When uninsured or underinsured patients need help at St. Luke’s Health System in Boise, ID, they will find plenty of options. “Our goal is to connect them with any available resources to alleviate their balances,” says Rachel Seaman, director of the patient access resource center. These include many different federal, state, and county programs.

Up until recently, Medicaid usually was not one of the available options. Currently, 36 states and Washington, DC, have adopted Medicaid expansion, and 14 states have not.1 Idaho recently expanded Medicaid coverage, making about 90,000 Idahoans newly eligible. “Before Medicaid expanding, it was pretty difficult for an adult to receive Medicaid,” Seaman says. “Now, more of our population will meet income criteria.”

Patient access is helping eligible patients enroll. “Those who had insurance are not losing it. Those who had no insurance are now gaining it,” Seaman reports. “We’ve got a pretty big initiative to help community members get enrolled if they’re eligible.” Here are more details about how St. Luke’s is helping patients enroll:

Staff look for all types of coverage the patient is on currently, including commercial insurance and Medicare. This happens for all patients who are admitted without insurance. “It’s not uncommon that we have to do some discovery and some research before we talk to an uninsured patient,” Seaman notes.

Some patients are going from commercial insurance to Medicaid. Of this group, many never had any coverage before, and they received letters informing them about their Medicaid eligibility. Even so, some are unaware they are eligible and possibly even already enrolled in the program.

For those newly eligible, “there are less financial barriers to care. They can remain compliant with follow-up care and medications because they have coverage they never had before,” Seaman observes.

Automated tools show what coverage the patient was under in the past, or is under currently (if any). Staff can tell if the patient is on Medicaid, was in the program in the past (and, if so, what type of Medicaid it was), or if the patient has ever qualified for the hospital’s internal charity program.

“If they have current coverage, great — we add it to the account, and it goes through the regular billing process,” Seaman explains. If not, staff focus on figuring out how to help the person enroll in some type of coverage.

Staff offer other options if someone does not qualify for Medicaid. The expansion covers only those with income up to 138% of the federal poverty level. If a patient does not meet this criterion, staff search for other help. “Our internal financial care program is still available to anyone who meets the criteria and isn’t eligible for external resources,” Seaman notes.

Some pharmaceutical companies offer programs to assist with medication costs. “We are also one of the last states to have the county medical indigency program,” Seaman adds.

The financial advocate team (all certified enrollment counselors) can help patients enroll in any existing Medicaid programs, or the new expanded Medicaid. Applications are a long and complex process, especially if someone is not feeling well. “It’s not uncommon to misunderstand what paperwork is needed and where to take it,” Seaman notes.

Various programs list different requirements. For example, Idaho Medicaid does not calculate assets in determining eligibility, yet the application asks for bank account and real property information. Well-trained staff can help sort these details. “The financial advocates handle it all during the admission,” Seaman says. “The patient doesn’t have to worry about it.”


  1. Kaiser Family Foundation. Status of state Medicaid expansion decisions: Interactive map. Published Nov. 15, 2019. Available at: http://bit.ly/2Qtgi4E.