Marilena Delgado of Orofino spoke about the consequences of Idaho's strict Medicaid rules. She noted she's been uninsured for the better part of 25 years, but learned to accept that because at least her kids were on Medicaid. In December, she turned 19 and lost her Medicaid coverage because she was too old.
Jan. 25--BOISE -- For 90 minutes Friday, people from across the state told lawmakers their health-care policies are failing Idaho citizens.
Marilena Delgado of Orofino spoke about the consequences of Idaho's strict Medicaid rules. David Lounsberry of Lewiston talked about veterans dying for lack of care. Another addressed ongoing problems with a new mental health contract.
They were among the 30 people who testified during a joint listening session by the House and Senate Health and Welfare committees. More than 150 people attended the meeting.
Delgado and her daughter drove six hours from Orofino to testify. She noted she's been uninsured for the better part of 25 years, but learned to accept that because at least her kids were on Medicaid.
That changed in December. Although her daughter has struggled with kidney issues for the past two years, doctors didn't figure out what the problem was until November. In December, she turned 19 and lost her Medicaid coverage because she was too old.
"We were right at the point of going to the nephrologist," Delgado said. "We had to cancel her January appointment. She can't afford insurance. Obamacare told us we're too poor to qualify (for a health insurance subsidy), and the only way she can qualify for Medicaid now would be if she married her boyfriend or got pregnant."
Unless they're pregnant or have certain disabilities, most Idaho adults don't qualify for Medicaid if they earn more than about $250 per month, or 26 percent of the federal poverty level.
That income limit is set by Congress; states can choose to raise it, but Idaho hasn't done so. The problem is that those same individuals won't qualify for subsidies through the state health insurance exchange if they earn less than 100 percent of federal poverty. That's because when Congress approved the Affordable Care Act, it assumed states would accept the expanded Medicaid option -- something the Idaho Legislature has so far refused to do.
Roughly 80,000 Idahoans fall in this income gap, earning too much to qualify for Medicaid and too little to qualify for health insurance subsidies.
Lounsberry, a second-generation Marine, is one of them, along with Delgado and her daughter.
"I'm 58. I work four part-time jobs," Lounsberry said. "I have a lot of friends who have passed for lack of Medicaid. They sit in their house and rot. These are veterans. These are hard-working men. I'm concerned there's no outlook for us. We don't have the medical support we need. I'd just ask you to remember us. The older generation needs it (Medicaid coverage), too. I love you all. God bless."
About half the people who testified Friday cited ongoing problems with Optum Idaho, a division of Minneapolis-based UnitedHealth Group.
The company was hired in September to manage community-based mental health and substance abuse services for Idaho Medicaid patients. It works with about 150 independent providers across the state, reimbursing them for the services but also requires prior authorization before those services can be billed.
Several speakers said Optum isn't issuing authorizations in a timely manner, resulting in delays and canceled appointments for people in crisis.
"Optum has been making promises since September that things are going to change, but by the end of next week we'll have 68 clients we can no longer serve," said Nikki Tangen, who owns a Boise behavioral health firm. "Last week we spent 78 hours on hold, waiting to get authorization. Due to the barriers Optum has created, we had one client be admitted to a psychiatric hospital, one committed a felony offense and one burned down his family's home, because they couldn't get the services they needed. We've been told over and over by Optum that they'll get this fixed, but we're out of time."
Tangen suggested the company set aside its prior authorization requirement until such time as it has enough staff to prevent the bottleneck.
Senate Health and Welfare Chairman Lee Heider, R-Twin Falls, said lawmakers are aware of the Optum issues.
"We'll try to get to the bottom of this," he said.
The company is scheduled to appear before the House Health and Welfare Committee next week.
Kathy Mercer of Meridian, who has a daughter with mental health issues and sits on the NAMI Idaho board (National Alliance on Mental Illness), said many of the problems raised by speakers Friday could be resolved by accepting the Medicaid expansion.
"The Medicaid redesign is the most important change the Legislature can make to improve mental health care in Idaho," she said. "If we made that change, 96 percent of the individuals would be covered. I hear lots of references here to 'doing the people's business.' I think improving access to health care is in the interests of all people. Why leave so many people foundering until a perfect version (of Medicaid) can be tweaked?"
Spence may be contacted at email@example.com or (208) 791-9168.
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