Summary
Medicaid’s rules, benefits and name can all vary by state. In Idaho, Medicaid is also called Idaho Health Plan Coverage. This article focuses on Idaho Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or AABD Medicaid. These programs are different from regular Medicaid, which is for financially limited people of all ages.
Idaho Medicaid will cover the cost of long-term care in a nursing home for eligible Idaho residents who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:
Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.
Idaho Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $40/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.
Idaho Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.
A Nursing Home Alternative – Idaho Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Idaho’s Money Follows the Person (MFP) program. This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In Idaho, the MFP program is called Idaho Home Choice.
Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Idaho seniors who require a Nursing Facility Level of Care remain, or return to, living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Idaho residents who live in their home, the home of a loved one, a certified family home (adult foster care home) or a residential assisted living facility. While Idaho’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs such as mortgage payments, rent, facility fees, utility bills or food expenses.
The HCBS Waiver relevant to Idaho seniors is the state’s Aged and Disabled Waiver.
Aged and Disabled (A&D) Waiver
Idaho’s Aged and Disabled (AD) Waiver will provide long-term care support to Idaho seniors who live in their own home, the home of a loved one, a certified family home (adult foster care home) or a residential assisted living facility. It can also be used to help Idaho Medicaid recipients who reside in a nursing home transition from the facility and return to living in the community.
To determine if A&D Waiver applicants require a Nursing Facility Level of Care, Idaho uses the Uniform Assessment Instrument. An applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry) is considered. Cognitive impairments such as Alzheimer’s disease and other dementias are also considered.
A&D Waiver benefits include skilled nursing services, adult day care, home modifications, housekeeping services, assistive technologies and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits are made available depending on each program participant’s needs and circumstances. For A&D Waiver beneficiaries who are moving from a nursing home and returning to the community, the Waiver will cover transition expenses like movers, utility set-up fees, deposits and basic furnishings.
Unlike Nursing Home Medicaid, the A&D Waiver is not an entitlement. Instead, there are a limited number of enrollment spots (about 12,000 per year as of 2022). Once those spots are full, additional eligible applicants will be placed on a waitlist.
Idaho’s Aid to the Aged, Blind, and Disabled (AABD) Medicaid provides basic healthcare coverage and long-term care services and supports to financially needy Idaho residents who are aged (age 65+), blind or disabled and live in the community. AABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially needy people of all ages. AABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait. In some states, AABD Medicaid is simply called ABD Medicaid.
The state will conduct an assessment of AABD Medicaid beneficiaries to determined what type of long-term care services and supports they need and the state will cover. These long-term care benefits can be delivered through the following programs:
1. Personal Care Services Program
Idaho’s Personal Care Services Program (PCSP) provides assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (shopping, cooking, cleaning, laundry, etc.) for AABD Medicaid beneficiaries who live in their own home or the home of a loved one. Some AABD Medicaid beneficiaries who live in certified family homes (adult foster homes) or assisted living residences may also be eligible for PCSP, but they cannot be receiving any other Medicaid-funded personal care services.
PCSP participants are not required to need a Nursing Facility Level of Care, but their need for personal care assistance must be deemed “medically necessary.” Idaho Medicaid uses the Uniform Assessment Instrument (UAI) to help make this determination.
PCSP benefits include prescription medication assistance, shopping for essentials, meal preparation, housekeeping services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Benefits will be made available depending on each beneficiary’s needs and circumstances.
Like Idaho’s AABD Medicaid itself, PCSP is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.
2. Medicare Medicaid Coordinated Plan
Idaho’s Medicare Medicaid Coordinated Plan (MMCP) streamlines the benefits of both Medicare and Medicaid into one plan for Idaho Medicaid recipients who are also covered by Medicare, which is known as being “dual eligible.” This means that all medical, dental, vision and behavioral health benefits, plus all long-term care supports and services, provided by either Medicaid or Medicare will be made available through one, coordinated plan. This plan will be administered by a Medicare Advantage Organization, which has a network of providers that will deliver all benefits.
