Health Insurance For Low-Income
Idaho Medicaid and CHIP provides healthcare coverage and programs for low-income 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 aged 65 or older or people who are blind or disabled (using Social Security criteria). With the introduction of Obamacare (The Affordable Care Act), Idaho opted to expand their Medicaid programs. If you were denied Medicaid coverage in Idaho prior to this expansion, you may now qualify.
Idaho Medicaid currently has 230,000 enrollees, growing 75% over the last 10 years. It is the single, largest healthcare plan in Idaho. Looking to the future, Medicaid is poised to play an even greater role in healthcare coverage as Medicaid benefits expand to more citizens through the Affordable Care Act. Idaho Medicaid is engaging stakeholders to help identify the essential elements of an accountable managed care system that promotes cost-effective care and improved health outcomes.
In this effort to preserve Medicaid’s safety net services, Idaho is developing managed care programs that have the potential to improve patient outcomes and maximize use of taxpayer dollars. Idaho Medicaid currently provides managed care programs for dental benefits, transportation, and primary care case management. The program has several managed care initiatives under development including:
- Mental health and substance use disorder services
- Coordination of care for people who have dual eligibility in both Medicare and Medicaid
- Medical home initiatives including Governor Otter's Multi-Payer Collaborative and pediatric medical homes under the Children's Healthcare Improvement Coalition and Medicaid Health Homes.
Idaho's waivers include:
- Aged and Disabled Waiver
- Developmental Disabilities Waiver
- Idaho Behavioral Health Plan (IBHP)
- Act Early Waiver
- Children's Developmental Disabilities Waiver
Idaho Medicaid Plan Options
Children’s Health Insurance Plan (CHIP)/Medicaid
The Children’s Health Insurance Program or CHIP is a low-cost health coverage program for children under age 19 whose family income is too high to qualify for Medicaid.
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Early and Periodic Screening, Diagnosis, and Treatment provides well-child care visits to a doctor that includes shots to prevent diseases and regular check-ups to make sure children are developing normally for individuals under 21 years of age.
The Wellness PHA is a program that provides parents of children on the Children's Health Insurance Program (CHIP) additional benefits for keeping their children up to date on well child checks and immunizations. If your child is on CHIP and you pay a monthly premium for your child’s Medicaid coverage, your child is eligible for the wellness PHA benefit.
Medicaid School-Based Services
School-based services are health-related and rehabilitative services are provided to children with disabilities who receive services under the Individuals with Disabilities Education Act (IDEA). These services are provided by school districts and charter schools and are considered medically necessary for children to participate in their educational program.
Idaho's Medicaid for Workers with Disabilities
The Medicaid for Workers with Disabilities (MWD) program provides health insurance for individuals that work and have a disability (by Social Security Administration definition) and are between 16 and 64-years-old, and meet certain income and resource limits.
Medicare-Medicaid Coordinated Plan (MMCP)
The Medicare-Medicaid Coordinated Plan (MMCP) is a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) that enrolls individuals over age 21 that are eligible for both Medicare and Medicaid. The Idaho Department of Health & Welfare (IDHW) has contracted with Blue Cross of Idaho to administer most of the state’s Medicaid benefits, including long-term care, home and community-based services, and the coordination of the delivery of Medicare and Medicaid services.
The MMCP is also required to integrate Medicare and Medicaid processes. In July 2014, the MMCP was enhanced to include Long Term Services and Supports. In addition to Care Coordination, the State’s program offers access to the Blue Cross of Idaho provider network. As evidence of the commitment to improving the quality of healthcare to Idaho Duals, Blue Cross has announced a pilot program exclusively for MMCP participants called Home Stay. The pilot program is designed to allow participants with chronic conditions to live in their own residence for as long as possible. Home Stay uses remote monitoring to establish a baseline, then detects variations in the participant’s daily routine. Changes in activity are examined, then determined if the change is an early indicator of deterioration in function, or linked to an acute health issue. If the change is ruled a potential health risk, notification is sent to a clinical team for review and to contact the participant to determine if help is needed. Home Stay is a time-limited program scheduled to begin in January 2016. The service is free of charge, voluntary, and enrollees can discontinue at any time.
Medicare-Medicaid Coordinated Plan (MMCP)
The Medicare-Medicaid Coordinated Plan (MMCP) is for participants who are eligible and enrolled for both Medicare and Medicaid. The Division of Medicaid has offered the MMCP to provide a coordinated health coverage plan. Enrolling in a Medicare Advantage Plan is voluntary. The MMCP covers all medically necessary and preventive services covered under Medicare Part A, Part B, and prescription drug coverage under Part D as well as additional services covered by Medicaid.
To qualify for this benefit, the participant must be over age 5, have Basic or Enhanced Medicaid coverage, and meet specific weight criteria.
Idaho Home Choice: Money Follows the Person (MFP)
The Money Follows the Person (MFP) program is designed to assist individuals to transition from an institution into a home and community-based living arrangements, such as a home or an apartment. MFP initiatives increase outreach to individuals in institutions and decrease barriers to transition. To participate in the MFP project, you must have lived for at least 90 consecutive days in a nursing facility, an intermediate care facility for individuals with mental retardation/intellectual disabilities, or an institution for mental diseases. You also must be Medicaid eligible at the time of discharge as well as qualify for the Aged and Disabled or Developmental Disability waivers and move to a “qualified residence”
Idaho Behavioral Health Plan (IBHP)
The IBHP provides services for children with serious emotional disturbance and adults with serious mental illness or serious and persistent mental illness as well as any adults or children who manifest symptoms indicative of behavioral health issues. United Behavioral Health (dba Optum Idaho) was selected to administer the plan using a managed care approach.
Innovative Health Plan Coordinates Medicare and Medicaid Services
Idaho Medicaid provides a coordinated health plan for most Idaho residents who are eligible and enrolled in Medicare Part A and Part B and full Medicaid coverage. The Medicare-Medicaid Coordinated Plan (MMCP) offers comprehensive benefits through one care management team to develop care plans and coordinate benefits. The MMCP is administered by Blue Cross of Idaho. The name of this plan is True Blue Special Needs Plan, and it is designed to address members' specific needs by providing a Care Coordinator to serve as a central point of contact to integrate each member's healthcare needs. The True Blue Special Needs Plan covers all medically necessary and preventive services covered under Medicare Part A, Part B, and Part D prescription drug coverage as well as services covered by Medicaid.
Medicare Costing Savings programs
The purpose of Medicare Costing Savings programs is to assist individuals in paying their Medicare premiums and by making payments to medical providers for coinsurance and deductibles for Medicare services; or Medicare Part B premiums only. The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part B premiums, coinsurance, and deductibles for eligible persons enrolled in Medicare Part A. The Specified Low Medicare Beneficiary (SLMB) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program, except for excess income.
HIPP (Health Insurance Premium Payment) Program
Health Insurance Premium Payment (HIPP) Program provides financial assistance to families that qualify for healthcare support, despite having insurance through their employer. This program allows the family to begin to increase their long-term health support system while being able to take advantage of Medicaid’s coverage options. To qualify for this program, one person in the family must be qualified for or currently using Medicaid.
Idaho Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following groups are eligible for Idaho Medicaid:
- Children 0 - 5 years with a household income below 142% of the Federal Poverty Limit (FPL);
- Children 6 - 18 years with a household income below 133% of the FPL;
- Parents with a household income below 24% of the FPL.
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in Idaho, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of Idaho's Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.