Meeting Agenda – September 2019
Hosted by Canyon County
September 30, 2019
11:00 am – 1:00 pm
Acapulco Mexican Restaurant
819 Main Street, Caldwell, ID
- Medicaid Expansion.
- Mental Health & Addiction Treatment.
- Medicaid Utilization at Allumbaugh House.
- Using the waiver process to incentivize better health and financial outcomes.
RSVP by September 27
Meeting Minutes – September 30, 2019
Guests and Staff
Dave Jeppesen – Director, Idaho Department of Health and Welfare
Bill Larsen – TVP
Welcome and Introductions
Canyon County Commissioner, Tom Dale welcomed everyone to the September meeting of the Treasure Valley Partnership.
Tom stated the previous week he had attended the IAC conference. Two main points of emphasis came out of that conference. One was, what is happening with Medicaid Expansion. The Governor was encouraging when he said he believed that property tax dollars should be collected by local government and should not be sent to the State. Then he went on to say that the Legislature determines that, not him.
Garret mentioned that he has been invited to participate in a legislative committee that is looking at property taxes. He felt it would be a good thing to be able to educate the legislature on property taxes and how cities and counties budget those dollars.
Debbie mentioned that the City of Nampa is holding a legislative town hall meeting in October and hoped this would be a good opportunity to educate legislators on city and county budgets.
Diana said it is too bad that Tammy was not present at the meeting. She asked if people had been following the City of Meridian’s Hands-Free Ordinance. This is the kind of thing that it doesn’t make sense to piece meal between our jurisdictions. She asked if there was an appetite to take this issue up across all jurisdictions of the Treasure Valley.
Garret felt this is just like the Pseudoephedrine issue. If we as a Treasure Valley Partnership did a Hands-Free Ordinance, the State would follow. He proposed we do an ordinance around this issue. He added that if you have Youth Council’s, the kids are interested in this topic and support it. When the State passed the texting while driving legislation, the area’s youth councils went and testified at the legislature and this carried a lot of weight.
Bill indicated he would get a hold of Meridian’s Ordinance and send it out to the TVP members, and we could take this up at our October meeting.
Alicia wanted to thank Stan Ridgeway and the City of Eagle for their generous donation of playground equipment. The City of Wilder was able to get playground equipment for two parks and thanks the City of Eagle for their donation.
Tom announced they just signed a 602 program for Syngenta. They are going to do a $14 million expansion of their operation. This is an international corporation that is improving their footprint in Canyon County.
Dave Jeppesen – Idaho Department of Health and Welfare
He has been with the Department since January. They are the largest State agency in terms of employees and dollars. They have roughly 3,000 employees and a budget of about $3.4 billion. The vast majority of their budget comes from the Federal government. They have a broad reach including everything from Medicaid to mental health (which is high on his list). They have accountability for all the benefit programs around the State (WIC, TANF, SNAP, etc.). They also license a few facilities around the State including hospitals, skilled nursing facilities and assisted living facilities.
Tom asked where the Department is on Medicaid expansion and Health District funding.
Dave said they will be going live on January 1st with Medicaid expansion. We are very fortunate in Idaho in that we have a single eligibility engine. So, when a person comes in to seek eligibility, they check eligibility for every program at the same time. The State is unique in this and they turn around eligibility in 24 hours.
There are roughly 91,000 people in the State that will be eligible for Medicaid expansion. Many of these people, they already know due to their being involved in other programs. They are expecting to enroll about 70,000 people prior to January 1.
He asked if anyone could guess which county has the highest number of Medicaid eligible people. It is Ada County and they have near 14,000 people eligible and Canyon County has near 10,000. As a percentage of population, which county has the highest percentage of Medicaid eligible people for the expansion program. Owyhee county has about 5%, Canyon has 4.5% and Ada has about 3.2%. The top county as a percentage is Madison County.
Garret asked what are the chances of additional physician practices that treat mental illness, opening up and accepting Medicaid patients. Dave said, on the medical side, he feels good that additional practices are going to start accepting Medicaid patients. On the mental health side, he doesn’t feel good about prospects of practices accepting Medicaid patients. This is a very large gap in every part of the State.
