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.

Idaho Medicaid Health Plan Booklet

Idaho Health Plan Coverage Booklet - English

Idaho Health Plan Coverage Booklet - Spanish 

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.

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

Rulemaking

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