MMCP program participants can live in their own home, the home of a loved one, a certified family home (adult foster home), a residential assisted living facility or a nursing home. There is no medical or functional criteria for the MMCP, but medical need will determine the types of services program participants receive. Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (shopping, cooking, cleaning, laundry, etc.) can be received only if it’s considered “medically necessary.” For more comprehensive home and community based long term care services and supports, or nursing home coverage, a Nursing Facility Level of Care is required.
MMCP program participants must be enrolled in Medicare Parts A, B and D, and they must be enrolled in Idaho Medicaid. They also must live in one of the 33 Idaho counties that offers the program – Ada, Adams, Bannock, Benewah, Bingham, Blaine, Boise, Clark, Bonner, Cassia, Clearwater, Bonneville, Boundary, Canyon, Elmore, Fremont, Gem, Gooding, Jefferson, Jerome, Kootenai, Latah, Lincoln, Madison, Minidoka, Nez Perce, Owyhee, Payette, Power, Shoshone, Twin Falls, Valley and Washington.
Although the MMCP is an entitlement program and all eligible applicants are guaranteed to be accepted into the program, all of its services are not guaranteed to be available. Most of the home and community based services are delivered through the Aged and Disabled Waiver, which has an enrollment limit (about 12,000 per year as of 2022). Once that limit is full, those in need of services will be placed on a waitlist.
3. Idaho Medicaid Plus
Idaho Medicaid Plus (IMPlus) is a managed care program for Idaho Medicaid beneficiaries who are also covered by Medicare, which is known as being “dual eligible.” IMPlus will coordinate all of Medicaid’s medical benefits and long-term care services and supports into one plan, but Medicare benefits will continue to be delivered to the program participant through the Medicare system.
IMPlus program participants can live in their own home, the home of a loved one, a certified family home (adult foster home) or a residential assisted living facility. There is no medical or functional criteria for IMPlus, but medical need will determine the types of services program participants receive. Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (shopping, cooking, cleaning, laundry, etc.) can be received only if it’s considered “medically necessary.” For more comprehensive home and community based long term care services and supports, a Nursing Facility Level of Care is required.
IMPlus program participants must be enrolled in Medicare Parts A, B and D, and they must be enrolled in Idaho Medicaid. They also must live in one of the 33 Idaho counties that offers the program – Ada, Adams, Bannock, Benewah, Bingham, Blaine, Boise, Clark, Bonner, Cassia, Clearwater, Bonneville, Boundary, Canyon, Elmore, Fremont, Gem, Gooding, Jefferson, Jerome, Kootenai, Latah, Lincoln, Madison, Minidoka, Nez Perce, Owyhee, Payette, Power, Shoshone, Twin Falls, Valley, and Washington.
Enrollment in IMPlus, or Idaho’s Medicare Medicaid Coordinated Plan, is mandatory for dual-eligible Idaho residents in 21 of those counties – Ada, Bannock, Bingham, Boise, Bonner, Bonneville, Boundary, Canyon, Cassia, Elmore, Fremont, Gem, Jefferson, Kootenai, Madison, Minidoka, Nez Perce, Owyhee, Payette, Power and Twin Falls.
Although IMPlus is an entitlement program and all eligible applicants are guaranteed to be accepted into the program, all of its services are not guaranteed to be available. Most of the home and community based services are delivered through the Aged and Disabled Waiver, which has an enrollment limit (about 12,000 per year as of 2022). Once that limit is full, those in need of services will be placed on a waitlist.
To be eligible for Idaho Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aid to the Aged, Blind, and Disabled (AABD) Medicaid.
Just For You: The easiest way to find the most current Idaho Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.
Financial Requirements
Idaho residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Idaho Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for a single applicant is $2,849/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Idaho Nursing Home Medicaid beneficiaries must give most of their income to the state to help cover the cost of nursing home care. They are only allowed to keep $40/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.
For married applicants with both spouses applying and both spouses living together in a nursing home, the 2024 asset limit for nursing home coverage through Idaho Medicaid is $3,000 combined. For married applicants who do not live together but are both applying for and receiving Medicaid assistance, the asset limit is $2,000 per spouse. The income limit for married couples with both spouses applying, no matter where they live, is a combined $5,678/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,849/month for the applicant, and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for Idaho Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Idaho has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through Idaho Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if an applicant requires a NFLOC for Medicaid purposes, Idaho uses the Uniform Assessment Instrument. An applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry) is considered. Cognitive impairments such as Alzheimer’s disease and other dementias are also considered.
