Medicaid covers adults with intellectual and development disabilities as well as adults with physical disabilities. Medicaid also covers elderly individuals who may need additional services to help them live as independently as possible. The goal of the Medicaid program is to get the right care at the right place at the right cost with the right outcomes. After Medicaid eligibility is determined, and individual will have an assessment regarding the level of care required to help meet individuals needs and care.
Individuals who are elderly or live with a disability can be eligible for Medicaid coverage if they meet the following criteria:
- Live in Idaho
- Be a U.S. citizen or eligible non-citizen
- Have a disability diagnosis under the Social Security Act (or)
- Be over the age of 65 years
- Meet certain income and resource guidelines
Those with Developmental Disabilities can receive services specific to their disability when they meet certain criteria.
A dual eligible beneficiary is someone over the age of 21, has Medicare A, B, and D and is eligible for enhanced Medicaid. There are two programs available for dual eligible beneficiaries, Medicare Medicaid Coordinated Plan and the Idaho Medicaid Plus Program. For more information, visit the Medicaid/Medicare Participants page.
There are different income limits for Medicaid for adults with disabilities, which depends on the level of care needed by the individual. Basic Medicaid coverage for Medicaid for the aged, blind, and disabled population can be found below. Income counted toward a Medicaid eligibility determination includes, but is not limited to:
- Social Security
- Supplemental Security Income (SSI)
- Interest from bank accounts and investments
- Retirement and other pensions
- Payments from trusts, annuities, etc.
- Wages from a job or self-employment
- Resources such as property and bank accounts will also be considered
To be eligible for Medicaid for the Aged, Blind and Disabled program, you cannot own resources in excess of the resource guidelines.
Resources that count toward eligibility:
- Certificates of deposit
- Mutual fund shares
- Promissory notes
- Cars (if more than one)
- Real estate
- Other resources
Resources that do not count include:
- Your home, as long as one spouse still lives there or you intend to return home
- One car
- Household goods and personal effects, including one wedding ring and one engagement ring
- Cash value of life insurance, if the face value of all policies is not worth more than $1,500 for each spouse
- Burial plots
- Up to $1,500 set aside for burial of each spouse
Depending on your specific needs, you may be eligible for the following services:
- Residential habilitation
- Chore services
- Respite services
- Supported employment
- Non-medical transportation
- Environmental accessibility adaptations
- Specialized medical equipment and supplies
- Personal Emergency Response Systems (PERS)
- Home-delivered meals
- Skilled nursing
- Behavioral management and crisis management
- Adult day health
- Self-directed community supports
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.
As individual circumstances vary, and for more information, please call the Estate Recovery Office at 866-849-3843.