Idaho Medicaid Long-Term Care Definition
Medicaid is a health insurance program for low-income individuals of all ages. While health coverage is provided to diverse groups of Idaho residents, the focus of this webpage is strictly on long-term care Medicaid eligibility for Idaho seniors, aged 65 and over. In addition to nursing home care, certified family home (adult foster care) services, and assisted living services, ID Medicaid pays for many non-medical supports and services that help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which Idaho seniors may be eligible.
1) Institutional / Nursing Home Medicaid – An entitlement; anyone who meets the requirements will receive assistance. Benefits are provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; there are a limited number of participant enrollment slots and waiting lists may exist. Benefits are intended to delay nursing home admissions and may be provided at home, adult foster care, adult day care, or in assisted living. More on Waivers.
3) Regular Medicaid / Aid to the Aged, Blind, and Disabled (AABD) – An entitlement; all eligible applicants are able to receive services. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
Medicaid in Idaho is also called Idaho Health Plan Coverage. While Medicaid is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The Idaho Department of Health and Welfare is the administering agency.
Income & Asset Limits for Eligibility
The three categories of Medicaid long-term care programs have varying financial and medical (functional) eligibility requirements. Further complicating financial eligibility is that the requirements change annually, vary with marital status, and that Idaho offers multiple pathways towards Medicaid eligibility.
Idaho seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant
must meet the following criteria: 1) Income under $2,849 / month 2) Assets under $2,000 3) Require a Nursing Home Level of Care
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from an Idaho Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Idaho. More.
2024 Idaho Medicaid Long-Term Care Eligibility for Seniors | |||||||||
Type of Medicaid | Single | Married (both spouses applying) | Married (one spouse applying) | ||||||
Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | |
Institutional / Nursing Home Medicaid | $2,849 / month* | $2,000 | Nursing Home | $5,678 / month* | $3,000† | Nursing Home | $2,849 / month for applicant* | $2,000 for applicant & $154,140 for non-applicant | Nursing Home |
Medicaid Waivers / Home and Community Based Services | $2,849 / month‡ | $2,000 | Nursing Home | $5,678 / month‡ | $3,000† | Nursing Home | $2,849 / month for applicant‡ | $2,000 for applicant & $154,140 for non-applicant | Nursing Home |
Regular Medicaid / Aged, Blind, and Disabled | $996 / month | $2,000 | Help with ADLs | $1,435 / month | $3,000 | Help with ADLs | $1,435 / month | $3,000 | Help with ADLs |
†This asset limit is specifically for couples who are both on Medicaid and live together. If both spouses are on Medicaid, but live separately, for instance, one spouse is in a nursing home and the other receives home and community based services at home, the asset limit is $2,000 per spouse.
‡Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.
Income Definition & Exceptions
Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. Countable assets include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in ID, the VA Aid & Attendance and Housebound Pensions, which are above and beyond the Basic VA Pension, do not count as income.
Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a Medicaid Waiver, only the income of the applicant is counted. The income of the non-applicant spouse is disregarded and does not affect the applicant spouse’s eligibility. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is a Spousal Impoverishment Provision and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal poverty.
Effective 7/1/24 – 6/30/25, the MMMNA in ID is $2,555. If a non-applicant’s monthly income is under $2,555, income can be transferred to them from their applicant spouse, bringing their income up to this level. In Idaho, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $766.50 / month (eff. 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s total monthly income over $3,853.50. This is the Maximum Monthly Maintenance Needs Allowance.. More about how this allowance is calculated.
Income is counted differently when only one spouse applies for Regular Medicaid / Aged, Blind, and Disabled; the income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.
Asset Definition & Exceptions
Countable vs. Non-Countable Assets
The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, promissory notes, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. There are also many assets that are not counted; they are exempt. Exemptions include personal belongings, such as clothing, household furnishings and appliances, an automobile, a burial plot, and generally one’s primary home. In Idaho, an applicant’s IRA is exempt if it is in payout status. This means that one’s Required Minimum Distribution (RMD) is being withdrawn. A non-applicant spouse’s IRA is automatically exempt.
Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. Spousal Impoverishment Rules, however, permit the non-applicant spouse of a Medicaid nursing home or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2024, the community spouse (the non-applicant spouse) can retain 50% of the couple’s assets, up to a maximum of $154,140. If the non-applicant’s share of the assets is under $30,828, 100% of the assets, up to $30,828 can be retained by the non-applicant. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.
