By Ruth Brown, Idaho Reports 

Part of a new Medicaid contract for Idaho’s dual-enrollment program isn’t starting until months after the old contract expires, leaving some enrollees with questions about their coverage during the gap period.  

The new contract impacts only dual-enrollees, or people who are eligible for and enrolled in both Idaho Medicaid and Medicare. People who are eligible for both Medicaid and Medicare often have low income and complex healthcare needs.  

In Idaho, about 26,000 people are enrolled in both Medicare and Medicaid, with federally funded Medicare acting as their primary insurance. Medicaid covers services that Medicare doesn’t, such as in-home care and behavioral health. It also covers Medicare premiums and offers expanded benefits for over-the-counter medical supplies and devices like canes, disposable gloves, and adult diapers.  

But just as importantly, dual enrollment provides care coordination and integration for enrollees who see multiple providers, and offers other benefits like non-emergency transportation for appointments. It also offers case management, providing a single point of contact and patient advocacy for enrollees.  

Last year marked the first time the dual enrollment program went through the competitive bidding process in Idaho. The Department of Administration ultimately accepted United Healthcare and Molina Health Care’s bid for the contract. 

In the procurement document, the state told potential bidders that the expected service go-live date was January 2026, and United Healthcare’s contract is scheduled to begin on Jan. 1, 2026. However, Blue Cross of Idaho’s current contract expires June 2, 2025, potentially leaving some dual enrollees with more than six months of jeopardized coverage. 

The Idaho Department of Health and Welfare confirmed Tuesday that it is evaluating all options to prevent disruption of care for enrollees and offer them coverage choices, but declined to further expand on details. 

In the meantime, at least some dual enrollees are being directed to Molina Healthcare, which also has a Medicaid contract with the state.  

Dual enrollees also will always have the option of fee-for-service, and can shop for other plans through the state’s insurance exchange – but those options come with additional costs, and may not cover everything that the Blue Cross dual enrollment plan does. The same is true for the Blue Cross Medicare advantage plans.  

Blue Cross confirmed to Idaho Reports that its dual enrollment contract ends this summer.  

“Blue Cross of Idaho partnered with the Idaho Department of Health and Welfare to design the dual-eligible Medicare/Medicaid program in 2014, providing personal care management to Idaho’s most vulnerable population,” said Bret Rumbeck, Blue Cross of Idaho public affairs manager in an email to Idaho Reports. “We will continue to serve this membership through mid-2025.”  

“Blue Cross of Idaho submitted a bid to continue to serve the dual-eligible membership, but the state chose to go in a different direction,” said Rumbeck. “We are working with the state to notify these members and their providers of the change that will occur in the coming months.” 

United Healthcare has not yet responded to Idaho Reports’ request for comment. 

THE IMPORTANCE OF CARE COORDINATION 

In the bid’s procurement statement for 2024, IDHW stated the Division of Medicaid administers two managed care delivery systems for Idahoans dually enrolled in Medicare Parts A and B and Medicaid, known as duals. The Medicare Medicaid Coordinated Plan and Idaho Medicaid Plus aim to “provide a better service delivery system for this vulnerable population.” 

The state’s procurement document stressed the importance of care coordination by the potential contract holder.  

“Care coordination is pivotal for these programs. The goal of care coordination is to promote whole-person care and connect enrollees to community supports,” the document says. “Care coordinators are located in Idaho. The state seeks to continue its efforts to improve care coordination and efficacy for the duals population and sub populations.” 

It’s unclear how, or when, IDHW is notifying affected people of the coverage change.  

IDHW referred Idaho Reports to the Division of Purchasing for additional questions about the contract. The Division of Purchasing has not yet returned two calls and an email requesting comment. 

Idaho Reports also filed public record requests on Jan. 16 for copies of the new contract with both IDHW and the Division of Purchasing. IDHW reported it did not have a copy of the contract for distribution, while the Division of Purchasing request remains pending. 

The Division of Purchasing’s website states that of procurement projects, the “Medicaid duals” project is listed as “on track” on Wednesday, but offers no further details. 

The change, as well as a lack of information from the state, worries some advocates and stakeholders.  

In a Friday meeting of the Idaho State Independent Living Council, executive director Mel Leviton briefly addressed the new contract, expressing concern to council members about case management during the transition.  

“This is huge, especially for the people directly impacted,” Leviton said. 

David Wilcox, president of Magic Valley Insurance in Twin Falls, told Idaho Reports that he has notified some of his clients of the change. But fewer than 50 of his insurance clients are dual enrollees. Many Medicaid enrollees do not use an insurance agent, he said.  

“These are the most vulnerable clients, and they are absolutely going to go through a big shift,” said Wilcox. “The bigger question is how many (providers) will now accept Medicaid patients?”  

MOLINA’S TROUBLED HISTORY IN IDAHO 

Shifting to Molina’s Medicaid coverage for the last half of 2025 is an option for dual enrollees, but one that raises more questions. 

It isn’t yet clear how many providers accept Molina, nor how Molina’s Medicaid reimbursement rates line up with Blue Cross of Idaho’s. Saint Alphonsus Health System confirmed last week that it has a contract with Molina Healthcare to cover dual eligible members. St. Luke’s Health System confirmed it accepts Molina for Medicare Advantage as well as dual eligible members.  

Idaho Medicaid Plus is promoted on the Molina website as “a health plan for people who are eligible for both Medicare and Medicaid benefits. With this plan, Molina helps coordinate the Medicaid portion of your health care.” 

Under the service, Medicare serves as a dual enrollee’s primary health insurance and Molina pays covered Medicaid services that are left, including Medicare coinsurance and deductible, according to Molina’s website. 

Molina’s efficiency with claims has a troubled history in Idaho. 

The Idaho Office of Performance Evaluations did a report in 2011 and follow-up in 2012 that found Molina’s contract contributed to delays in Medicaid claim payments. Follow-up reports from OPE found providers were unsatisfied with Molina.  

“Evaluators determined that when Molina Healthcare, Inc. began processing claims in June 2010, only about half of the total Medicaid providers were properly enrolled in the new system,” according to a 2011 OPE news release.  

Nationally, Molina Healthcare has also faced issues. In Massachusetts in 2022, Molina Healthcare agreed to pay $4.625 million to resolve allegations that it violated the False Claims Act by submitting reimbursement claims while violating multiple regulations related to the licensure and supervision of staff, according to the Massachusetts U.S. Attorney’s Office. The company also faced whistleblower lawsuits around overbilling in claims, according to Axios.com. 

Molina has not yet responded to a request for comment.  

The Idaho Medicaid Advisory Committee meets at 2 p.m. Wednesday. The new contract for dual coverage is on the agenda.  

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