Idaho Medicaid Definition
Medicaid in Idaho is also called Idaho Health Plan Coverage, and 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, whether that be at home, in an adult foster care home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Idaho seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying 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. This means anyone who meets the requirements will receive assistance, which is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are a limited number of participant enrollment slots. Therefore, wait lists may exist. Benefits are provided at home, adult foster care, adult day care, or in assisted living.
3) Regular Medicaid / Aid to the Aged, Blind, and Disabled (AABD) – this is an entitlement program, which means all eligible applicants are able to receive services. Benefits are provided at home or adult day 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 below does not mean one is ineligible or cannot become eligible for Medicaid in Idaho. More.
|2020 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||$2,369 / month*||$2,000||Nursing Home||$4,718 / month*||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||$2,369 / month for applicant*||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,369 / month||$2,000||Nursing Home||$4,718 / month||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||$2,369 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$836 / month||$2,000||None||$1,195 / month||$3,000||None||$1,195 / month||$3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, 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.
When only one spouse of a married couple is applying for nursing home Medicaid or a HCBS Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded and does not affect the applicant spouse’s eligibility. For clarification purposes, it is important to mention that income is counted differently for married couples with just one spouse applying for regular Medicaid. In this case, the income of both spouses is counted towards the income eligibility of the applicant spouse. In order to learn more about how Medicaid counts income, click here.
For married couples with non-applicant spouses (of nursing home Medicaid or Medicaid waiver applicants) that have insufficient income with which to live, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is intended to prevent impoverishment of non-applicant spouses. In simple terms, if the non-applicant spouse, also called the community spouse or well spouse, has income under $2,155.00 / month (this figure is effective July 2020 – June 2021), he or she is entitled to a portion of the applicant spouse’s income. If the well spouse has income equivalent to $2,155.00 / month or more, he or she may be entitled to a greater amount of the applicant spouse’s income based on his / her shelter and utility costs. However, the maximum monthly income the non-applicant spouse may be entitled to is $3,216.00 / month (this figure is effective January 2020 – December 2020). This spousal income allowance does not extend to non-applicant spouses of regular Medicaid applicants.
*Note that while there is an above mentioned income limit for nursing home Medicaid, beneficiaries are not able to keep monthly income up to this amount. Instead, all of a recipient’s monthly income, minus a personal needs allowance of approximately $40 / month, and potentially a monthly maintenance needs allowance for a non-applicant spouse, must be paid towards the cost of nursing home care.
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. However, for Medicaid eligibility, there are many assets that are not counted. In other words, they are exempt. Exemptions include personal belongings, such as clothing, household furnishings and appliances, an automobile, a burial plot, a prepaid funeral contract, and one’s primary home, given the Medicaid applicant either resides in the home or has “intent” to return to it, and his / her equity interest in the home does not exceed $893,000 (in 2020). (Equity interest refers to the amount of the home’s value the applicant owns). If a non-applicant spouse is living in the home, it is exempt regardless of where the applicant lives or the applicant’s equity interest in it.
For married couples, as of 2020, the community spouse (the non-applicant spouse of a nursing home Medicaid applicant or a HCBS Medicaid waiver applicant) can retain half of the couples’ joint assets (up to a maximum of $128,640), as the chart indicates above. That said, if a couple has resources equal to or less than $25,728, the non-applicant spouse is able to retain 100% of the assets. This spousal impoverishment rule is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from having too little from which to live. As with the monthly maintenance needs allowance, this asset allowance is not relevant for the non-applicant spouses of regular Medicaid applicants.
Please note, it is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Idaho has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past transfers to ensure no assets were sold or given away for less than they are worth. If one is found to be in violation of the look-back period, one 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) – QIT’s, also referred to as Miller Trusts, are special trusts for Medicaid applicants who are over the income limit but still cannot afford to pay for their long-term care. This type of trust offers a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT 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. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and must have the state of Idaho listed as the remainder beneficiary. In addition, the money in the account can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee. Learn more about QITs.
Unfortunately, Qualified Income Trusts do not assist persons in qualifying for Medicaid if their assets are over the eligibility limit. Said another way, if one meets the income requirement for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in “spending down” his or her excess assets. However, one can “spend down” assets by spending assets over the asset limit on non-countable assets. Examples include 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.
2) 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 persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Idaho Medicaid Programs
1) HCBS Aged & Disabled (A&D) Waiver – this waiver is intended to prevent and delay nursing home placement of seniors and disabled individuals. Supportive services may be provided 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 a nursing home diversion program, 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) – intended 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. Unfortunately, as of June 2020, this program is not available statewide.
How to Apply for Idaho Medicaid
Seniors interested in applying for Medicaid in Idaho have a variety of options. First, persons can apply online via idalink. Second, persons can apply at their local Department of Health and Welfare field office, or alternatively, call 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.