The Idaho Health Care Plan Using State Innovation Waivers to Increase Access to Health Care

The Idaho Health Care Plan (IHCP) is a unique and innovative approach to extending opportunities for affordable health insurance coverage to some Idahoans in the health insurance gap, and to provide Medicaid coverage for Idahoans with certain diagnoses. IHCP requires two State Innovation Waivers, a Medicaid waiver under §1115 of the Social Security Act, and a waiver under §1332 of the Affordable Care Act.

The §1115 Waiver would allow Idaho to extend Medicaid coverage to people who have certain conditions which result in very high medical costs. Removing these people from the Idaho health insurance exchange and transferring their coverage to Medicaid will reduce costs and risk for the insurance carriers selling plans on the exchange. This in turn will result in lower premiums for insurance exchange customers, and also in lower federal premium assistance costs.

The §1332 Waiver would use some of those savings to extend premium assistance to households with incomes below the Federal Poverty Level making insurance affordable for about 30,000 Idahoans currently in the “gap”.

This helps Idahoans with disabilities in two ways:

  1. People with one or more of the listed diagnoses (which include e.g., spinal cord injuries, cerebral palsy, several forms of cancer, Multiple Sclerosis, Osteogenesis Imperfecta) will have access to the full range of Medicaid covered services. Some of these people are currently without coverage, and some currently have a policy on the exchange. Medicaid covers long term services and supports (LTSS) which are not covered by private insurance policies. Even people who are currently covered by insurance will benefit from coverage of these services, and more comprehensive coverage from Medicaid.
  2. Many people with disabilities, living below the FPL, who don’t have one of the listed conditions (e.g. people with mental illness) will at least have access to affordable health insurance on the exchange.

The IHCP is not a complete solution to the Idaho’s Health coverage problems. At least 20,000 Idahoans will still be left in the insurance gap. The IHCP does not provide premium assistance to people who do not have taxable income. Medicaid Expansion under the Affordable Care Act would provide much better coverage for Idahoans with disabilities, especially people with serious mental illness. It would also provide significant savings to the state of Idaho, not realized by the IHCP ( )

However, an estimated 5,000 Idahoans with serious health conditions would gain access to Medicaid coverage under the IHCP. Another 30,000 Idahoans living below the poverty level will have access to affordable coverage on the Idaho insurance exchange (Your Health Idaho). Many of these people also have disabilities and serious health conditions. These factors make the IHCP a significant step forward and a great improvement on the status quo. The IHCP is an opportunity to move Idaho in the right direction by making affordable health care available to Idahoans with low incomes, including many Idahoans with disabilities.

James R. Baugh, DisAbility Rights Idaho, 4477 Emerald St. Ste. B-100, Boise, ID 83706 phone (208)336-5353