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Medicaid News
Idaho Becomes First State with Approved Medicaid
Reform Plan
States have sweeping new options
to design
Medicaid programs
May 26, 2006 - 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.
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Medicaid |
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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.
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