Medicaid/Medicare Participants

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. 

Medicare Medicaid Coordinated Plan

The Medicare Medicaid Coordinated Plan is a voluntary program that integrates both Medicare and Medicaid coverage into one single plan, at no cost to the participant, which means members will have:

  • One set of comprehensive benefits. One accountable entity to coordinate delivery of services. One care management team to coordinate care.
  • Receive additional supplemental benefits over and above original Medicare and Medicaid.
  • Participants Medicare premium is paid by Medicaid.
  • Participants will have access to the health plans network of providers.

This program is for Dual Eligible participants who are 21 years of age or older and are eligible and enrolled in both Medicare (Parts A, B, and D) and Enhanced Medicaid. The Department of Health and Welfare has partnered with Molina Healthcare of Idaho and Blue Cross of Idaho to administer the Medicare Medicaid Coordinated Plan. 

An older couple looking at their cell phone
Idaho Medicaid Dual Eligible Program Options and Worksheet
Learn more about the Dual Eligible Program
How to enroll in the Medicare Medicaid Coordinated Plan (MMCP)

There are two different health plans that offer Medicare Medicaid Coordinated Plan (MMCP) based on the MMCP service area. Please call Blue Cross of Idaho or Molina Healthcare of Idaho if you would like to enroll or receive additional information.

Blue Cross of Idaho: 888-495-2583

Molina Healthcare of Idaho: 866-403-8293

The MMCP covers all medically-necessary and preventive services covered under Medicare Part A, Part B, and Part D prescription drug coverage, as well as additional services covered by Medicaid, including:


Hospital, Medical, Prescription drugs, Behavioral Health, Nursing Home, Aged & Disabled (A&D) Waiver, Personal Care Services, Targeted Service Coordination, Community Based Rehabilitation Service as well as Care Coordination.

*Developmental Disability Services, Medical Transportation and Dental are all available through Idaho Medicaid.

The MMCP also offers additional services over and above original Medicare/Medicaid such as

 

BLUE CROSS OF IDAHO

MOLINA HEALTHCARE OF IDAHO

Care Coordinators each participant is assigned a Care Coordinator to serve as YOUR advocate and central point of contact

Nurse Advice Line – Call a Nurse 24/7 to discuss any concerns you may have related to your healthcare

Gym Membership and at home fitness kits 

Vision – one eye exam and $100.00 toward eyewear

Over the Counter items - $40.00 allowance for non-prescription over the counter products each quarter

Care Coordinators - each participant is assigned a Care Coordinator to serve as YOUR advocate and central point of contact

Nurse Advice Line – Call a Nurse 24/7 to discuss any concerns you may have related to your healthcare

Gym Membership and at home fitness kits

Vision – one eye exam each year and $150.00 toward eyewear

Over the Counter items - $75.00 allowance for non-prescription over the counter products each quarter

This is not a full listing of benefits. Please contact each of the plans for the full listing of all supplemental benefits available through the MMCP.

Idaho Medicaid Plus (IMPlus)

Idaho Medicaid has successfully implemented a mandatory managed care program, called Idaho Medicaid Plus (IMPlus).This program is for Dual Eligible participants who are 21 years of age or older and are eligible and enrolled in both Medicare (Parts A, B, and D) and Enhanced Medicaid. The Department of Health and Welfare has partnered with Molina Healthcare of Idaho and Blue Cross of Idaho to administer IMPlus, which covers most Medicaid services and provides members with a care specialist. The care specialist serves as a single point of contact to assist participants in navigating their Medicaid services.

Idaho Medicaid Plus = Medicaid Benefits Only! With no changes to your Medicare coverage.

IMPlus is a mandatory program in the following counties: Twin Falls, Bonner, Bannock, Bonneville, Bingham, Kootenai, Nez Perce, Boise, Boundary, Cassia, Elmore, Fremont, Gem, Jefferson, Madison, Minidoka, Owyhee, Payette, Power, Ada, and Canyon. 

IMPlus is open for voluntary enrollment in the following counties: Adams, Benewah, Clark, Gooding, Jerome, Latah, Shoshone, Valley, and Washington. Individuals in these counties can choose to opt-out of IMPlus.  If a participant chooses to opt out of IMPlus, their services will remain with Idaho Medicaid. 

IMPlus covers all medically necessary Medicaid benefits: 

  • Hospital costs after Medicare payment
  • Medical costs after Medicare payment
  • Behavioral Health, including Community Based Rehabilitation Services
  • Nursing Home after Medicare payment
  • Aged & Disabled (A&D) Waiver
  • Personal Care Services
  • Care Specialist

 

    How to enroll in the Idaho Medicaid Plus Program

    Idaho Duals will have the opportunity to select either Molina Healthcare of Idaho or Blue Cross of Idaho for their Idaho Medicaid Plus plan. Duals have ninety (90) days before the program effective date to select a health plan and an additional ninety (90) days after the effective date of their program to change their health plan. After the initial enrollment period there will be an Annual Open Enrollment (October 15 through December 7) in which Duals can change plans if they would like to.

    1. Call us toll free at (833) 814-8568 to speak with our Beneficiary Support Specialist, or email us at Idahoduals@dhw.idaho.gov
    2. When you receive your Idaho Medicaid Plus Selection Notice in the mail, just complete the enclosed Idaho Medicaid Plus Enrollment form and mail it in the envelope provided.
    Complaint Submission System

    The Bureau of Long Term Care hosts an online Complaint Submission System.  This system is available to all stakeholders and allows you to enter a complaint and provide us with all the details to help us investigate and resolve your concerns.  Once the complaint is received, it is routed directly to our triage team and either Blue Cross of Idaho or Molina Healthcare of Idaho who are responsible to prioritize and manage all submitted complaints.

    Complaint Submission System