Financial Requirements
Idaho residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Idaho is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for a single applicant is $2,849/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying and both spouses living together, the 2024 asset limit for HCBS Waivers through Idaho Medicaid is $3,000 combined. For married applicants who do not live together but are both applying for and receiving Medicaid, the asset limit is $2,000 per spouse. The income limit for married couples with both spouses applying, no matter where they live, is a combined $5,678/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,849/month for the applicant, and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for Idaho HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Idaho has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Idaho Medicaid is needing a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if HCBS Waiver applicants require a Nursing Facility Level of Care, Idaho uses the Uniform Assessment Instrument. An applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry) is considered. Cognitive impairments such as Alzheimer’s disease and other dementias are also considered.
Financial Requirements
Idaho residents have to meet an asset limit and an income limit in order to be financially eligible for Aid to the Aged, Blind, and Disabled (AABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for a single applicant is $996/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants, the 2024 asset limit for AABD Medicaid is a combined $3,000, and the income limit is a combined $1,435/month. This applies to married couples with both spouses applying or with just one spouse applying.
Plan Ahead: There are alternative pathways to eligibility for AABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Idaho has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to AABD Medicaid applicants. However, AABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The only functional requirements to receive basic healthcare coverage through Idaho’s AABD Medicaid are being aged (65 or over), blind, or disabled. For AABD Medicaid applicants who require long-term care services and supports, Idaho Medicaid will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of benefits the applicant needs and the state will cover.
One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:
These rules apply to all three types of Medicaid, with one important exception – AABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status.
Idaho Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Idaho and how you can protect your home from it, click here.
The first step in applying for Idaho Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aid to the Aged, Blind, and Disabled (AABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Idaho Medicaid when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Idaho Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Idaho residents can apply for Medicaid online through idalink. They can apply in person at their local Department of Health and Welfare field office. They can apply over the phone by calling the Department of Health and Welfare at 877-456-1233. Or they can download an application and email the completed application to my [email protected], mail it to their local Department of Health and Welfare field office or fax it to 866-434-8278.
For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.
Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.
After being approved for nursing home coverage through Idaho Medicaid, you or your loved one has to choose which Medicaid-accepting nursing home best meets your needs. Even though Idaho Medicaid nursing home coverage is an entitlement, not all nursing homes accept Medicaid, and those that do may not have available space. Finding the right nursing home can be a challenge, especially if you’re looking in a specific geographic area.
There are roughly 70 nursing homes in Idaho that accept Medicaid. About 20 of those nursing homes are in the southwest corner of the west in and around the cities of Boise, Meridian, Nampa and Caldwell. There are seven around Pocatello and four more near Idaho Falls in the southwest part of the state. There are six nursing homes that accept Medicaid in the Idaho panhandle around the cities of Coeur d’Alene and Post Falls. People in those communities might regularly travel across the border into Washington for personal and business reasons, including healthcare. But Medicaid coverage does not travel across borders. So, someone who has Idaho Medicaid will not be covered in a nursing home in Spokane, Washington, even if there are more options there.
TOOLS: To find a nursing home, Idaho residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. This Idaho Department of Health and Welfare webpage also has a list of nursing homes in the state.
Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in the state.
After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? Does it provide transportation? How does it handle oral and vision care? What are the meals like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.
Data collected by CMS from 2019-2022 shows the Idaho nursing homes were close to equal with the national averages when it came to health inspections, resident-to-staff ratio and resident satisfaction, with one notable exception. Idaho nursing homes report 0.14 physical therapist staff hours per resident per day, which is twice the national average of 0.07.
If you need Medicaid long term care but do not meet the financial eligibility criteria, consider working with a Medicaid Planning professional. These fee-based experts help families structure their finances to become eligible, while streamlining the application process and preserving assets for spouses and family members.
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