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Idaho Medicaid Rules & Regulations

Medicaid is a state-operated, federally and state-funded health insurance program for certain low-income populations. Every state covers the elderly and disabled, pregnant women and children who meet income requirements under Medicaid. Idaho's Medicaid program also covers low-income women with breast or cervical cancer or pre-cancer. You may apply for Medicaid by downloading an application from the Idaho Department of Health and Welfare's website (see resources) and submitting it in person to your local Health and Welfare office, by fax or by mail.

  1. Citizenship / Residency

    • You must be an Idaho resident and a U.S. citizen or legal non-citizen to qualify for Idaho Medicaid.

    Income Limits

    • Income limits must be met to qualify for Medicaid. The following limits are accurate as of June 2010. If you are pregnant and live alone, your income limit is $1,201 per month. If you are pregnant and live in a household with a dependent child under the age of 19 with two total individuals, the income limit is $1,615 per month. For a household of three it's $2,030 per month, for four it is $2,444 per month, for five the limit is $2,859 per month, for six it is $3,273 per moth, the limit for a household of seven is $3,688 per month and for eight it is $4,102 per month for pregnancy coverage. Add $415 for each additional household member to determine the income limit for households with a size greater than eight. If you are receiving Medicaid due to being elderly, disabled or another reason, contact your local Department of Health and Welfare office to find out your specific income limit.

    Resource Limits

    • As of June 2010, resource limits are typically $1,500 for an individual and $2,250 for a couple.

    Your Responsibilities

    • Everyone enrolled in Idaho Medicaid must adhere to the responsibilities outlined in the program handbook. These responsibilities include providing true and complete information about yourself and your circumstances, reporting any changes as soon as possible, paying out-of-pocket for services that require a Healthy Connections referral if the service is accessed prior to requesting a referral, ensuring that you are accessing a provider that accepts Medicaid and paying any cost sharing, co-payments and premiums in a timely manner. Failure to adhere to these responsibilities may result in loss of Medicaid coverage.

    Fraud/Abuse

    • If you commit fraud, such as misrepresenting your information for the purpose of obtaining benefits for which you would otherwise be ineligible or breaking other rules of the program, you may lose your coverage either temporarily, or if the infraction is serious enough, for a lifetime. You may also be prosecuted and be required to repay the benefits you received.

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