A Guide to Healthy Connections - Idaho Medicaid

In this Idaho health care guide, you’ll learn what Idaho Medicaid is, including information on who is eligible and how to apply. We’ll also describe the coverage under Idaho Medicaid and detail what each plan covers and doesn’t cover.

If you need medical services that Medicaid won’t cover, you can find affordable third-party health insurance plans that extend your health coverage. Insurdinary makes it easy to compare multiple insurance plans so you can find coverage at the best price. We can optimize your coverage to include a more comprehensive range of benefits and services by way of private health insurance.

    What Is Idaho Medicaid?

    The Idaho Medicaid plan provides healthcare coverage for low-income adults, seniors, pregnant women, and people with disabilities who meet the plan’s specific income requirements. The state of Idaho and the federal government of the U.S. jointly provide funds for the Idaho Medicaid program, enabling the plan to offer free or low-cost health coverage to individuals who need it.

    Idaho Medicaid offers three different healthcare coverage programs, each with certain criteria for eligibility. Depending on your circumstances, you could be eligible for one of the following three Medicaid plans:

    • Basic Plan: Health and wellness benefits for adults without specific health needs.
    • Enhanced Plan: Health plan for adults with disabilities or other special healthcare needs.
    • Medicare-Medicaid Coordinated Plan: Health care plan for individuals who qualify for both Medicaid and Medicare, which includes enrollment in a managed care plan.

    The Enhanced Plan includes all the benefits of the Basic plan plus extra benefits, and the Medicare-Medicaid Coordinated Plan has all the benefits of the Enhanced Plan plus access to the managed care plan.

    A managed care plan, such as Idaho’s Healthy Connections program, gives you access to a care coordinator who can help you get appropriate health care for your complex medical conditions. Most people with Idaho Medicaid must enroll in Healthy Connections.

    Whether or not you have co-payments depends on factors including your age and income, and you’ll find out if you have co-payments and how much they are when you start your Idaho Medicaid plan. Your monthly premium could be between $0 and $15, depending on your income.

    What Is an Idaho Medicaid Card?

    Idaho Medicaid

    If you apply for Idaho Medicaid and are eligible, you’ll receive an identification card in the mail. You’ll present your Idaho Medicaid card to your health care providers, including your primary doctor and pharmacy. You might have to show a picture ID along with your Idaho Medicaid card.

    You should always show your Medicaid ID card before receiving medical services to determine whether the provider accepts Idaho Medicaid, even if your doctor referred you to a specific specialist.

    If your name changes, you need to report it to the Health and Welfare office to get a new ID card. In some cases, a provider won’t accept your Medicaid card if you’re going by a different name.

    Your Idaho Medicaid card is permanent, meaning that even if you lose benefits and regain them later, you’ll be using the same ID card. It’s best to keep your card in your wallet or purse so you have it whenever you might need it.

    Applying for Idaho Medicaid

    To apply for Idaho Medicaid, you need to fill out an application for the plan. You can complete an application in the following ways:

    • Visit the website to apply online.
    • Apply over the phone by calling the Idaho Department of Health and Welfare’s Benefits Customer Service center at 877-456-1233, available Monday to Friday from 8 a.m. to 6 p.m.
    • Go to your local Health and Welfare office to apply, available Monday to Friday from 8 a.m. to 5 p.m.
    • Call the Idaho CareLine at 2-1-1 or 800-926-2588 and request an application.

    You can receive an application in English or Spanish, and language interpretation services are available. Parents and guardians can apply on behalf of their dependent, and you can get friends or family to help you fill out the form if needed.

    You will need the following information for your application:

    • Identification card
    • Monthly expenses
    • Income
    • Housing costs
    • Immigration status (if applicable)

    If you filled out a paper application, you can submit it in the following ways:

    • Submit in person at the nearest Health and Welfare office
    • Email it to MyBenefits@dhw.idaho.gov
    • Fax it to 1-866-434-8278
    • Mail it to Self Reliance Programs, PO Box 83720, Boise, ID 83720-0026

    Your Idaho Medicaid application can take up to 45 days to process, and, upon approval, the health department will choose a Medicaid plan that fits your needs.

