This booklet has information about each of Medicaid’s healthcare benefit plans. This booklet will answer many of the questions you may have about getting started with Idaho Medicaid and using your benefits. People are different, and so are their healthcare needs. It explains healthcare services, behavioral health (mental health and substance use disorder) services, prescription drug coverage, and long-term services and supports. It describes the Healthy Connections Primary Care program and the importance of using your Healthy Connections doctor, when to use the emergency room, and keeping your child’s wellness exams and immunizations up-to-date. It also has links to connect you with more specific program information, important phone numbers, and office locations.
Idaho Medicaid administers comprehensive healthcare coverage for eligible Idahoans. Medicaid contracts with individual healthcare providers, agencies, institutions, and managed care entities to provide healthcare services for low-income people and families, including children, pregnant women, the elderly, and people with disabilities.
Medicaid participants have access to covered benefits through three plans that align with health needs:
Basic Plan - Designed to meet the health needs of people in generally good health, without disabilities or special health needs. This plan provides health, prevention, and wellness benefits. Most participants will be in this benefit plan.
Enhanced Plan – Designed for people with more complex needs and medical conditions, disabilities or special health needs, and people over the age of 65. This plan has all the benefits of the Basic Plan, plus developmental disability services, children’s service coordination, and long-term services and supports.
Medicare-Medicaid Coordinated Plan - Designed for people who are eligible and enrolled in both Medicare and Medicaid, also known as dual eligibles. This plan has all the benefits of the Enhanced Plan, plus allows people to enroll in a managed care plan to help coordinate Medicare
and Medicaid benefits. There are many advantages to enrolling in managed care, one of the most valuable is access to a care coordinator who assists people with complex medical conditions to achieve better health.