If you meet the eligibility requirements, you can get free and low-cost healthcare from the Idaho Medicaid program!
The Idaho Medicaid program covers most basic healthcare services, like doctor visits, hospital stays, cancer treatment, and even some home health services. Coverage is broken up into four plans - standard, basic, enhanced, and coordinated. The Standard Plan provides the federal mandatory minimum Medicaid benefits. The Basic Plan is only for low-income children and adults with eligible dependent children, and the Enhanced Plan is for those with disabilities or other special healthcare needs. Then, the Medicare Medicaid Coordinated Plan is for those eligible for both Medicare and Medicaid.
Idaho Medicaid members can receive coverage for genetic testing and molecular pathology. For coverage, a doctor must determine that you are high-risk or show signs and symptoms and it must be a necessary tool for diagnosis. The test must be performed at a qualified health center.
Durable Medical Equipment (DME) and Home Health
Home Health consists of durable medical equipment/supplies, home aides, and home nurses. Idaho Medicaid limits Home Health to 100 visits per calendar year. Every visit must be medically necessary.
Members can receive coverage for reasonable and cost-effective durable medical equipment when considered necessary. The Idaho Medicaid program follows the federal Medicare criteria for durable medical equipment. Medicare considers items like hospital beds, wheelchairs, oxygen supplies, sleep apnea devices, and glucose monitors to be durable medical equipment.
The Idaho Department of Health and Welfare will cover up to $2,040 of speech and physical therapy services per calendar year as well as another $2,040 for occupational therapy services. Chiropractic services are completely different and are limited to six visits per calendar year and only for manipulation of the spine when medically necessary. If you need more than six visits, your doctor will need to submit an authorization form proving your diagnosis and your need for treatment.
The Idaho dental program for Medicaid members, operated by MCNA Dental, is called Idaho Smiles. Children and adults in either the Basic or Enhanced Medicaid plans, as well as pregnant women, are eligible. The benefit includes preventative and diagnostic services (cleanings, exams, X-rays, fluoride, sealants, etc.) and therapeutic services (cavity treatment, gum/tooth plan relief, fillings, extractions, root canals, emergencies, etc.).
Vision coverage is typically limited to medically necessary services. Adults can get treatment for necessities like foreign objects in the eyes; those with chronic diseases can get yearly eye exams. Those under age 21 can get frames and lenses as needed but will only cover contacts when medically necessary.
Not only does the Medicaid program cover ambulance travel, but Idaho also covers non-emergency medical transportation. Eligible members who do not have their own means of transportation can request transportation to and from Medicaid-covered medical appointments.
The Idaho CHIP (Children’s Health Insurance Program) is called the Idaho Health Plan for Children. Even if you and your family do not qualify for Idaho Medicaid, your kids might qualify based on your total household income. Typically, while an individual can qualify for Medicaid with an income as high as 128% of the Federal Poverty Level (FPL), kids may be able to qualify with a family income of up to 400% of the FPL. Depending on your income, you may have to pay a small monthly premium ($10 or $15 per month) for your Idaho Health Plan for Children coverage.
EPSDT stands for Early, Periodic Screening, Diagnostics, and Treatment. This benefit allows kids under 21 to receive screenings, diagnostics, and treatment beyond the scope of what Medicaid normally covers in some circumstances. The point is to promote early detection and treatment of certain diseases that can be stopped if caught early enough. To receive EPSDT, the parents/guardians (or the child over 18) and the primary care provider must sign the EPSDT Request for Additional Services form. Idaho Medicaid will then send a notice either approving or denying the request with the option to appeal.
Aside from EPSDT, CMS has mandated that Idaho children with Medicaid be tested for elevated blood lead levels at 12 and 14 months (or older if they haven’t been tested before). Children under the age of six are at the highest risk for high blood levels and side effects from that, like hyperactivity, reduced IQ, and even kidney damage. The test is a simple finger prick and will be completely reimbursed.
Kids with disabilities who are Idaho Medicaid members can receive reimbursed services that are deemed medically necessary for the sake of their education. Parents will be given the opportunity to sign a release form allowing the school to bill Medicaid for the services. The school-based services program includes evaluations, medical supplies, nursing services, speech/occupational/physical therapy, transportation, interpretation, and mental health care.
To qualify for Medicaid in Idaho, you must either be under 19, a pregnant woman, an adult with a child under 19, blind, disabled, or over 65. You must also be a legal Idaho resident and must make less than the income limits listed below:
If you do not qualify for Medicaid and do not have other insurance but still have low income, you may qualify for covered pap tests and mammograms with the Department of Health and Welfare’s Women’s Health Check Program.
There are a few ways to apply for Idaho in Medicaid. You can either apply online through the Idalink portal, you can download the application and mail it in, you can visit yourhealthidaho.com, or you can visit a Health and Welfare office near you.
If you qualify for both Medicare and Medicaid, you can apply for Idaho’s Medicare/Medicaid Coordinated Alternative Benefit Plan. This option combines your Medicare and Medicaid benefits into one coordinated plan.
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