    Eligibility Requirements

    Each plan under the Idaho Medicaid program has different eligibility requirements, and your circumstances will determine which plan is suitable for you. To qualify for any of the Idaho Medicaid plans, you must live in Idaho and be a U.S. citizen or eligible non-citizen.

    All adults with an income under 138% of the federal poverty level (FPL) are eligible for Medicaid, regardless of health conditions.

    Here are a few examples of income limits for different Idaho Medicaid health programs:

    • Adult Medicaid (one household member): $1,677
    • Pregnancy Coverage (two household members, including unborn child): $2,268
    • Children’s Health Insurance Plan (two household members): $3,123
    • Long-Term Care (individual): $2,762
    • Aid to the Aged, Blind, and Disabled (individual): $967

    When determining your income and the value of your assets, you should identify what counts towards your eligibility.

    For example, your countable income includes employment wages, alimony, pension, Social Security Disability income, and Supplemental Security Income. If only one spouse in a married couple is applying for Medicaid, the spouse’s income doesn’t count.

    Regarding your resources (or assets), you must count things like cash, stocks, bonds, bank accounts, leftover funds from COVID-19 stimulus checks, and real estate. Exemptions include personal belongings (clothes, furniture, etc.) and your primary home.

    If you’re married, you must consider you and your spouse’s assets as jointly owned.

    The following is an overview of the general eligibility criteria for each Medicaid plan:

    • Basic Plan
      • Meet income requirements
      • Have no disabilities or special health needs
    • Enhanced Plan
      • Meet income requirements
      • Have a disability based on Social Security criteria
      • Have a variety of health needs
      • Be over the age of 65
    • Medicare-Medicaid Coordinated Plan
      • Meet income requirements
      • Qualify for both Medicaid and Medicare
      • Be over 21 years old

    Getting an Idaho Medicaid Card

    You’ll receive an Idaho Medicaid card within two weeks after approval of your application. If you don’t receive your card after 14 days, you should contact the Health and Welfare department at 877-456-1233.

    As we mentioned in a previous section, you should keep your card in your wallet or purse, ensuring you always have it to show your doctor or other care provider.

    Renewing or Replacing Your Idaho Medicaid Card

    If you change your name or lose your Idaho Medicaid card, you can get a replacement by contacting the Idaho Department of Health and Welfare at 877-456-1233.

    Medicaid Coverage

    Your Idaho Medicaid coverage depends on which plan you’re eligible for. All plans have the benefits of the Basic Plan, but the Enhanced Plan and Medicare-Medicaid Coordinated Plan include a few additional benefits.

    Below, you can find brief examples of services you might have coverage for from your Idaho Medicaid plan.


    Idaho Medicaid covers dental services through a dental insurance plan known as Idaho Smiles, and a managed care contractor, MCNA Dental, manages your Medicaid dental benefits.

    Idaho Smiles provides the following coverage:

    • X-rays
    • Dental exams
    • Fillings
    • Oral surgery
    • Emergency dental care
    • Necessary orthodontics
    • Restorative services

    Adults over 21 do not receive coverage for root canals and crowns.

    For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Idaho is advisable.

    Prescription Drugs

    Your Idaho Medicaid health plan covers medications that your doctor prescribes, but some types or brands of prescription drugs require authorization. If one of your drugs requires authorization, your provider or pharmacist will submit the request on your behalf.

    Certain non-prescription medicines or items have coverage if ordered by your doctor.

    Extended Health Care

    Depending on your age, disability status, and health conditions, you could qualify for the Idaho Medicaid Enhanced Plan. If you’re eligible, you get all the benefits of the Basic plan, and you might be able receive the following additional services:

    • Nursing home: Coverage for nursing home level of care that you receive if your doctor or Medicaid determines you need to be in a nursing home.
    • Home and community-based services: Supportive services in your home or community rather than an institution and transition services for individuals moving from an institution to a home. This coverage is available for children and adults with developmental disabilities, children with serious emotional disturbance (SED), elderly adults, and adults with a physical disability.
    • Hospice: In-home care for terminally ill individuals who have six months or less to live.
    • Respite: Short-term care to provide rest to caretakers of children with SED. Respite services can be at your home or certain provider agencies and have a limit of 300 hours per year.
    • Personal care services: In-home services that help individuals live independently and maintain a better quality of life, with a limit of 16 hours per week.
    • Service coordination: A service coordinator helps you access and organize necessary care and services. You can qualify for different types of service coordination services, depending on your health condition and age.

