Close the Gap Idaho Healthcare coverage options for

low-income and uninsured adults

Richard ArmstrongDirector

Department of Health & Welfare

August 21, 2015

Today’s Presentation

1. The scope of poverty in Idaho counties

2. Healthcare coverage Gap

3. Solution = Provide legislators options

4. Idaho options to “Close the Gap”

5. Next steps

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The Scope of Idaho Poverty

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People on Medicaid

Uninsured adults identified with incomes below 100% poverty

threshold

People on Food

Stamps

People receivingtax credits to

purchase insurance

*Living wage data courtesy Massachusetts Institute of Technology, www.livingwage.mit.edu

Additional Idaho Demographics

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The Gap Dilemma

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• Gap adults do not earn enough to qualify for federal subsidies to purchase private health insurance

• Estimated 78,000 Idaho adults are in coverage Gap

• Majority of Gap don’t receive care or access it through federally qualified health centers, charity care or indigent care programs

• Idaho spends $60 million per year on crisis health episodes for low income adults

Key to Legislative Success = Options

• Governor’s Workgroup recommendedMedicaid expansion twice – no hearing or bill moved forward

• Legislative leaders want another choice that does not involve federal funds or any ties to Obamacare

• Several legislators voiced support for a direct primary care model

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Draft Options to Close the Gap Option A: Idaho taxpayer funded, basic

health care plan providing primary care services for Gap population

Option B: Federally funded, care management program with full medical benefits for Gap

Both Options use Your Health Idaho exchange for coverage above 100% of poverty

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Option A: First Health Home Enroll adults under 100% FPL in a health home

Pay private sectorproviders to delivercoordinated care services

Engage primary care network for statewidedelivery

Leave indigent system in place for services outside primary care service umbrella

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Benefits/Advantage Not health coverage nor an entitlement program and

fully controlled by Idaho

Will reduce costs to county and state indigent programs

Provides a true safety net of routine healthcare

Provides basic coordinated and integrated behavioral health to our most vulnerable adults

Provides an alternative to judicial mental health holds through improved continuity of care

Provides coordination of care for post incarceration re-entry to reduce recidivism

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Option B: Healthy Idaho Plan• A unique benefit design under Idaho Medicaid

• Full coverage, including pharmacy, hospital, specialties

• Eliminates County Indigent/State CAT programs

• Utilizes current Medicaid contracted network

• 90% or more federally funded

• Provides the full spectrum of behavioral health services

• Care coordination for all services10

Political Landscape• Medicaid expansion (Option B) remains a

lightning rod

• Medicaid expansion would be a legislative challenge and require strong, grassroots business sector support

• Governor testing legislative interest in Option A

• Option A funding solutions could involve premium tax and/or cigarette tax

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Hospital Support to Close the GapIt is critical for Idaho hospitals to provide community/state leadership for any option to succeed:

•Engage state legislators, county commissioners, community & business leaders at grassroots level

•Consider staff and funding resources to promote ‘Close the Gap’ efforts

•Share the story of people in your communities who suffer because they cannot afford basic coverage

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Resources• Governor’s Medicaid Redesign Workgroup

Recommendationhttp://gov.idaho.gov/pdf/1204%20Medicaid%20Workgroup%20Report.pdf

• Close the Gap Idahohttp://closethegapidaho.org/about-the-issue/

• Direct Primary Carehttp://www.dpcare.org/

• MIT Livable Wage Calculatorhttp://livingwage.mit.edu/

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Close the Gap Idaho Healthcare coverage options for

low-income and uninsured adults

Richard ArmstrongDirector

Department of Health & Welfare

August 21, 2015