Interview with Juliet Charron, Director of Idaho DHW

Recently, we hosted our first sit down interview in our brave, new, virtual world of Health Policy Commons.

Juliet Charron leads Idaho’s health and human services department, the Dept. of Health and Welfare. The work of the agency ranges from managing the child welfare program to operating the state’s mental health hospital.

Idaho is also one of the last states to operate most of the state’s Medicaid system, from claims to customer service.

The agency does a lot with very little, as Charron explains.

“If we just looked at our Medicaid program and the staffing that we have for that, it’s just over a $5 billion program here in Idaho.

We run on approximately 2% or less administratively, meaning that’s what we’re allocating for our personnel resources, but even functions in the IT space and contractor supports. So, very, very lean.

It’s something that we really pride ourselves on in that we really try to be smart and efficient with the state resources that we have.”

As the legislature has directed the agency to move to a “comprehensive managed care” model, it included specific language about incorporating “Idaho values” in the new model of care financing. These “Idaho values” were in the legislation adopted and will likely be in the new MCO RFP. So, I asked her to talk through what that looked like.

“When we say “Idaho first values,” it is really about supporting — MCOs that are going to be successful in this bid — supporting and maintaining the integrity of what is going to be important to Idahoans.

And that is maintaining that connection to rural community and identity. Maintaining that connection to independence that is very important to Idahoans. And really, very importantly, fostering strong relationships.”

The federal rural health transformation grant is something she says is occupying a large portion of her focus, even on a day-to-day basis as the agency operationalizes those grant funds.

Idaho has a few “limited service contracts” in Medicaid managed care: a managed behavioral health network, a dual eligible program, and a managed dental care program. Charron says her agency has learned lessons from those implementations they can put to use as Idaho prepares for “comprehensive managed care.”

“I think we have learned about the importance of the up front stakeholder engagement, and when I say stakeholders, I’m applying that pretty broadly, meaning we need to understand what the beneficiaries are wanting and expecting from us in receiving Medicaid coverage and benefits. What has been their experience, either in fee for service or in a previous managed care contract.

Having the conversations with providers. And then of course too hearing from MCOs and things maybe they have found very limiting or challenging in working with us, or from interested bidders, things they have seen work very well in other states.

And so that’s why we have spent a ton of time this last year doing very, very robust stakeholder engagement.”

Charron also highlighted the value and importance of close legislative engagement through the process of stepping into a new model for Medicaid managed care.

“The bill that gave us the direction to implement comprehensive managed care, HB 345, I think really spawned this legislative engagement in the first place. But I’ve so appreciated it because now we really have partners who are so invested in seeing this through and working alongside our agency, and really spending a lot of time frankly just understanding managed care, which is complex if it’s not your day to day business and the work that you do.

So, I think that has been different and incredibly valuable and will pay off in dividends.”