Promoting and protecting the health and safety of all Idahoans

Medicaid Policy

With so many new and amended federal statutes, state statutes, and federal regulations going into effect every year, the Medicaid policy team works diligently to keep abreast of the latest changes, perform the appropriate public and Tribal notifications, and maintain strict compliance with all federal and state mandates. 

This page offers access to key documents that impact the operations of the Idaho Medical Assistance Program, such as the following:

  • State plan and related documents representing Idaho’s contract with the U.S. Department of Health and Human Services to provide healthcare services.

  • Medicaid policy documents, which offer guidelines to providers and staff regarding the methodology Idaho Medicaid uses in reimbursing claims for specific services.

  • Idaho’s approved waiver applications, which allow Medicaid to deliver services to targeted populations of Idahoans with special needs.

  • Tribal policy documents, which underscore the Department’s longstanding commitment to the process of consultation with Tribal leaders, Indian Health Programs, and urban Indian organizations.

  • Information Releases to Medicaid providers.

  • Rulemakings.

For further information, please use the link in the right column to email the policy staff. 

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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.

Title XXI

The Idaho Children’s Health Plan, also known as CHIP is operated under Title XXI authority.  Idaho’s CHIP program currently provides coverage for eligible children up to 185% of the Federal Poverty Level. 

The Title XXI State Plan is typically updated on an annual basis with an
amendment due to CMS on or before June 30th of each year. 

  • Title XXI State Plan 

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


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