Medicaid payment woes plague Idaho mental health service providers

A contractor the state hired to manage payments issues checks worth pennies


BOISE STATE PUBLIC RADIO, adutton@idahostatesman.comAugust 25, 2014

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The state’s effort to rein in Medicaid costs has created deep friction between small businesses that deliver behavioral-health services to Medicaid patients and a new contractor hired to manage them.

Service providers across Idaho have raised complaints over the last 11 months that the contractor, Optum Idaho, a unit of United Behavioral Health, has created red tape and cut services needed by at-risk patients.

Now providers in the Treasure Valley have raised another complaint: Optum isn’t paying them promptly, putting their businesses’ survival and employees’ jobs at risk.

Optum says it has fixed a glitch that resulted in tiny claims payments to the companies, which provide counseling and other behavioral health services to low-income and disabled adults and children on Medicaid.

Optum says it erroneously sent small checks totaling amounts like $.05, $.07, or $.11 starting Aug. 1 to providers who care for Medicaid patients who need behavioral-health treatment.

“(We) apologize for any inconvenience caused by this temporary error, and we invite any provider with concerns or questions to call Optum Idaho,” Optum said in a statement.

But some providers say the problem actually began last September, when Optum took over management of Idaho’s Medicaid behavioral health system.

Two of the Treasure Valley’s largest mental health care providers for Medicaid patients say these tiny payments have recurred throughout Optum’s first 11 months in Idaho.

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Idaho losing $3.3 billion in federal Medicaid funds, says study

By Statesman staff

August 7, 2014

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A new report says Idaho will lose $3.3 billion in federal Medicaid funds, and $1.5 billion for hospital reimbursement, over roughly the next decade by not expanding its Medicaid program to all poor adults.

The report from the Urban Institute and the Robert Wood Johnson Foundation, released Thursday, says Idaho’s savings and new state revenues from a Medicaid expansion would the cost of implementing an expansion. Hospitals also would get reimbursed for newly eligible Medicaid patients who now lack insurance.

“The impact of not expanding Medicaid has broader implications than just the number of people who gain insurance. It significantly impacts state economies and hospital budgets,” said Kathy Hempstead, director of the Robert Wood Johnson Foundation, whose goals include 95 percent of Americans being covered by health insurance. “States are literally leaving billions of dollars on the table that would support their hospitals and stimulate the rest of their economies.”

States were required under the 2010 Affordable Care Act to expand their Medicaid programs to include anyone living in poverty — not just poor children, poor pregnant and new mothers and adults with disabilities, as is the case in Idaho. However, the U.S. Supreme Court ruled that states don’t have to comply with that part of the law. The Idaho Legislature and Gov. Butch Otter have opted not to expand Idaho’s Medicaid program.

States that expand Medicaid will have at least 90 percent of their new Medicaid costs covered by the federal government, under the law. Idaho lawmakers have voiced concerns about that federal-match rate being cut, leaving Idaho responsible for medical costs of significantly more people — a concern the new report addresses.

Miles for Meghan: Students buy adaptive bike for classmate

by Maggie O’Mara


Posted on May 11, 2014 at 11:16 PM

Updated Monday, May 12 at 7:10 AM

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EAGLE — Students at Eagle Middle School are going the extra mile to help out one of their classmates — they’ve raised more than $3,300 to help buy a special bicycle for her.

We first brought you Meghan Wildman’s inspirational story last June. The 13-year-old was paralyzed in a car accident last year. At the time, Meghan’s dance teacher made her dream to dance again possible, helping her to learn to dance in a wheelchair.

In addition to dancing, Meghan also loved bike riding, but hasn’t been able to since her accident. Her friends at school decided to change that.

Seventy-eight National Honors Society students organized Miles for Meghan – a rally to raise the money to buy her an adaptive hand cycle.

In the last year, Meghan has been doing a lot of physical therapy to get stronger.

“It was a really hard year, really hard,” said Meghan’s mom, Trina Holley Wagoner. “We’ve actually taken a turn toward hope.”

Hope that Meghan will walk again with the help of braces.

Her family is overwhelmed by the show of support from Eagle Middle School.


Susan G. Komen gives 250k for cancer screening and assistance

by Andrea Lutz


Posted on March 24, 2014 at 7:25 PM

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BOISE– There continues to be a need in Idaho to get women screened for breast cancer, and Race for the Cure is right around the corner in May.

Money raised from that event as well as others is given to Idaho hospitals and clinics for breast cancer screening and financial assistance to patients.

This year Susan G. Komen Idaho is dispersing $250,000 in grants on April 1.

