1. Close the Gap Idaho Healthcare coverage options for low-income and uninsured adults Richard Armstrong Director Department of Health & Welfare August 21, 2015

2. 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 2

3. The Scope of Idaho Poverty 3 People on Medicaid Uninsured adults identified with incomes below 100% poverty threshold People on Food Stamps People receiving tax credits to purchase insurance

4. *Living wage data courtesy Massachusetts Institute of Technology, www.livingwage.mit.edu Additional Idaho Demographics 4

5. The Gap Dilemma 5 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

6. Key to Legislative Success = Options Governor’s Workgroup recommended Medicaid 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 6

7. 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 7

8. Option A: First Health Home Enroll adults under 100% FPL in a health home Pay private sector providers to deliver coordinated care services Engage primary care network for statewide delivery Leave indigent system in place for services outside primary care service umbrella 8

9. 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 9

10. 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 services 10

11. 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 11

12. Hospital Support to Close the Gap It 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 12

13. Resources Governor’s Medicaid Redesign Workgroup Recommendation http://gov.idaho.gov/pdf/1204%20Medicaid%20Workgroup %20Report.pdf http://gov.idaho.gov/pdf/1204%20Medicaid%20Workgroup %20Report.pdf Close the Gap Idaho http://closethegapidaho.org/about-the-issue/ http://closethegapidaho.org/about-the-issue/ Direct Primary Care http://www.dpcare.org/ http://www.dpcare.org/ MIT Livable Wage Calculator http://livingwage.mit.edu/ http://livingwage.mit.edu/ 13

14. Close the Gap Idaho Healthcare coverage options for low-income and uninsured adults Richard Armstrong Director Department of Health & Welfare August 21, 2015