Q: What is the suitable representative plan?

A: The judge in the K.W. v. Armstrong class action lawsuit ruled that Idaho Medicaid had to make big changes. One thing they have to do is make sure that adults with development disabilities can get help appealing their budgets. Medicaid has to make sure everyone who wants one has a “representative” to help them get a higher budget when they need it.

Medicaid has a new plan to make sure people can get a representative to help them. This is called the “suitable representative” plan.

Q: I thought I could already get a suitable representative to help me with an appeal?

A: For the past 5 years, Medicaid has paid the K.W. v. Armstrong lawyers to give a free training about how to appeal your budget. Service Coordinators and Support Brokers can get paid to help with appeals if they get the training. Anyone can get help by phone or email with an appeal question be contacting a hotline.

The new plan will change that. The new plan is for representatives to help appeal budgets under the new budget system. The new budget system will start in June 2022. The new plan is different.

Q: How is the new suitable representative plan different?

A: Here are some big differences between what you can get now and Medicaid’s new plan:

1.    The free training will be done by Medicaid, not the K.W. v. Armstrong lawyers.

2.    The free training will only be online. There will not be any live training in person.

3.    Service Coordinators and Support Brokers may not be able to get paid to help with appeals.

4.    The hotline may not help with appeal questions anymore.

5.    If you can’t find a representative to help you, you might get a Medicaid employee as your representative.

We are still waiting for more information about the plan. If we learn about other big differences, we will add them to this list.

Q: How can I see the actual, full plan?

A: Here’s the complete plan that Medicaid provided.

Q: Is the new plan final?

A: No! We need to hear what you think about the new plan. If we like the plan, we can tell Medicaid we agree with it. If we don’t like the plan we can object to it. We will have at least until early May 2022 to decide.

Q: How can I learn more and say what I think about the new plan?

A: The K.W. v. Armstrong lawyers will hold an online meeting so you can learn more and tell us what you think. This meeting is just for people who get Medicaid DD services in Idaho and their primary advocate. The meeting will not be recorded.

Learn more from the K.W. v. Armstrong lawyers:

Thursday, May 5, 2022
4:30 PM MT to 6:00 PM MT / 3:30 PM PT to 5:00 PM PT

You must register in advance to attend. Register here.