About Medicaid for Adults

Medicaid offers healthcare coverage for adults that address a variety of health needs, including coverage for low-income adults, pregnant women, the elderly, and people with disabilities who meet certain income criteria.

ALERT: Medicaid members have been involved in two data breaches in 2023. Learn more.

Medicaid programs

Medicaid offers different programs to provide healthcare coverage for adults in Idaho:

Adults with income under 138 percent of the federal poverty level (FPL)
Pregnant women with income under 138 percent of FPL
Women diagnosed with breast or cervical cancer through Women's Health Check.
People aged 65 or older who meet income requirements
People who are blind or disabled (using Social Security criteria)
Medicare Savings Program

Idaho Medicaid Health Plan Booklet

This booklet has information about each of Medicaid’s healthcare benefit plans.

Medicaid Brochure

Learn about Medicaid coverage and benefits available to you.

Medicaid plans available

Basic Plan – This plan provides health, prevention, and wellness benefits for adults who typically do not have special health needs. This plan includes annual physicals, immunizations, most prescriptions, doctor and hospital visits, and more.
Enhanced Plan – This plan is for individuals with disabilities or special health needs. This plan has all the benefits of the basic plan, plus additional specialized benefits. Most of the time, individuals will need to be referred by a doctor to become eligible for the enhanced plan.
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 helps people with complex medical conditions to achieve better health.

To view more details about available health plans and find cost-sharing information please see below:

View All

Idaho Medicaid contracts with MTM (Medical Transportation Management, Inc.) to manage a statewide network of transportation providers for Idaho's NEMT services for Medicaid eligible participants who have no other means of transportation. The Idaho NEMT program covers transportation in-state and out-of-state, to and from healthcare services covered under the Medicaid program.

Idaho rules for the NEMT program can be found at IDAPA 16.03.09.870 through 873.

MEMBER SERVICES

If you have a medical appointment but you do not have a car, cannot operate a car, or do not have a friend or family member who can take you, you can request transportation through MTM.

If you have a vehicle to transport yourself or family members to their appointments, please contact MTM and ask about their mileage reimbursement program.
MTM will review your request and decide if Medicaid will pay for your transportation. MTM will review your request based on the least expensive transportation available and the closest available Medicaid provider for the service.
If you have been referred for medical care outside your community, MTM may ask for a referral from your doctor before they will schedule your transportation.
You need to call at least two (2) business days before your appointment.

You may reach MTM to request transportation by calling 1-877-503-1261, by visiting MTM's Medicaid Transportation website, or by using MTM's Transport Service Management Portal. Trips can be scheduled twenty-four (24) hours a day, seven (7) days a week.

If you or someone you are helping has questions about MTM, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1-888-561-8747.

Appeals or Grievances: If you or someone you are helping has questions about the grievance or appeal process, please call: 1-866-436-0457 or complete the MTM “contact us” on-line form. Information and personal contact information will be securely transmitted directly to MTM and will be kept confidential to the extent required by HIPAA.

If you have questions or feedback for the Medicaid NEMT Team responsible for overseeing the contract with MTM, you may complete our online feedback form, email the team at MedicaidTransport@dhw.idaho.gov, or call 1-800-296-0509.

EXTERNAL RESOURCES

Medicaid Transportation Services - Visit MTM

Find non-emergency medical transportation for Medicaid participants.

Appeals and Fair Hearings

Medicaid Appeals and Fair Hearings

If you disagree with a decision from the Department about the benefits you receive, you can appeal that decision. See the library for more information.

Estate recovery process

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 people receiving Medicaid benefits:

Anyone over the age of 55 who has received Medicaid assistance, and
Anyone who is permanently institutionalized and has received Medicaid assistance, regardless of age.

The estate recovery program may collect money from the estate of a deceased Medicaid recipient as repayment for any medical care services that were provided to the recipient and paid for by Medicaid, while the recipient was over 55 years of age, 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 participant 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. The federal government directs states to pursue Medicaid estate recovery for these services.

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 who is under age 21 years or 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 (AI/AN) and located within the boundaries of a tribal reservation.

As individual circumstances vary, and for more information, please call the Estate Recovery Office at 866-849-3843 or email FinancialRecovery@dhw.idaho.gov