    Travel and Out-of-state Coverage

    You typically won’t be able to use your Idaho Medicaid coverage while traveling or visiting another state. Healthcare providers generally can’t bill Medicaid from a different state, but you might be able to find specific providers that accept Idaho Medicaid.

    Every state has its own eligibility requirements, and coverage can’t transfer from one state to another. Even if you move to a different state, you have to apply for Medicaid in that state and won’t be able to use your Idaho Medicaid coverage.

    If you want to use your Idaho Medicaid plan out of state to cover medical services, you might need prior authorization. However, there is an exception if you require emergency medical care. To qualify for this exception, you must need immediate care and not have enough time to return to Idaho to see your regular doctor. If you are traveling outside of Idaho for leisure, invest in proper travelers insurance.

    Students & Seniors

    Idaho Medicaid health plans are available to students and seniors who meet the criteria, including income limits. Students with eligible income, a disability diagnosis, or other special health needs might qualify for Idaho Medicaid coverage.

    Adults over the age of 65 who meet the income and resources requirements could qualify for the Idaho Medicaid Enhanced Plan, which includes coverage for things like personal and long-term care services.

    Idaho Medicaid long-term care coverage falls under three categories:

    • Nursing home services
    • Home and community-based services
    • Medical services for the aged, blind, and disabled

    Depending on which programs you’re eligible for, you might receive coverage for services such as:

    • At-home personal care
    • Adult foster care
    • Assisted living
    • Hospice
    • Home-delivered meals
    • Respite services
    • Medical equipment

    Coverage for Subgroups

    Idaho Medicaid offers programs for specific groups of people that require special healthcare services or support. Certain programs provide services for individuals with household incomes that exceed Medicaid requirements.

    Workers with Disabilities

    The Idaho Medicaid for Workers with Disabilities (MWD) program can help you work and earn money while maintaining eligibility for Medicaid. The income limits are higher to compensate for employment earnings, but you might have a premium to pay depending on your income level.

    Here’s an overview of the premiums for certain incomes of individuals who qualify for the MWD program:

    • $0 to $1,636: $0 premium
    • $1,636 to $3,058: $10 premium
    • $3,058 to $6,095: $10 to $200 premium

    Individual applicants must have less than $10,000 in resources, while couples must have less than $15,000.


    The Idaho Medicaid health plan has additional programs for children, including:

    • Children’s Developmental Disabilities Program: A care system that provides a range of home and community-based services for children with developmental disabilities, including support, intervention, and respite.
    • Children’s Health Insurance Program (CHIP): Low-cost health plan for children under 19 whose household income is too high for Medicaid qualification.
    • Youth Empowerment Services (YES): A program that provides support and services for children with SED and their families, helping them live and participate in their community fully.
    • Early Periodic Screening, Diagnostic, & Treatment (EPSDT): A benefit that helps children under 21 receive medically necessary services that exceed Idaho Medicaid plan limits.
    • Medicaid School-Based Services: School-based health and rehabilitative services for children with disabilities that receive support under the Individuals with Disabilities Education Act (IDEA).

    What Idaho Medicaid Does Not Cover

    Some services that Idaho Medicaid covers have limits or require prior authorization. If a service needs authorization, you or your healthcare provider will need to submit a request and provide information showing the service is medically necessary.

    The following are some services that might require prior authorization:

    Non-emergency medical transportation
    Certain medical equipment and supplies
    Early and Periodic Screening, Diagnostic, and Treatment
    Certain vision services
    Outpatient behavioral health services
    Personal care services
    The permanently or temporarily injured

    Although a burial fund of $1500 may be issued towards the cost of a funeral, considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.

