BOISE — Idaho will start enrollment in its newly expanded Medicaid program on Nov. 1, with benefits starting Jan. 1, and the state already has identified about 70,000 people it knows are likely to be eligible and sign up.
“We have good information on those folks, because we have an integrated eligibility system in Idaho,” said Matt Wimmer, administrator of the Division of Medicaid for the Idaho Department of Health & Welfare.
That means when people apply for a variety of state programs through Health & Welfare — including SNAP or food stamp benefits; Medicaid; CHIP (Children’s Health Insurance Plan); the state insurance exchange, Your Health Idaho; Temporary Assistance to Needy Families; and mental health programs — they go through the same eligibility system, filling out a single, integrated application for any of an array of benefits.
“All of that runs through the same system,” Wimmer told a recent legislative hearing. “Because of that, we’ve got information on a lot of the folks who would be potentially eligible.”
The department has identified about 69,860 of those Idahoans, and is conducting an assisted enrollment program to notify them and get them enrolled in the state’s new Medicaid expansion.
“They just need to respond, confirm their information … and then we’ll go ahead and enroll them,” Wimmer said. That process started in July and is continuing; 17,000 people have already confirmed.
The figures on people who likely are eligible can be broken down by county, based on information in the existing system. They show that there are 14,612 in Ada County residents and 10,418 in Canyon County.
In addition, Wimmer said, an estimated 21,000 people who aren’t already known through the eligibility system are expected to enroll, based on actuarial estimates. They’ll get their chance in an open enrollment period that starts Nov. 1.
Medicaid expansion serves people who earn up to 138% of the federal poverty level; that’s $17,236 a year for a single person, or $35,535 for a family of four. Without it, Idahoans have faced a health coverage gap, as the existing Medicaid program serves only the very lowest-income people who also have specific disabilities or family situations, and the Your Health Idaho insurance exchange offers subsidized private health insurance only for those earning 100 percent of the poverty level or above.
Anyone whose income is below 100% of the poverty level, but not low enough to qualify for the current limited Medicaid program, falls into the coverage gap — they make too much to be on regular Medicaid, but not enough to qualify for subsidized insurance through the exchange. For a parent of one child, for example, the current maximum income for Idaho’s Medicaid program is just $3,468 a year.
State lawmakers this year attached some strings to Medicaid expansion, which voters approved by initiative last November, requiring the state to apply for a series of waivers from federal rules to add everything from work requirements to family planning restrictions. However, they also specified that none of those waiver issues could delay the start of Medicaid expansion in Idaho, so it will start on Jan. 1 regardless.
Wimmer, addressing the Idaho Indian Affairs Council earlier this month, said with 70,000 people already known to be eligible, the department was concerned about whether there were enough primary care doctors to serve all the newly eligible patients, especially given Idaho’s physician shortage.
The department surveyed all the primary care providers in the state, and got an 85% response rate to its survey.
“We have confirmed that we’ve got enough capacity in primary care to make sure that all these folks will be able to have a primary care provider as soon as they are eligible,” Wimmer said. “We’ve also done some efforts to make it easier for people to pick a primary care provider. … Once enrolled, they can go out to our website, Live Better Idaho, and they will be able to pre-select the primary care provider that they want to have … prior to becoming enrolled.”
In addition to the income criteria, people eligible for Medicaid expansion must be between the ages of 19 and 64; be a citizen or legal resident; and not be receiving Medicare, which provides coverage for Americans age 65 and older. There’s more information online at medicaidexpansion.idaho.gov.
On Monday from 3-4 p.m., the department will hold a “Medicaid expansion provider listening session” to hear input and answer questions. The session won’t address the waiver process; that’s subject to separate hearings and public comment procedures. “This listening session will be for comments and questions specific to providers and continuity of care,” the department said in an announcement of the session, which will be at the Idaho Medicaid office, 3232 Elder St. in Boise. People also can participate by phone, by dialing 415-655-0003, guest code 801 742 732, password 93238734.