Mission Manager Jody Weak said that money is used in any and every way possible.

“We are granting to various hospitals clinics other non profits that are helping people with free mammograms, diagnostics services, patient assistance,” Weak explains. “It will help people pay for things like utility bills, travel to and from treatment, things like that.”

According to Weak fundraising is down from the previous year, and that is a problem.

“Idaho is last in the nation for women getting screening mammograms,” said Weak.  “It’s something that we are not proud of. It’s a number we really want to change.”

That alarming statistic is something Saint Alphonsus Regional Medical Center is among those trying to change as well.

Saint Al’s will get $52,000 of the Komen grant money, and $20,000 of it will go toward funding their mobile mammography buses.

“We are putting it to our greatest need,” explains Sharma Benard with the Saint Al’s Breast Cancer Center.

There are now two pink buses in their fleet. Several times a week they travel to rural areas of Idaho and Oregon bringing preventative care to women who might not otherwise get the chance to be screened.

“We want to catch it when it’s small so early detection is the best prevention,” said Benard. “They never say stop having mammograms. As you get older, your chances increase.”

Inmates give donation to injured Kuna football player

by Karen Zatkulak


Posted on March 12, 2014 at 6:08 PM

Updated today at 8:26 AM

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KUNA — A group of inmates from the Community Work Center gave a special donation to injured football player Boone Bartlome, Wednesday morning.

There are 100 inmates at the Work Center, all nearing the end of their time behind bars.

One of them is Thomas Massey. He’s been locked up since 2005 on meth charges but says he’s worked hard to change his life around.

“This is the last step before you get back to society. This place here helped me to change my life, and to put me back on the right path so Idaho did help me to do something in my life, to change,” said Massey. He’s been at the work center for the last three years, working as the head cook.

Massey said he watched the news coverage of Boone’s accident and followed along during his recovery.

Vince Samares was also following Boone’s story.

Both decided they wanted to help Boone and decided to raise money for a donation.

Samares says the inmates are one step away from being released and want to show that they can be a helpful piece of society.

“People get to work in the community, save money, and when they get out they aren’t a burden on the resources,” said Samares.

Massey and Samares had been waiting for weeks to meet Boone and hand over their donation.


Amid jokes and laughter, both inmates helped Boone inside the visitor area. Massey, Samares and Boone talked about football and trucks.

They also shared pieces of their personal journeys, and something they have in common with Boone — getting through difficult times.

Massey said he understood Boone’s situation, as he’s dealt with challenges in his own life.

“I know you have a change to do and it’s hard but I commend you because you didn’t stop, and I’m not going to stop either,” said Massey.

Boone said he may remember this donation most, because of the people behind it.

“When we were told we were getting a donation from here, you don’t hear anything about that and so they don’t know you guys are doing good for the community,” said Boone.

The check was for $760, money donated from those still paying for their crimes.

Some, like Massey, make just $100 a month. Others on work release have full time jobs but are charged 35 percent of their wages for room and board.

Boone said he really enjoyed meeting Massey and Samares.

“When you hear something like this, you find that really cool, I thought out of all the donations, this was one of the coolest ones,” said Boone.

The donation seemed to have touched Massey just as much.

“It helps us understand that we are humans too. Even though we did make mistakes in our life and meeting Boone was really one of the highlights of my life,” said Massey.

Developer brings opportunities, optimism to downtown Boise

by Justin Corr


Posted on February 9, 2014 at 6:13 PM

Updated Sunday, Feb 9 at 6:13 PM

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BOISE — The face of downtown Boise is changing quickly. There’s finally a building at 8th and Main, the convention center is expanding, and there’s talk about a new transportation hub.

The developer at the center of all that, is Gardner Company.

“Three years ago, if a genie appeared and granted me three wishes, among the top of them would’ve been, fill the hole in the ground and expand the convention center,” said Boise Mayor David Bieter. “Well, I didn’t really need a genie. What I needed was Gardner Company and Tommy Ahlquist.”

Tommy Ahlquist is Gardner’s Chief Operating Officer.

“I just think that people weren’t ready for something to come so quickly on the heels of 8th and Main,” Alquist said.

But now, Boise’s city and business leaders are ready and excited.

“In the ten years I’ve been here, there have never been more opportunities and great things cooking all at once, than there are now,” said Bieter.

While Gardner has a number of projects around the state, they also have more in the works for downtown Boise. They want to create a transportation hub, possibly under the U.S. Bank Building, which they recently purchased.

