Idaho Medicaid Definition
Medicaid in Idaho is also called Idaho Health Plan Coverage. It is administered by the Idaho Department of Health and Welfare.
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides health coverage for various groups of Idaho residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. However, the focus of this webpage is strictly on Medicaid eligibility for Idaho elders, aged 65 and over, and specifically for long term care. In addition to nursing home care, adult foster care services, and assisted living services, Idaho Medicaid pays for many non-medical supports and services that help frail seniors remain living in their homes.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Idaho seniors may be eligible. These programs have varying financial and medical (functional) eligibility requirements, as well as benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Idaho offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; 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) – These are not entitlement programs; There are a limited number of participant enrollment slots and wait 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) – This is an entitlement program; 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.
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.
|2022 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||$2,543 / month*||$2,000||Nursing Home||$5,066 / month*||$3,000†||Nursing Home||$2,543 / month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,543 / month‡||$2,000||Nursing Home||$5,066 / month‡||$3,000†||Nursing Home||$2,543 / month for applicant‡||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged, Blind, and Disabled||$894 / month||$2,000||Help with ADLs||$1,281 / month||$3,000||Help with ADLs||$1,281 / 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.
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. This income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. Holocaust restitution payments and Covid-19 stimulus checks do not count as income, and therefore, do not impact Medicaid eligibility.
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. This means 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 impoverishment. Effective 7/1/22 – 6/30/23, the MMMNA is $2,288.75. If a non-applicant’s monthly income is under $2,288.75, income can be transferred 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 $686.63 / month (effective 7/1/22 – 6/30/23). However, in 2022, in no case can a spousal income allowance put a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal 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. To learn more about how Medicaid counts income, click here.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, promissory notes, credit union, savings, and checking accounts, 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, a prepaid funeral contract, and generally one’s primary home. For home exemption, the Medicaid applicant must reside in the home or have intent to return, and in 2022, their home equity interest must not exceed $750,000. Equity interest is the amount of the home’s value owned by the applicant. If a non-applicant spouse lives in the home, it is exempt regardless of where the applicant lives or their home equity interest. An applicant’s IRA is also exempt if it is in payout status, and a non-applicant spouse’s IRA is automatically exempt. Learn more about IRAs and Medicaid eligibility.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, spousal impoverishment rules permit the non-applicant spouse of a Medicaid nursing home or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.
Idaho has a 60-month (5 year) Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this period, 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” is intended to discourage persons from transferring assets to meet Medicaid’s asset limit. If one violates the look-back period, they will be penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
For elderly Idaho residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for 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. This can be done by 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 the look back period was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of 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. Read more or connect with a Medicaid planner.
Specific Idaho Medicaid Programs
Like all states, Idaho Medicaid pays for nursing home care for state residents who are medically and financially eligible for such care. ID Medicaid also offers Medicaid programs for seniors who require nursing home level care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.
1) HCBS Aged & Disabled (A&D) Waiver – Seniors and disabled persons 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) – This program provides support with a variety of daily living activities. Examples include housekeeping services, laundry, preparation of meals, medication management, and assistance with bathing, grooming, eating, and mobility, etc.
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 currently 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.
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 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]
For additional, but general, information on applying for long-term care Medicaid, click here.