sense for beneficiaries and the very future of the Medicaid program."

Under the plan approved today, Idaho will offer three benefit packages aimed at meeting the health care needs of different groups -- children, people with disabilities and beneficiaries who are eligible for both Medicaid and Medicare. All of these packages are voluntary. Any enrollee who chooses one of the new plans can "opt out" at any time and return to standard Medicaid.

"Idaho's new, targeted system will be more efficient while meeting the specific needs of the people who count on it," said Mark B. McClellan, M.D., Ph.D., administrator of the Centers for Medicare & Medicaid Services, (CMS) the agency which oversees the Medicaid program. "We expect more states to follow Idaho's lead in redesigning their programs to give people access to affordable care that better reflects their own health needs and preferences.

"These changes will make Medicaid more sustainable without restricting eligibility or access to services that low-income and disabled individuals need."

Medicaid enrollees can choose to sign up for the most appropriate benefit plan based on their needs:

  • The Benchmark Basic plan will serve healthy children and adults and will cover most of the traditional Medicaid benefits, except long-term care, organ transplants and intensive mental health treatment. Children under age 19, however, will continue to receive all of these and other benefits through the mandatory Early, Periodic Screening, Diagnostic and Treatment feature of the Medicaid program.
  • The Enhanced Benchmark plan will serve individuals with more complex health care needs, such as the elderly and disabled. The Enhanced plan will cover all the traditional Medicaid benefits, including long-term or institutional care. Persons enrolled in the Basic plan who need benefits not covered there will be transferred to the Enhanced plan.
  • The Coordinated Benchmark plan, will include all the benefits of the state's traditional Medicaid program and will serve Medicaid enrollees who are also eligible for the Medicare program-the so-called "dual eligibles." 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.

All three of the new packages will feature some new benefits, including preventive and nutrition services and "preventive health assistance" to help the obese, smokers and others adopt healthier health habits.

Idaho will also institute a program allowing the working disabled to purchase Medicaid's basic benefits package. The state's Medicaid reform will also include simplified eligibility for children in Medicaid and the State Children's Health Insurance Program (SCHIP) and the elimination of an assets test for some children. Today's approval will also allow the state to award grants under SCHIP for schools to offer preventive health services to low-income children.

Other states that have remodeled their Medicaid programs since passage of the DRA include Kentucky and West Virginia.