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.

The Idaho Divisions of Public Health and Medicaid are both located within the Idaho Department of Health and Welfare, which enhances shared opportunities for systems-building and policy development. The current Memorandum of Understanding between the Divisions of Public Health, Medicaid, and Welfare (see Attachment) seeks to improve public health service delivery and public health outcomes for low-income populations. Specifically, the divisions share available data; coordinate administration of programs designed to improve the health of women of child-bearing age, infants, children, and children and youth with special health care needs (CSHCN); and coordinate implementation of policies that affect shared populations. In addition, the MCH Program coordinates with Medicaid to promote awareness of programs, promote healthy behaviors, and facilitate referrals to appropriate benefit programs, with an emphasis on CSHCN. Meaningful collaboration between Medicaid and Title V has ebbed and flowed over the past years due to staff turnover resulting in constant need for re-education about Title V and relationship-building efforts. The Title V MCH Program aims to increase communication and partnership opportunities with Medicaid in the coming year to improve coordination of services and systems-building efforts.CH P 

The Title V 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.

Through the Title V Idaho Medical Home Project, two public health districts worked with up to four pediatric or primary care clinics in Regions 1 and 7 to support transformation and adoption of patient-centered medical home principles through intensive quality improvement and guided practice change. One incentive the health districts used to recruit clinics is the ability to receive increased Medicaid reimbursement once the National Council on Quality Assurance (NCQA) levels are met. The Medical Home Project staff guided clinics through this process and offered technical assistance on meeting the NCQA requirements.

In 2019, the Idaho Governor signed the Medicaid expansion bill into law, which included 10 sideboards, work requirements, family planning restrictions, and substance abuse assessment. The included sideboards were the result of numerous iterations of the expansion bill, and may not reflect the intentions of voters that passed the Medicaid expansion ballot initiative. It is estimated that Medicaid expansion could serve up to 91,000 people.

The Medicaid expansion legislation included a family planning clause indicating that Idaho would seek a 1115 or family planning waiver, which would require a referral to receive family planning services or supplies from a provider other than the assigned primary care provider. The Idaho MCH Director has been in contact with Medicaid leadership to seek understanding of the impact of the 1115 waiver to Family Planning Program service delivery and to educate Medicaid about Title X and the provision of reproductive health services and supplies through the Family Planning Program across the state. As of July 2020, the outcome of the waiver application was still pending.

In late 2018 and early 2019, Idaho Divisions of Public Health, Medicaid, and Behavioral Health came together to review and consider application for the CMS Maternal Opioid Misuse (MOM) Model grant. After numerous meetings and emails, a decision was made not to apply for the grant due to low capacity for implementation and concerns about the funding levels relative to the work required. However, new connections across the agencies were formed with future plans to address opioid use disorder during pregnancy and to explore Medicaid coverage changes relevant to women with substance use disorder such as coverage of in-patient postpartum insertion of long-acting reversible contraception (LARCs).

The MCH Director oversees the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, which funds evidence-based home visiting services for pregnant women and families with young children through the local public health districts. The MCH Director, the MIECHV Program Manager, and Divisions of Medicaid and Public Health leadership were part of meetings in 2019 and 2020 to discuss the potential for a Medicaid state plan amendment to cover home visiting services provided by public health districts and other organizations. The state plan amendment for home visiting coverage would request reimbursement for the Parents as Teachers model, and increase the state’s capacity to serve additional families.

Idaho Medicaid utilizes a managed care approach through the Idaho Behavioral Health Plan which provides services for children with serious emotional disturbance and adults with serious mental illness or serious and persistent mental illness, as well as any adults or children who manifest symptoms indicative of behavioral health issues. The plan is administered by Optum Idaho, which is accredited by NCQA.

In 2019, Idaho Medicaid had proposed state plan amendments for children’s enhancement services related to behavioral intervention, crisis intervention, family directed services, community-based supports, and respite. Idaho Medicaid has the following approved waivers that are relevant to MCH populations:

• Idaho Behavioral Health Plan
• Act Early Waiver
• Children’s Disabilities Waiver
• Dual-eligibility Waiver
• Dental Waiver (1915b)

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.