Idaho

What Is Idaho Medicaid Long-Term Care?

Idaho’s Medicaid program, also referred to as the Idaho Health Plan Coverage, helps low-income individuals access health care. While it serves various groups, this section focuses specifically on long-term care benefits available to Idaho seniors aged 65 and older. Medicaid covers care in nursing homes, assisted living facilities, certified family homes (adult foster care), and also pays for non-medical services that enable elderly residents to remain in their homes.

What Long-Term Care Medicaid Options Are Available in Idaho?

What Is Institutional / Nursing Home Medicaid?

This is an entitlement program. If an individual qualifies, they will receive benefits to cover care provided only in licensed nursing home facilities.

What Are Medicaid Waivers or Home and Community Based Services (HCBS)?

Unlike institutional Medicaid, these are not entitlements. There are enrollment caps and potential waitlists. Services are provided at home, in adult day care, assisted living, or adult foster care to help delay or avoid nursing home placement.

What Is Regular Medicaid for the Aged, Blind, and Disabled (AABD)?

This entitlement program provides services like personal care assistance or adult day care to eligible seniors.

What Are the 2025 Income and Asset Limits for Idaho Medicaid Eligibility?

What Are the Basic Financial Requirements for a Single Nursing Home Applicant in 2025?

• Income must be under $2,901/month
• Assets must be below $2,000
• Applicant must require a Nursing Home Level of Care

What Are the 2025 Income and Asset Limits for Different Types of Medicaid?

How Does Medicaid Define and Count Income?

What Types of Income Count Toward Medicaid Eligibility?

Most forms of income are considered “countable,” including wages, pensions, Social Security, IRA withdrawals, and dividends. Certain payments like Holocaust restitution or VA Aid & Attendance benefits are excluded.

How Is Income Handled for Married Couples?

For Nursing Home or Waiver programs, only the applicant’s income is counted. The non-applicant spouse may be eligible for a spousal income allowance to avoid poverty.

• MMMNA (2025): $2,643.75/month
• Shelter standard: $793.13/month
• Maximum monthly allowance: $3,948

For Regular Medicaid, income from both spouses is counted toward the applicant’s eligibility, and no spousal allowance is available.

How Are Assets Evaluated for Medicaid?

What Are Countable and Non-Countable Assets?

Countable assets include bank accounts, stocks, bonds, cash, and non-resident real estate. Non-countable (exempt) assets include a primary home (with conditions), one vehicle, personal items, and an IRA in payout status. A spouse’s IRA is always exempt.

How Are Assets Treated for Married Couples?

All assets are considered jointly owned. For Nursing Home Medicaid and HCBS, the non-applicant spouse may retain a portion under the Community Spouse Resource Allowance (CSRA).

• Maximum CSRA in 2025: $157,920
• If below $31,584, the full amount can be retained

Regular Medicaid does not include CSRA.

What Is the Medicaid Look-Back Period and Why Does It Matter?

How Far Back Does Idaho Review Asset Transfers?

Idaho enforces a 60-month (5-year) look-back for Nursing Home Medicaid and HCBS Waivers. The program checks for assets given away or sold for less than fair market value, which can trigger a penalty period of ineligibility.

Do Federal Gift Tax Rules Affect Medicaid Eligibility?

No. Even if a gift is below the $19,000 federal exemption (2025), it still violates Medicaid’s rules during the look-back period if improperly transferred.

How Does Medicaid Treat a Senior’s Home?

When Is a Home Exempt from Medicaid’s Asset Limit?

If the applicant or their spouse lives in the home, it’s exempt. If not, the applicant must express intent to return. In 2025, equity must be under $750,000. No equity limit applies for Regular Medicaid.

Is the Home Safe from Medicaid’s Estate Recovery Program?

Not necessarily. After death, Medicaid may seek repayment through the estate, often involving the home, unless proactive planning is done.

What Medical or Functional Needs Are Required?

What Level of Care Must Be Needed to Qualify for Long-Term Care Medicaid?

• For Nursing Home Medicaid and HCBS: Nursing Facility Level of Care (NFLOC) is required
• For Regular Medicaid: Need for assistance with Activities of Daily Living (ADLs) is sufficient

How Can You Still Qualify If You’re Over the Limits?

What Is a Qualified Income Trust (QIT) and How Does It Work?

Also called a Miller Trust, this allows applicants with too much income to qualify by placing the excess income into an irrevocable trust. Funds can only be used for specific care-related expenses.

What Does “Spending Down” Assets Mean?

Spending down means using countable assets to pay for exempt goods or services, such as home repairs, medical devices, debt, or funeral arrangements. This must be done carefully to avoid violating the look-back rule.

How Can Medicaid Planning Help?

If you’re over the financial limits but still can’t afford care, a Certified Medicaid Planner can help structure finances, protect assets, and guide you through the application process.

What Medicaid Programs in Idaho Support Seniors at Home or in the Community?

HCBS Aged & Disabled (A&D) Waiver

This waiver provides supportive services like personal care, adult day care, homemaking, respite, and more. It includes an option for participants to self-direct services and hire family members.

Personal Care Services Program (PCSP)

Also known as State Plan Personal Care Services, this program offers help with daily tasks like hygiene, cooking, medication management, and housekeeping.

Medicare Medicaid Coordinated Plan (MMCP)

This managed care program integrates Medicare and Medicaid for dual-eligible individuals. It offers nursing home care, dental, personal care, prescriptions, and waiver services. Availability varies by location.

Idaho Medicaid Plus (IMPlus)

Another program for dual-eligibles, IMPlus covers only Medicaid benefits and includes hospitalization, long-term care, and home-based services. It is not offered statewide.

Money Follows the Person (MFP) Program

Called Idaho Home Choice, this federal initiative assists Medicaid-eligible individuals in transitioning from institutions back into their homes or communities.

How Do You Apply for Idaho Medicaid?

Applicants can apply:

• Online: idalink.idaho.gov
• Phone: 1-877-456-1233
• Fax: 1-866-434-8278
• Email: MyBenefits@dhw.idaho.gov
• Mail:
  Self-Reliance Programs – Statewide Application Team
  PO Box 83720
  Boise, ID 83720-0026

It is strongly recommended that seniors confirm eligibility before applying. Those who are uncertain or over the financial limits should consider professional Medicaid planning services to improve their chances of approval and preserve assets.