Health Care Delivery System

The Idaho MCH Program is committed to collaborating with federal, state, local, and non-governmental partners to provide a system’s approach to ensuring access for MCH populations to quality health care and health promotion services. The MCH Program also supports collaborative efforts on policy development and benefit changes that would impact MCH populations. Idaho Medicaid is a critical MCH partner and efforts to coordinate services and benefits are discussed below.

Public and Private Partnerships

The MCH Program continues to fill a valuable role in ‘gap-filling’ services for children with special health care needs via the Children’s Special Health Program (CSHP). Children with qualifying medical conditions are often referred to CSHP by hospitals or providers to obtain financial support to pay for eligible medical services and prescription drugs. For most qualifying conditions, families must demonstrate no creditable health insurance in order to enroll in the CSHP. The CSHP requires that all new clients apply for Idaho Medicaid benefits prior to enrollment into the program. This ensures linkage with public insurance for those who were otherwise uninsured and allows for coordination of benefits for those diagnoses that can carry health insurance. Title V is the payer of last resort and does not cover claims for services that are covered by Idaho Medicaid, although Title V covers the cost for some Cystic Fibrosis supplements not covered by Medicaid. The CSHP also supports the direct purchase of medical formula and food for PKU clients, and reimbursement is sought from clients with Medicaid and private payer health coverage.

Idaho lags behind the nation in adopting value-based payment models. For rural and frontier providers, including hospitals and clinics, implementing value-based payment models remains particularly difficult for many reasons: they often have limited financial resources to invest; lack interoperable data systems; face challenges with managing population health over large, sparsely populated geographical areas; and experience burdens of satisfying performance measurement and reporting requirements. The Idaho rate for value-based payments is 29% compared to 59% nationally. In February 2019, the state established the Healthcare Transformation Council of Idaho (HCTI) to continue transformation efforts and movement towards value-based payment models. The HTCI receives support from the Office of Healthcare Policy Initiatives (OHPI) in the Bureau of Rural Health and Primary Care within the Division of Public Health. The OHPI supports HTCI by implementing strategies that encourage the adoption of value-based models so that Idaho can achieve a more efficient healthcare system with improved outcomes. The OHPI also convenes workgroups under the direction of HTCI to move ideas into action. Current initiatives include advancing telehealth, identifying cost drivers to contain healthcare costs, and developing an innovative value-based model for rural and frontier areas.

In November 2014, Your Health Idaho began operating as Idaho’s fully state-run health insurance marketplace. In 2018, the Idaho Governor and Department of Insurance Director announced they would allow insurers to offer plans that are not compliant with the Affordable Care Act, such as charging people based on their health history, or by not covering some health needs like maternity care. Insurers also could require patients to support a much larger share of their total medical costs than they would have to under ACA plans. Insurers indicate this is a strategy to link Idahoans with individual health insurance at a lower cost. 

In the past year, the MCH Program has worked to strengthen their relationship with internal DHW partners. This included strategies as simple as meeting with other programs regularly and communicating our goals and state action plan objectives. Programs within the Division of Public Health that we coordinate with frequently include Project Filter, Idaho Oral Health Program, HIV/STD/Hepatitis programs, WIC, Idaho Immunization Program, Idaho Careline, Idaho Poison Control, and the Bureau of Vital Record and Health Statistics.