Idaho Medicaid Information

Idaho's Medicaid is a state-operated, federally and state-funded health program designed for low-income individuals from specific low-income populations. You may apply for Medicaid by completing an application for assistance.

Populations

• Idaho's Medicaid program provides health coverage for low-income individuals from the following populations: children under age 19, parents or other related adults with children under age 19, pregnant women, women diagnosed with breast or cervical cancer or pre-cancer, people 65 years old or older and people who are blind or disabled, according to Social Security criteria.

Eligibility Criteria

• To qualify for coverage, individuals must be a resident of Idaho, a U.S. citizen or legal resident, and meet certain income limits. Resource limits must also be met and vary depending on the type of Medicaid and family size. For adults without dependent children, the income limit is $205 per month as of 2010. To determine the amount for larger family sizes, add $65 per additional adult. Pregnancy and children's Medicaid coverage income requirements are based on 133 percent of the poverty line, so the income limit for a family size of one is $1,201. For larger family sizes, add $415 per additional individual.

Types of Plans

• A standard plan that covers most medical expenses is available. An enhanced plan is available that provides additional services not covered by the standard plan. Those include case management services, developmental disability services, home and community based services, hospice care, higher maximum limits on mental health services, nursing home coverage, personal care and additional services for women's health.

Medicare-Medicaid Coordinated Plan

• The Medicare-Medicaid Coordinated Plan is for workers with disabilities who are eligible and enrolled in Medicare Part A & B. It involves coordinating service delivery and payment between a Medicare Advantage Plan and Medicaid. The Medicare Advantage Plan covers most services, while Medicaid covers those services not covered by the Medicare Advantage Plan. Those include psychosocial rehabilitation services, nursing facility, personal care and other home and community based services and services for the developmentally and mentally disabled.

Healthy Connections

• Healthy Connections is a managed care program that is mandatory for most Medicaid recipients. If you do not already have a primary care physician that accepts Medicaid, you may locate a participating provider from a provided list or request to have one assigned by a Healthy Connections representative. Your primary care physician will be responsible for making referrals to most services, except specific services listed that do not require a referral from the primary care physician. Those include dental care, chiropractic care, family planning, immunizations, tests for sexually transmitted diseases, vision care and other services.