Medicaid’s Look-Back Rule
Idaho has a 60-month (5 year) Medicaid Look-Back Period that immediately precedes one’s Medicaid application date for Nursing Home Medicaid or a Medicaid Waiver. During the “look back”, Medicaid checks all past asset transfers to ensure none were gifted or sold under fair market value. This includes transfers one’s spouse has made. The Look-Back Rule is intended to discourage persons from transferring assets to meet Medicaid’s asset limit. If one violates this rule, they will be penalized with a period of Medicaid ineligibility. The Look-Back Period does not apply to Regular Medicaid applicants and their spouses.
The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.
Idaho Medicaid Home Exemption Rules
For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $750,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.
While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Idaho’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.
Medical / Functional Need Requirements
An applicant must have a medical need for Medicaid long-term care. For Nursing Home Medicaid and HCBS Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, certain benefits may have additional eligibility requirements specific to that benefit. For example, for a Waiver to cover the cost of respite care, an inability to safely be home alone might be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.
Qualifying When Over the Limits
For elderly Idaho residents (aged 65 and over) who do not meet the financial eligibility requirements above, there are other ways to qualify for long-term care Medicaid.
1) Qualified Income Trusts (QIT’s) – QITs are special trusts that provide a way for Nursing Home Medicaid and Waiver applicants who are over the income limit to still qualify for long-term care Medicaid. Also called Miller Trusts, money deposited into this type of trust does not count towards Medicaid’s income limit. In simple terms, one’s excess income (over the Medicaid income limit) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of the money. Trust funds can only be used for very specific purposes, such as paying long-term care services / medical expenses accrued by the Medicaid enrollee. A QIT must be irreversible, meaning once it has been established, it cannot be changed or canceled, and the state of Idaho must be listed as the remainder beneficiary.
2) Asset Spend Down – Persons who have countable assets over Medicaid’s asset limit can “spend down” assets on non-countable ones and become asset-eligible. Examples include: making home modifications and additions (wheelchair ramps, roll-in showers, stair lifts, and adding first floor bedrooms), home improvements (replacing faulty electrical wiring, updating plumbing, and replacing old water heaters), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt. Remember that assets cannot be gifted or sold under fair market value, as it violates Medicaid’s Look-Back Rule. When “spending down”, it is best to keep documentation of how assets were spent as evidence this rule was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of long-term care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.
Specific Idaho Medicaid Programs
In addition to paying for nursing home care, Idaho Medicaid offers the following programs relevant to the elderly that help them to remain living at home or in the community.
1) HCBS Aged & Disabled (A&D) Waiver – Seniors and persons with disabilities may receive supportive services at home, assisted living facilities, and adult foster care homes. Benefits may include adult day care, meal delivery, attendant care, homemaker services, respite care, companion services, and more. There is a participant directed component to this waiver that allows program participants to hire the provider of their choice, including some family members, for some services.
2) Personal Care Services Program (PCSP) – Also called State Plan Personal Care Services, support with a variety of daily living activities is provided. Examples include changing bed linens, laundry, preparation of meals, medication management, and assistance with bathing, grooming, eating, and toileting.
3) Medicare Medicaid Coordinated Plan (MMCP) – For Idaho residents that are eligible for both Medicare and Medicaid, MMCP streamlines the benefits of each of the programs into one program. Available benefits include personal care services, nursing home care, dental care, prescription drugs, Aged & Disabled Medicaid Waiver services, and more. This program is not available statewide.
4) Idaho Medicaid Plus (IMPlus) – For persons who are dual eligible (Medicare and Medicaid), although only Medicaid benefits are provided via this program. Benefits may include hospitalization, medical care, and nursing home care (following Medicare payment), personal care services, and long-term home and community based services available via the Aged & Disabled Waiver. IMPlus is not available statewide.
5) Money Follows the Person (MFP) – Also called Idaho Home Choice in Idaho. This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.
How to Apply for Idaho Medicaid
Seniors interested in applying for Medicaid in Idaho can apply online via idalink, in person at one’s local Department of Health and Welfare’s Benefits Customer Service field office, or by calling the Department of Health and Welfare at 1-877-456-1233. There is also the option to download an application and fax it to 1-866-434-8278, mail it to a local field office, or email it to [email protected]. The application process may vary based on the program for which one is applying.
Prior to applying for Medicaid, it is imperative that Idaho seniors be certain that all eligibility requirements discussed above are met. If one is over the income and / or asset limit(s), or are unsure if they meet the eligibility criteria, Medicaid Planning can be invaluable. The application process, which can be lengthy, is also complicated. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.