This article is a collection of the best answers to Idaho Medicaid’s most frequently asked questions.
Medicaid is a government-sponsored healthcare program for low-income families and individuals who fulfill specific income and resource requirements. Only the aged, blind, or disabled can access resources within the defined restrictions.
We have scoured the internet to provide all you need to know about the Idaho Medicaid Benefits.
You will learn everything you need to know about Idaho Medicaid in this article.
Table of Contents
What is the Idaho Medical Program?
The state-federal cooperation known as Idaho Medicaid offers low-income individuals in Idaho who fall into specific categories of health insurance. Its goal is to help those whose health could otherwise suffer from a lack of healthcare access for themselves and their children.
Who is eligible for the Idaho Medical Program?
You must be a resident of Idaho, a national or citizen of the United States, a permanent resident, or a legal alien needing health care or insurance help, and have a low income to qualify for Idaho Medicaid. You also need to fit one of the following criteria:
- Pregnant, or
- Be in charge of a youngster who is under 18 years old, or
- Blind, or
- Have a disability or live with a family member who has a disability, or
- Be 65 years of age or older.
Annual Household Income Limits (before taxes)
| Household Size* | Maximum Income Level (Per Year) |
| 1 | $18,075 |
| 2 | $24,353 |
| 3 | $30,630 |
| 4 | $36,908 |
| 5 | $43,186 |
| 6 | $49,463 |
| 7 | $55,741 |
| 8 | $62,018 |
*For households with more than eight people, add $6,277 per additional person.
How do I contact Medicaid in Idaho?
Phone
1-877-456-1233
Website
What are the Medicaid plans in Idaho?
The state enters into direct contracts with primary care providers to manage care for Medicaid participants in the Healthy Connections program.
Primary care providers are paid a monthly per-member case management fee in addition to the regular Medicaid fee-for-service reimbursement. The state also contracts with three prepaid, limited benefit plans to provide dental, transportation, and behavioral health benefits.
These plans include one national, not-for-profit (Blue Cross of Idaho) and two national, for-profit entities (Access2Care, owned by American Medical Response, and OptumHealth, owned by United HealthCare, for behavioral health starting in 2013).
- Healthy Connections primary care case management (PCCM) program
- Medicare-Medicaid Coordinated Plan coordinates benefits and services between the two programs, all Medicare- and limited Medicaid-covered services.
- Idaho Smiles is a prepaid limited-benefit plan that offers dental care to kids and low-income adults. People who qualify for both Medicaid and Medicare and are enrolled in-home, and community-based services, American Indians and Alaska Natives are also covered in this plan.
- A non-emergency transportation plan, called Access2Care, is also available statewide to most Medicaid beneficiaries.
- Idaho Behavioral Health Plan (IBHP) is a limited benefit capitated managed care program providing outpatient mental health, substance use disorder, and case management services.
- The state has also developed three medical home initiatives: a multi-payer collaborative; pediatric medical homes; and a Medicaid Health Homes program.
What is covered by Idaho Medicaid?
Medicaid in Idaho provides coverage for the following services:
| Annual physicals | Medical equipment and supplies |
| Counseling and mental health services | Medical transportation services |
| Dental services | Nurse midwife |
| Doctor visits | Pregnancy and family planning services |
| Durable medical equipment | Prescriptions |
| Early periodic screening (children only) | Primary care case management |
| Emergency medical transportation | Prosthetics/orthotics |
| Home health care (doctor prescribed) | Smoking cessation |
| Hospice care | Substance abuse treatment |
| Immunizations | Vision services |
| Inpatient and outpatient hospital care | Weight loss |
| Lab tests | X-rays |
Copayments?
A small portion of Medicaid recipients must contribute the $3.65 payment.
How many types of Idaho Medicaid are there?
Depending on your medical needs, Idaho offers three distinct benefit options. It classifies your healthcare coverage as either Basic, Enhanced, or Medicare-Medicaid Coordinated.
Can I have both Idaho Medicaid and Medicare?
Idaho Medicaid Plus, a required managed care program, has been effectively implemented (IMPlus). Participants in this program must be Dual Eligible, which means they must be at least 21 years old, eligible, and enrolled in both Enhanced Medicaid and Medicare (Parts A, B, and D).
What is the highest income limit for Idaho Medicaid?
The maximum income limit for a household size of one in Idaho is $18,075.
Does Idaho have low income health insurance?
Selected groups of low-income individuals in Idaho are covered by health insurance through the state-federal cooperation known as Idaho Medicaid. Its goal is to help those whose health could otherwise suffer from a lack of healthcare access for themselves and their children.
Does the disabled person get Idaho Medicaid?
If they fit the following descriptions, people who are elderly or have a handicap may qualify for Medicaid coverage:
- Live in Idaho
- Be a U.S. citizen or eligible non-citizen
- Have a disability diagnosis
- under the Social Security Act (or)
- Be over the age of 65 years
- Meet certain income and resource guidelines
When people meet specific requirements, they can receive services tailored to their handicap.
How much money can you have in the bank on Idaho Medicaid?
Your “patient liability” or “contribution” refers to the portion of your care you are responsible for funding. Medicaid pays for the remainder.
The maximum amount of assets, real estate, and savings one person may own is $2,000. Several “exempt” resources are not considered when figuring out if you are inside this limit.
Will you still have Idaho Medicaid once you are over 18?
No matter their health status, Medicaid offers health care to all adults with incomes below 138 percent of the federal poverty level as long as they complete the requirements.
For adults who qualify and are enrolled in either the primary or extended Medicaid plans, the Adult Medicaid program offers complete coverage.
Does Idaho expand Medicaid?
As of January 2020, Medicaid was expanded in Idaho. The first day of enrollment was November 1, 2019, and coverage started on January 1, 2020. By June 2021, around 109,000 people had signed up.
Before the COVID outbreak, the state had anticipated that 91,000 people would eventually be enrolled in extended Medicaid.
What is not covered by Medicaid?
Medicaid is not required to pay for private nursing or home care services given by family members. Bandages, adult diapers, and other disposable items are typically not covered, and neither are elective procedures like cosmetic surgery.
What documents do I need to apply for Medicaid?
The application must be accompanied by the following paperwork:
- Social Security Number;
- Proof of Identity (driver’s license);
- Proof of Citizenship (birth certificate);
- Health Insurance;
- Pregnancy (doctors’ confirmation of the pregnancy and the anticipated delivery date, if any);
- Income of Non-pregnant parents applying for Medicaid for themselves should bring proof of resources (last three months’ bank statements, checking or savings account statements, life insurance policies, stocks, and bonds);
- Current monthly expenses;
- If applicable, immigration status.
