The Idaho Department of Health and Welfare is enrolling eligible Idaho adults in Medicaid who earn up to 138 percent of the Federal Poverty Limit. Benefits for those folks will begin on Jan. 1, 2020.

So if someone applies in December and is determined to be eligible, will they be able to access their benefits on Jan. 1?

Medicaid expansion will be effective January 1. However, depending on when the application and all verifications were submitted, they may not have a final decision about eligibility on January 1. Medicaid operates under what is called month-effective eligibility. That means if a person applies and is eligible on Jan. 6, they will be eligible for all of January.

Open enrollment for buying insurance on Your Health Idaho ends on Dec. 16. Does that same deadline apply to Medicaid?

There really is no deadline to apply for Medicaid. People who think they may be eligible can apply at any time. If you’re not sure, you should start that process now, so if you’re not eligible for Medicaid but you are eligible for a tax credit, there is still time to purchase insurance on the state-based health insurance exchange.

How does someone apply?

Idahoans can apply online, over the phone, in-person in one of our field offices, or by mail, email, or fax. You can get those details at our website at medicaidexpansion.idaho.gov.

What are the eligibility criteria for Medicaid expansion?

• Eligible people are:
  • Idaho citizens and legal residents.
  • Those who meet specific income guidelines.
  • Between ages 19 and 64.
  • Not on Medicare.

What does Medicaid cover?

You can see a more complete list of what it covers on our website, but it covers a variety of services, including:

• Annual physicals
• Counselling and mental health services
• Dental care
• Doctor visits
• Emergency Medical Transportation
• Home health care (Doctor prescribed)
• Hospice Care
• Immunizations
• Inpatient and outpatient hospital care
• Lab tests
• Treatment for substance use disorder
• More

What can you tell me about the status of the sideboards or waivers, like for work requirements?

Department staff are hard at work on the waivers to implement requirements outlined in SB1204, but none have received approval from the federal government so far. The waivers are related to work requirements, family planning referrals, allowing adults between 100 and 138 percent of FPL to continue using a tax credit to buy private insurance if they choose, and allowing Medicaid to pay for inpatient services in an Institution for Mental Diseases. We’re keeping track of the status of the waivers at medicaidexpansion.idaho.gov.

What happens if none of the waivers have been approved by the federal government by Jan. 1? Does Medicaid expansion still happen?

Idahoans who are newly eligible for Medicaid will be able to access benefits starting Jan. 1 or shortly after their applications are processed, even if none of the waivers have been approved. The department will implement the waivers when and if they are approved, but the Centers for Medicare & Medicaid Services (CMS) is not obligated to approve or deny any waiver, so timelines are difficult to estimate.

(Note: A Closer Look At Your Health airs at around 6:50 a.m. most Tuesdays on KBOI News Radio 670. This is a slightly edited transcript of the segment from Dec. 10.)