By Ruth Brown
Idaho Revises Healthcare Coverage for Dual-Eligible enrollees This Summer
This summer, major changes are coming to the healthcare coverage of some disabled Idahoans as the state transitions its dual-enrollee program from Blue Cross of Idaho to United Healthcare. This transition represents a significant shift in how Medicaid and Medicare services are managed for over 26,000 Idaho residents.
The Transition Explained
A dual-enrollee is an individual enrolled in both Medicaid and Medicare. Due to their low income and complex healthcare needs, dual-enrollees benefit from a coordinated healthcare approach. Idaho recently altered its dual enrollment contracts, moving from Blue Cross of Idaho to United Healthcare. Initially, concerns arose from the overlap in contract timelines, as the previous contract ended in June, while the new contract was set to start in January 2026. However, the Department of Health and Welfare has announced that United Healthcare will begin coverage for dual-enrollees in June 2025, addressing potential gaps in coverage.
The Scope of the Change
In Idaho, approximately 26,000 individuals are enrolled in both Medicare and Medicaid. Medicare functions as the primary insurance provider, funded by the federal government. Meanwhile, Medicaid handles services not covered by Medicare, such as in-home care, behavioral health services, and over-the-counter medical supplies like canes, disposable gloves, and adult diapers. Medicaid also covers Medicare premiums and offers expanded benefits.
In a letter dated February 5 to stakeholders, providers, and enrollees, the Idaho Department of Health and Welfare detailed the upcoming changes. Effective June 1, 2025, dual-enrollees in 34 counties will be required to enroll in UnitedHealthcare’s IMPlus plan or choose to remain with Molina Healthcare’s Medicare-Medicaid Coordinated Plan. In the remaining 10 counties, where managed care is not available for dual-enrollees, Medicaid benefits will continue under a fee-for-service model provided by Idaho Medicaid.
Details of Automatic Enrollments
The transfer will occur automatically for dual-enrollees currently covered by Medicaid or enrolled with Blue Cross of Idaho, unless they opt for Molina Healthcare’s Medicare-Medicaid Coordinated Plan. Important to note, Molina Healthcare will be the only plan offering Medicaid-Medicare coverage from June 1, 2025, to December 31, 2025. Starting January 1, 2026, dual-enrollees can enroll in the Medicare-Medicaid Coordination Plan (MMCP) with UnitedHealthcare.
Communication from the Department
Idaho’s Department of Health and Welfare plans to provide more information via mail in March and has a dedicated FAQs website to address any concerns or questions regarding the transition. Ensuring smooth communication and support for affected residents is paramount during this period of change.
Ruth Brown | Producer
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