Idaho Seeks Waiver to Shift Medicaid Enrollees to ACA Marketplace Coverage
Idaho has submitted a waiver application requesting federal approval to move Medicaid beneficiaries to Affordable Care Act Marketplace plans while maintaining Medicaid-specific requirements, including work requirements. The proposal would affect thousands of Idaho Medicaid enrollees who would face higher out-of-pocket costs and reduced benefit packages compared to traditional Medicaid coverage. The state would continue to enforce Medicaid program rules despite moving coverage to commercial marketplace plans. If approved by CMS, this approach could represent a significant departure from traditional Medicaid program design and potentially serve as a model for other states seeking similar coverage shifts.
This waiver could fundamentally alter the relationship between Medicaid managed care and marketplace coverage, creating operational complexity for MCOs managing dual populations and potentially reducing Medicaid enrollment while increasing cost-sharing burdens on low-income beneficiaries.
Managed Care · Finance
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