“People are like, ‘Why does it have to be underground?,'” said Alquist. “But, when you start seeing the bigger vision, where you have this underground downtown hub, that’s going to connect us across the river to Boise State and to the airport. Then, you put a convention center on top of it, and all this extra retail and office, and really transform again this downtown area to be the hub of all the activity that will build around it. Then, it makes all the sense in the world.”

Mental health care providers blast private manager


Associated PressJanuary 24, 2014

BOISE, Idaho — Mental health professionals blasted a private company now managing behavioral health care for low-income Idaho residents, saying the contract is plagued with problems and hours-long delays that not only make the process more difficult but could put their clients at risk.

A joint House and Senate Health and Welfare Committee meeting Friday provided a venue to criticize Optum, a Minnesota-based health care services management company whose parent company is UnitedHealth Group.

Since September, it’s being paid $10.5 million monthly to administer outpatient behavioral health services for Idaho’s Medicaid program as the state seeks to as it seeks to control costs, boost efficiency and give incentives to providers to offer appropriate services when they’re needed. However, private providers in Idaho say the transition has been fraught with poor communication, including spending hours on hold with the company’s representatives as they seek to authorize services for people suffering from mental illnesses.

Nikki Tangen, of Boise-based Access Behavioral Health Services, contends Optum has exacerbated a bottleneck in getting care to clients in crisis. One prospective patient barred from getting help is now in a psychiatric hospital, another committed a felony offense and another burned his house down, Tangen said, complaining she currently has 16 new clients on hold because nobody will tell her if services will be covered.

Amazing Amigos: Group provides social interaction for special needs adults

by Maggie O’Mara


Posted on January 12, 2014 at 10:52 PM

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BOISE — Adults with special needs often don’t get many opportunities to get out and make new friends. But that’s all changing in the Treasure Valley, thanks to a special group called the Amazing Amigos.

“One of our parents started activities at their house,” said Clint Swaim. “We’d meet Fridays and play games.”

Swain sent KTVB an email, telling us about The Amazing Amigos – a social group for adults with special needs.

Freddie Gallas is one of the organizers of the group and hosted the gatherings until the group got too big.

“It was in our house for a while, we had a huge basement, we outgrew the basement even.”

Crossroads Community Church in Nampa then generously offered the Amigos some space to meet.

“We have adults that when they first started coming would barely talk to anyone, and now they have buddies they hang with,” said Gallas.

When the Amigos started, there were just a few people in the group, but word spread fast. Now they have more than 40 members.

“We have people who drive from Boise, we have people from Caldwell,” said Gallas. “That tells me right there, the word is getting out about us.”

They meet every Friday for lunch and activities.

“My mom decided the group is totally good for me to get out and see everybody, meet new friends,” said Amazing Amigo Meghan.

“We get out and have fun and it gives us a chance to meet people like us,” said Amazing Amigo Jared.

Camouflage Christmas will benefit veterans

Operation “Camouflage Christmas” takes place Dec. 18 at 11 a.m. when members of the Idaho Air Guard, Idaho Army Guard plus Navy and Marine Reserve units from Gowen Field convoy to the Idaho State Veterans Home – Boise, 320 Collins Road, to deliver Christmas gifts to veteran residents.

Volunteers will place nearly 500 gifts around the Christmas tree in the home’s dining room.  Men and women from all branches of service will pay visits to veterans before returning to their duties at the base or with their civilian employers.  Many of the service members will return to help the veterans open their gifts at the Christmas party on Dec. 20, starting at 2 p.m.


From one teen to another: Saving a friends’ life means speaking up

by Dee Sarton


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BOISE — Like a lot of young adults, Kaitlyn Carpenter has a tattoo, “It says ‘I’m the hero of this story.’ I got it my senior year because of everything I went through.”

This BSU freshman is a survivor, and now she’s helping others survive the very real danger of depression and suicidal thoughts.

“It’s extremely terrifying not to be able to trust your own mind,” said Carpenter.

Kaitlyn has dealt with depression since she was in high school. At first, she did what a lot of teens do, reached out to friends and often in the middle of the night with a text.

“It wasn’t until I went though treatment that I realized how dangerous it was to only rely on friends for support,” Carpenter said.

Now she shares her story and her warning to adolescents in schools and churches. Her biggest concern is that teens are texting in their darkest hour — a form of communication that is superficial and doesn’t convey the possible urgency of the moment.

“I would say the number one reason these kids who receive texts don’t say anything is because they feel an obligation to text them until they go to sleep then count that as a victory if they don’t hurt themselves and they feel an obligation not to say anything about it and keep it to themselves,” said Carpenter. “It’s a game that’s so dangerous, It’s becoming deadly and that’s something I want high school kids in particular to understand.”