They do offer some direct services for severe mental illness. He asked folks to contact him to get a referral to those resources. There are 8,000 people that H&W serves in this capacity.
One of his goals in his job is to move the behavioral health system in Idaho from a policy/systems level. The governor is behind this.
They are going to put together a cross-functional group to focus on a strategy to move forward on the behavioral health system. They have studied this problem a lot, and he wants to look forward to an action plan. The one thing H & W is building up is provider access in the State. Crisis centers are wonderful. They are point solutions. What we really need is a full continuum of care and he wants to develop this.
Tom asked if we have a shortage of primary care Doctors in Idaho. Dave said the physician coverage in the Treasure Valley is above what they would call a shortage area. However, there are a lot of wait times. When you move around the State, almost every county is what they would call a medical shortage area. Part of what happens is if you live in a rural county, you are coming to a metro area. So even though we have a lot of physicians in the Treasure Valley, you have a lot of people coming here from rural counties to access medical care, which increases wait times.
He is glad to see ICOM here as it is helping with the physician shortage. However, we are going to have to be creative with how we use the resources we have. We have not really begun to tap tele medicine which can help alleviate some of this problem. Another is increasing the use of physician assistants.
Tom asked if there are any discussions on increasing the pie for mental health services. Dave said there doesn’t appear to be any talk from legislators in this regard. He added that the tax revenue coming into the State is a little lower than planned. This has hampered budget requests for 2021. On a longer term, there might be some creative federal funding increases coming down.
Tom said that one of the Medicaid Waivers was to allow private mental health facilities to be able to utilize Medicaid. Dave said, about 40 years ago an important policy decision was made to move people out of institutions and into the community. To help move that along, a regulation passed that said we won’t pay for inpatient mental hospitals through Medicaid. The realization now is that we must have these facilities paid through Medicaid because they are part of the continuum of care. There is an IMD (Inpatient Mental Disease) waiver. They are going to go after this in two ways.
First, there was an act called the Support Act. It focused on substance abuse to put more money into the system. What that does is we can apply for a State Plan amendment for anybody that has a mental health issue and a co-occurring substance abuse issue, where we can actually start paying for inpatient mental stays for this population. We are going to pursue this because they think they can get this up and running on January 1.
They are going to pursue the IMD waver as well. This is much more difficult. What they don’t want to have happen, is a move back to institutionalization. They want the State to build the community-based services out. This waiver probably won’t happen till next year. 22 States have applied for this waiver and 22 have been approved. The filing for this waiver is by far the most arduous of any of the waiver processes.
Darin asked what the trends are for the number of people qualifying for Medicaid benefits. Dave indicated they are seeing the number of individuals that are qualifying for benefits is going down steadily. They think this is happening because the economy is up, and the unemployment rate is down. However, under the health insurance exchange, the participation rate has gone up. Idaho is the second highest in the country per capita for people that are receiving coverage under the health insurance exchange. Idaho does have the most successful health insurance exchange in the country. It has the lowest cost, the lowest rate it charges the carriers and the second highest per capita number of people enrolled.
John said one of the challenges local jurisdictions face is that police officers must have social work skills to be successful. It is that emergency resource capability we have challenges with. There are a few beds at Allumbaugh House, but this is a voluntary program. There are fewer resources to deal with the acute issue we run into.
Dave said there is one resource in the valley called TIP (Trauma Intervention Program). Beyond that, one of the things they are going to do is create mobile crisis units to help manage this situation.
Diane said she is excited to be able to take the waiver program and incentivize better outcomes. Dave indicated they are going to release an RFI in November asking health insurance providers and others to move forward to incentivize better outcomes.
Bill directed everyone’s attention to the minutes and financial statement which includes the end of the year budget vs. actual figures. Also included in the packet is an index associated with the redesign of the Treasure Valley Website.
He included a section on Ordinances the Partnership has undertaken over the years. As an example, he included the work the Partnership concluded on the Pseudoephedrine Control Ordinance back in 2006. He asked for a few volunteers from the Partnership to approve content as it gets developed for the website. Tom said he would volunteer to approve content as it is developed.
Joe moved and Gheen seconded to approve the minutes and financial statement. Motion approved.