Medicaid covers adults with intellectual and developmental disabilities (DD) as well and adults with physical disabilities. Medicaid also covers elderly persons who may need additional services to help them live as independent as they can. The goal of the Medicaid program is to get the right care at the right place at the right cost with the right outcomes. After Medicaid eligibility is determined, and person will have an assessment regarding the level of care required to help meet the person's needs and care.
If you’re someone who is elderly or lives with a disability, you can be eligible for Medicaid coverage if you meet the following criteria:
- Live in Idaho
- Are a U.S. citizen or eligible non-citizen
- Have a disability diagnosis under the Social Security Act (or)
- Are over 65
- Meet certain income and resource guidelines
If you have a DD, you can receive services specific to your disability when you meet certain criteria.
Medicare/MEDICAID Participants
If you’re over 21 and have Medicare A, B, and D and are eligible for enhanced Medicaid, you’re a dual eligible member. There are two programs available for you to choose from, the Medicare Medicaid Coordinated Plan (MMCP) and the Idaho Medicaid Plus (IMPlus) Program. For more information, visit the Medicare/Medicaid Members page.
If you’re an adult Medicaid member with disabilities, there are different income limits depending on the level of care you need. Basic Medicaid coverage is for the aged, blind, and disabled members and can be found below. Income counted toward a Medicaid eligibility determination includes, but is not limited to:
- Social Security
- Supplemental Security Income (SSI)
- Interest from bank accounts and investments
- Retirement and other pensions
- Payments from trusts, annuities, etc.
- Wages from a job or self-employment
- Resources such as property and bank accounts will also be considered
To be eligible for Medicaid for the Aged, Blind and Disabled program, you can't own resources in excess of the resource guidelines.
Resources that count toward eligibility:
- Cash
- Savings
- Certificates of deposit
- Stocks
- Bonds
- Mutual fund shares
- Promissory notes
- Contracts
- Cars (if more than one)
- Real estate
- Other resources
Resources that do not count include:
- Your home, as long as one spouse still lives there or you intend to return home
- One car
- Household goods and personal effects, including one wedding ring and one engagement ring
- Cash value of life insurance, if the face value of all policies is not worth more than $1,500 for each spouse
- Burial plots
- Up to $1,500 set aside for burial of each spouse
Depending on your specific needs, you may be eligible for the following services:
- Residential habilitation
- Chore services
- Respite services
- Supported employment
- Non-medical transportation
- Environmental accessibility adaptations
- Specialized medical equipment and supplies
- Personal Emergency Response Systems (PERS)
- Home-delivered meals
- Skilled nursing
- Behavioral management and crisis management
- Adult day health
- Self-directed community supports
Medicaid estate recovery is the process through which each state recovers the costs of medical services it has paid from the estate of the person who received those services. The Medicaid estate recovery program impacts two groups of members receiving Medicaid benefits:
- Members 55 or over who received Medicaid assistance, and
- Members who were permanently institutionalized and received Medicaid assistance, regardless of their age.
The estate recovery program may collect money from the estate of a deceased Medicaid member as repayment for any medical care services that were provided to the member and paid for by Medicaid, while the member was over 55, or permanently institutionalized, regardless of age.
Medical care includes a wide range of services, including nursing home and community based in-home care services. It also includes any hospital and prescription drug services the member received while in a nursing home, or while receiving in-home care. Medical care also includes capitation payments to Medicaid contracted health insurance companies or medical providers administering a defined package of benefits.
Federal law recognizes that the needs of certain relatives can take precedence over the state’s interest in recovering assets from the deceased. For this reason, states are not allowed to pursue Medicaid estate recovery under the following circumstances:
- During the lifetime of the surviving spouse, regardless of where he or she lives.
- From a surviving child under 21, or a child of any age that is blind or permanently disabled (based on Social Security criteria), regardless of where he or she lives.
Idaho Medicaid Estate Recovery will exempt all property, whether held in trust or not, if the property is owned by an American Indian or Alaskan Native and located within the boundaries of a tribal reservation.
As individual circumstances vary, and for more information, call the Estate Recovery Office at 866-849-3843 or email FinancialRecovery@dhw.idaho.gov.