Groups Brace For Medicaid Changes

Changes are coming to Idaho’s Medicaid program and a lot of groups are anxious about what’s coming.

The Governor’s Medicaid Reform Advisory Council met in Idaho Falls Thursday, another in a statewide series on a preliminary plan to change Medicaid’s direction.

“Our job is to ensure taxpayers that their funds are being used as prudently as possible … and to see that those who really need help get it,” said council member Ray Rigby, Rexburg. “People have been forced to take all the program offers or nothing. We want people to get only what they need and not waste dollars.”

Of concern to many mental health care providers was the council’s recommendation to change managed care. Currently, each case is handled on an individual basis. Someone on the Idaho mental health staff acts as a gatekeeper, authorizing a patient to get help, said Theo Murdock, welfare policy program specialist for Health and Welfare. The recipient is allowed to choose the care provider.

“We already have a good system. Don’t trade it in for a pig in a poke,” said Joe Keele, a representative of Transitions Inc.

Under the recommended change, Medicaid would assign groups of clients to a provider, who would be paid a flat fee for care. The provider would decide how much service each client got and would be responsible for all elements of the clients’ recovery.

“The state would pay a set dollar amount per person, per capita. The provider would assume all treatment responsibility for that group of people,” Murdock said. “It’s a profit or loss situation for them. It just depends on how well they do their job.”

Although providers in Idaho Falls are not in favor of the change, other areas of the state seem eager for the reform.

Another recommendation that drew concern was a proposal that would require patients to use overthe-counter drugs when available instead of prescription strength drugs.