Adults with disabilities can qualify for Medicaid based on their income and household status. The type of service or care that will be covered by Medicaid is called a Level of Care Determination which will occur after an individual has been determined financially eligible for Medicaid.
Adults with a physical or developmental disability can be eligible for Medicaid in Idaho 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 assessed to have functional impairments that qualify for the Developmental Disability Program
If the individual needs home and community-based services or nursing home services, a Level of Care Determination must be completed.
If you are approved for the Medicaid, you may be required to pay a share of your medical costs. Based on our income, a share of cost will be determined. You will receive information about your share of cost in a notice from the department.
The application process for the Adult with Disabilities Program has two steps.
Step 1: Apply for Medicaid
Step 2: Participate in a Level of Care Determination
- Apply: Online using idalink
- Be prepared to provide this information with the application:
- Verification of identity (e.g. driver's license)
- Household income
- Household resources
- Current monthly expenses
- If applicable, immigration status
- Interview
- Call: 877-456-1233 (toll free)
- Visit: Closest field office
- Be prepared to provide this information with the application:
- Verification of identity (e.g. driver's license)
- Household income
- Household resources
- Current monthly expenses
- If applicable, immigration status
- Download and complete an application
- Then Apply by either:
- Email: MyBenefits@dhw.idaho.gov
- Fax: 1-866-434-8278 (toll free)
- Mail: Self Reliance Programs, PO Box 83720, Boise, ID 83720-0026
- Be prepared to provide this information with the application:
- Verification of identity (e.g driver's license)
- Household income
- Household resources
- Current monthly expenses
- If applicable, immigration status
If an individual with disabilities is eligible for Medicaid and needs home and community-based services, a Level of Care Determination must be completed. The Level of Care Determination is the process the Idaho Medicaid program uses to determine if a person needs the kind of care provided in a nursing home or long-term care facility.
If an individual with disabilities in not eligible for regular Medicaid due to their income but needs the kind of care provided in a nursing home or long-term care facility, a Level of Care Determination must be completed If the individual meets the level of care, a higher income limit can be used (see income limits on HCBS or Nursing Home page).
- You will receive two different notices/contacts from DHW:
- One notice will let you know whether you are eligible for Medicaid.
- You will be contacted by a DHW representative to schedule an appointment for the Level of Care Determination.
- You may need to provide additional information, but we will let you know if additional documentation is needed.
REMINDER: There is a re-evaluation process each year for Medicaid. You will receive a notice in the mail with instructions on completing your re-evaluation.
File an Appeal
This page explains how to file an appeal for an eligibility decision for public assistance programs.