Idaho Department of Health and Welfare, Division of Medicaid

Idaho has long-standing experience in designing managed care programs for full-benefit dual-eligible individuals, including fully integrated dual-eligible special needs plans (FIDE SNPs) launched in 2014 through the state’s Medicare Medicaid Coordinated Plan (MMCP). The state also launched Idaho Medicaid Plus (IMPlus) in 2018, which provides comprehensive Medicaid services including long-term services and supports to individuals not enrolled in MMCP.

While 60 percent of Idaho’s full-benefit dual-eligible population is enrolled in the FIDE SNP program, enrollment is concentrated in more populous areas of the state and several communities remain underserved by MMCP.

Project Goals

With support from Arnold Ventures under the Advancing Medicare & Medicaid Integration initiative, the state seeks to: (1) increase access to MMCP; (2) improve the quality of care that MMCP provides to dual-eligible individuals in the state, including those historically underserved; (3) improve state oversight of the MMCP’s FIDE SNPs; and (4) enhance care management for those populations served by the FIDE SNPs.

Project Approach

To achieve the project goals, Idaho is undertaking a 26-month effort that is organized around three main activities:

• Increasing Enrollment: The state will increase outreach and engagement among diverse populations who have historically not enrolled in the FIDE SNP program, including tribal, Latino, and refugee communities. By increasing outreach and communication, the state hopes that a better understanding of these communities’ unique needs can create opportunities for improved access and enhanced program design. Additionally, engagement with the underserved communities will inform state requirements for dual-eligible special needs plans (D-SNPs) to meaningfully engage diverse communities; provide culturally sensitive training to D-SNP staff; and offer care management that is tailored to different enrollee populations.
• Improving State Oversight of Payment and Quality: Informed by stakeholder engagement with underserved communities, the state will develop quality measures that more accurately capture the outcomes of FIDE SNP enrollees and their care preferences and experiences. The state will use these measures to develop and implement a quality payment program that incentivizes D-SNPs to continually improve the quality of services for enrollees, such as plan efforts to maintain and expand provider networks and continue stakeholder engagement. The state will develop penalties for those plans not meeting expected outcomes.
• Enhancing Care Management: To improve the care experience among enrollees, the state will work with the D-SNPs to identify and enhance the D-SNPs’ care management models to meet the needs of enrollees. The state will develop care management guidelines for the D-SNPs that will be informed by stakeholder engagement with underrepresented populations, including considering options to incorporate community health workers into D-SNPs’ care management models.

Support for Other States

Many states are in the same position as Idaho — they know that they want to improve access and quality of care for their dual-eligible populations via fully integrated programs, but face resource gaps that prevent them from moving forward. As a result, Arnold Ventures launched the Advancing Medicare & Medicaid Integration initiative to support states and help fill those resource gaps. Learn more about funding opportunities.