|By William L. Spence, Lewiston Tribune, Idaho|
|McClatchy-Tribune Information Services|
They were among the 30 people who testified during a joint listening session by the
Delgado and her daughter drove six hours from
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
"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
Unless they're pregnant or have certain disabilities, most
That income limit is set by
Roughly 80,000 Idahoans fall in this income gap, earning too much to qualify for
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
About half the people who testified Friday cited ongoing problems with Optum Idaho, a division of
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
Tangen suggested the company set aside its prior authorization requirement until such time as it has enough staff to prevent the bottleneck.
"We'll try to get to the bottom of this," he said.
The company is scheduled to appear before the
Spence may be contacted at [email protected] or (208) 791-9168.
(c)2014 the Lewiston Tribune (Lewiston, Idaho)
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