Promoting and protecting the health and safety of all Idahoans

About Medicaid

Medicaid has different programs available that provide health coverage for:

  • 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
  • People who are blind or disabled (using Social Security criteria)

APPLY FOR MEDICAID

You can apply for Medicaid with just your name, address and signature on an application for assistance, or you may use any of the following options to apply for Medicaid and other Health Coverage Assistance options:

•  Telephone application, 1 (877) 456-1233
•  Visit YourHealthIdaho.org 

Call 1 (877) 456-1233 for more information.

If your family’s income is determined too high for Medicaid, you still may qualify for other Health coverage assistance programs.  To view other programs, visit the Health Coverage Assistance page.

ELIGIBILITY REQUIREMENTS

In order to receive Medicaid, certain eligibility requirements must be met in areas such as, citizenship/immigration status, income, resources, work requirements, and other areas based on your household's circumstances.

MEDICAID AND SCHIP COVERAGE

Medicaid and SCHIP will pay for a number of services, such as prescriptions and dental care. While it is possible to have Medicaid and private health insurance, children who have private health insurance cannot qualify for SCHIP.

BENEFIT PLANS

The Idaho Medicaid State Plan is made up of the Standard State Plan which includes mandatory minimum benefits and three Benchmark Benefit plans that are aligned with the health needs of Idahoans and includes an emphasis on prevention and wellness.  Click on the plan titles below to see the benefits included in each.

Health Plan Booklet

Idaho Health Plan Coverage booklet 

This booklet has information about each of Medicaid’s benefit plans, the importance of using your Healthy Connections doctor, when to use the emergency room, and keeping your child’s well-child checks and immunizations up-to-date. It also has links to connect you with more specific program information, important phone numbers, and office locations. 

Standard Plan – Provides the mandatory minimum benefits. 
Basic Plan -  For low-income children and adults with eligible dependent children.
Enhanced Plan - For participants with disabilities or special health needs. 
Medicare Medicaid Coordinated Plan - For participants who are eligible and enrolled for both Medicare and Medicaid.

Medicaid Benefits Comparison Sheet

Medicaid Management Information System Procurement

The Division of Medicaid is in the initial planning stages for the replacement of the current Medicaid Management Information System (MMIS).  The MMIS is an integrated group of systems and subsystems used to support key business processes including claim and encounter processing, financial management and reporting, payment calculations, third-party liability verification and collections, pharmaceutical drug rebates, prior authorization of services, provider enrollment, participant eligibility, participant enrollment in health plans, premium collections, care management and coordination and program integrity. 

The current MMIS was procured in 2007 and is planned to be strategically replaced over multiple years. The high-level objectives of the next generation MMIS are:

  • An enterprise system that is compliant with applicable Federal and State policy An enterprise system that is flexible to quickly adapt to the dynamic, evolving needs of existing programs and support new regulations, policies and innovations using business driven technical solutions 
  • An enterprise system where business processes are automated wherever possible
  • An enterprise system that provides centralized access to data and data analytics tools to support changing the health status of participants 
  • An enterprise system that includes standardized and automated electronic communication and data exchange capabilities and easily integrates with other systems to enable enterprise wide program management

Click here to view a high-level timeline of procurement activities. 

Visit the Division of Purchasing website to learn more about future procurement opportunities.  https://purchasing.idaho.gov/information-for-vendors/

Idaho Access Monitoring Review 2016

Medicaid recently completed a report using paid claims data to better understand how our members access the following services: 

Primary Care, Specialists, Labor and Delivery, and Home Health.  This report will be repeated a minimum of every three years to monitor access trends.  Updates to this report will be posted on Medicaid’s web site as they occur. We welcome your comments about the report.  We are providing a comment period for 30 business days (August 18, 2016 to September 17, 2016).  All comments are to be emailed to the Access Review project lead no later than the end of day on September 17.  

Access Monitoring Review - 2016

Proposed Changes & Public Notice for Waiver Services

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Rulemaking

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Click here to expand contentClick here to collapse content  2019
Click here to expand contentClick here to collapse content  2018
Click here to expand contentClick here to collapse content  2017
Click here to expand contentClick here to collapse content  2015
Click here to expand contentClick here to collapse content  2014

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