The Affordable Care Act and Medicaid Readiness

The Patient Protection and Affordable Care Act (PPACA) has two major portions that have deadlines that Idaho is quickly trying to meet. The first, the health insurance exchange, we discussed in the last newsletter (See more on health insurance exchange).  The second is Medicaid readiness.

The federal agency that overlooks Medicaid has put forth a set of guidelines that states must follow to continue the Medicaid funding match that Idaho is currently receiving from the federal government. According to Dick Armstrong (Director of the Idaho Health and Welfare Department complying with federal guidelines will allow Idaho to make substantial improvements to our current system. The revamped system will drastically benefit Idaho’s Medicaid system regardless of the outcome of the lawsuit against PPACA.

Medicaid Readiness is the new program that Idaho is using to assure it is complying with federal requirements.

The program is divided into two strategic phases:

Simplification (Modernization). Through the PPACA and various other federal programs, Idaho can now have the needed resources to help solve some immediate problems and gaps we have struggled with in our current Medicaid system.  Recall the billing and payment problems with Molina that caused so many Medicaid providers to go out of business. This project will replace band aid fixes with real fixes. Medicaid eligibility will be moved to a new system (IBIS) that will also efficiently determine eligibility for Food Stamps and cash assistance.  Modernizing other systems will allow rural families access via computer, eliminating long drives to surviving offices and replacing many ineffective systems allowing the state to verify and check for misuse.

Expansion. Because the law was intended to increase access to healthcare for our most needy, Medicaid will be available to any adult under the age of 65 who earns at or below 133% of the Federal poverty line. For a single person, that would mean earnings of approximately $14,500/year. For a family of four, that corresponds to just over $29,500. For many, it will be a much needed relief since many adults subsist at one-quarter to one half of the poverty level but have never been eligible for help. For Idaho, payment for these individuals would be completely covered by the federal government for the next couple years. As a bonus, the $40 million that we now spend in the catastrophic healthcare fund (without any federal matching funds) will be mostly replaced by this system where Idaho gains a 70% match for each dollar that we spend. That’s big savings for taxpayers.