Day 42 – Medicaid at 50: State Highlight: Idaho

Over the coming weeks this blog will highlight a key feature of Medicaid and the individual states that administer Medicaid and CHIP leading up the the program’s 50th anniversary (July 30th). Hopefully, you’ll learn some interesting facts about Medicaid and each of the 51 state programs.

Basics: Idaho Medicaid covers 276,235 lives

Thirty-five of Idaho’s 44 counties are rural or frontier (a frontier area means there are 6 or fewer people per square mile…!!). As you can imagine, this presents quite the challenge for network adequacy. The state is looking to telemedicine to help improve access to care. Mental health is a particular need: only about 100 of the 7,000 doctors in Idaho are psychiatrists, but the burden of mental illness in the state is very high. The Department of Health and Welfare contracts for mental health services in the Medicaid program and their contractor, Optum, has been testing telemedicine services for psychiatry and therapy.

Telehealth is an innovation to watch. it will be interesting to see the therapeutic benefits/limitations, as well as the regulatory issues. In 2014, a doctor in Idaho was sanctioned by the state board of medicine for prescribing an antibiotic over the phone, who considered her actions a violation of the standard of care because she did not first perform a physical exam. (This was not a case of recklessness – the doctor in question was quite an upstanding citizen: she has an MD and PhD, and started doing telemedicine after working in ERs and seeing how many patients lacked primary care.) The Idaho legislature, concerned about access to care, was not pleased that the state was inhospitable to telemedicine. A telehealth council is directed by the state to study and pursue the benefits of telemedicine in Idaho. In March of 2015, HB189 was passed, which requires that the Board of Medicine set up licensing and standards for telemedicine.

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