    Idaho Medicaid does provide some coverage for those who become injured or ill either in the short or long term. Depending on the nature of the injury or illness, it’s wise to explore disability insurance options to ensure no unnecessary out-of-pocket costs are incurred.

    Idaho Medicaid also won’t pay for some services that you get without a Healthy Connections referral. Unless you have exemption, you must enroll for a Healthy Connections primary care provider (PCP) that will coordinate your health services. Some services, such as dental services and pregnancy-related services, don’t require a referral from your PCP.

    Common Procedures and Idaho Medicaid Eligibility

    It can be confusing to determine what Idaho Medicaid does and doesn’t cover, so we provided a list of common services and their Idaho health care coverage eligibility below.

    X-Rays and Exams All plans have coverage
    Wisdom Teeth All plans have coverage
    Eye Exams Coverage with limits
    Glasses Coverage with prior authorization
    Laser Eye Surgery No
    Rhinoplasty Coverage with prior authorization
    Breast Reduction Coverage with prior authorization
    Hospital stays Coverage with limits
    Ambulance transportation Coverage with limits
    Giving birth All plans have coverage
    Therapy and Counselling
    Idaho Medicaid will cover therapy and counseling, such as assessments and psychotherapy, with prior authorization.
    Sexual Health
    Gynecologist visits Coverage with limits
    Erectile Dysfunction No
    Birth Control All plans have coverage
    Fertility Treatment No
    Specialist Services
    Dermatology Coverage with limits
    Physiotherapy Coverage with limits
    Massage Therapy No
    Podiatry and Foot Care All plans have coverage
    Allergy Testing Coverage with prior authorization
    Sleep Physician Services and CPAP Machines Coverage with prior authorization

    Extending Idaho Medicaid Coverage

    Idaho Medicaid provides coverage for many health services to ensure individuals with low income can still access quality care. However, the plan generally limits its coverage to services that are medically necessary, leaving out certain procedures that could improve your quality of life. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.

    If you want to find a cost-effective plan to cover services that Medicaid doesn’t, Insurdinary can make it easy for you. You can browse options from various health insurance providers and compare them all in one place, saving you tons of time and effort.

    Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:


    How long does it take to get approved for Idaho Medicaid?

    The approval process duration for Idaho Medicaid can vary based on individual circumstances. On average, it takes about 45 days. Expedited processing is available for urgent cases.

    What are the methods to apply for Idaho Medicaid?

    You can apply for Idaho Medicaid through various means: online, in person, by mail, or at a local Idaho Department of Health and Welfare office. Ensure you provide essential documents like proof of income, household size, and residency when submitting your application.

    Does Idaho Medicaid cover the expenses of funerals?

    No, Idaho Medicaid is primarily focused on providing healthcare coverage and does not include benefits for funeral expenses. If you're seeking assistance with funeral costs, you may want to explore alternatives like funeral insurance.

    Who is eligible for Idaho Medicaid?

    Eligibility for Idaho Medicaid is determined by factors such as income, household composition, and other considerations. Generally, the program extends coverage to low-income individuals, families, pregnant women, children, elderly individuals, and those with disabilities.

    What is Idaho Medicaid?

    Idaho Medicaid is a program designed to offer medical coverage to eligible low-income residents of the state. Funded through both federal and state resources, its goal is to ensure access to essential healthcare services for those in need.

    What other types of insurance does Insurdinary offer?

    Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:


    1. https://healthandwelfare.idaho.gov/services-programs/medicaid-health/about-medicaid-adults
    2. https://healthandwelfare.idaho.gov/services-programs/medicaid-health/manage-my-adult-medicaid
    3. https://healthandwelfare.idaho.gov/medicaid-program-income-limits
    4. https://healthandwelfare.idaho.gov/services-programs/medicaid-health/about-medicaid-elderly-or-adults-disabilities#:~:text=What%20income%20counts%20toward%20eligibility%3F
    5. https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=2080&dbid=0&repo=PUBLIC-DOCUMENTS&cr=1
    6. https://healthandwelfare.idaho.gov/services-programs/medicaid-health/medicaid-programs-0
    7. https://healthandwelfare.idaho.gov/services-programs/medicaid-health
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