Idaho Medicaid Income Limits 2024

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Idaho Medicaid Income Limits 2023 : Idaho Medicaid is the state and Federal partnership that provides health coverage for selected categories of people in Idaho with low incomes. Its purpose is to improve the health of people who might otherwise go without medical care for themselves and their children.

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Idaho Medicaid Income Limits 2023

Who is eligible for Idaho Medicaid?

To be eligible for Idaho Medicaid, you must be a resident of the state of Idaho, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:

  • Pregnant, or
  • Be responsible for a child 18 years of age or younger, or
  • Blind, or
  • Have a disability or a family member in your household with a disability, or
  • Be 65 years of age or older.

Your Health Idaho Income Limits 2023

The income limits for Idaho Medicaid in 2023 are determined by both household size and monthly income. Here’s a breakdown of the income limits for various household sizes:

  • Household of Two: For a household with two members, the income limit is $3,123 per month.
  • Household of Three: In a household of three members, the monthly income limit is $3,937.
  • Household of Four: A family of four can have a maximum monthly income of $4,750 and still qualify for Medicaid in Idaho in 2023.
  • Household of Five: For households with five members, the income limit is set at $5,564 per month.
  • Household of Six: In a household with six members, the income limit increases to $6,378.
  • Household of Seven: Families with seven members can earn up to $7,192 per month and remain eligible for Medicaid.
  • Household of Eight: For households consisting of eight members, the income limit is $8,006 per month.
  • Additional Members: If a household has more than eight members, they can add $814 to the income limit for each additional member.

Idaho Medicaid Income Limits | Your Health Idaho Income Limits

These income limits are essential for individuals and families to determine their eligibility for Medicaid in Idaho. If a household’s monthly income falls below the specified limit for their household size, they may qualify for Medicaid coverage, which includes access to medical services, doctor visits, hospital care, and more.

It’s important to note that income limits are subject to change, and applicants should always verify the current limits with the Idaho Department of Health and Welfare or the official Medicaid website.

Idaho Medicaid Income Limits 2023

Household Size* Maximum Income Level (Per Year)
1 $19,392
2 $26,228
3 $33,064
4 $39,900
5 $46,737
6 $53,573
7 $60,409
8 $67,245

*For households with more than eight people, add $6,836 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.

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Idaho Medicaid Income Limits 2023 Adults Age

Effective March 2023

HOUSEHOLD SIZE INCOME
1 $1,677
2 $2,268
3 $2,859
4 $3,450
5 $4,042
6 $4,633
7 $5,224
8 $5,815
Each additional member (+)$592

The unborn child(ren) of a pregnant adult counts as part of the household size.

For more eligibility information and instructions on how to apply, visit Adult Medicaid.

Idaho Medicaid Income Limits 2023 Pregnant Woman

Effective March 2023

HOUSEHOLD SIZE* MONTHLY INCOME
2 $2,268
3 $2,859
4 $3,450
5 $4,042
6 $4,633
7 $5,224
8 $5,815
Each additional member (+)$592

The unborn child(ren) of a pregnant adult counts as part of the household size.

For more eligibility information and instructions on how to apply, visit Pregnancy Coverage.

Your Health Idaho Income Limits 2023 Medicare Savings Program

Effective January 2023

   INCOME  RESOURCES
PROGRAM INDIVIDUAL  COUPLE INDIVIDUAL  COUPLE
Qualified Medicare Beneficiary – QMB
(Income between 0-100% FPL)
$1,235 $1,664 $9,090 $13,630
Specified Low-Income Medicare Beneficiary – SLMB I
(Income between 100-120% FPL)
$1,478 $1,992 $9,090 $13,630
Qualified Individual – QI
(Income between 120-135%
$1,661 $2,239 $9,090  $13,630

For more eligibility information and instructions on how to apply, visit Medicare Savings.

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Idaho Medicaid Income Limits 2023 Child

Effective March 2023

HOUSEHOLD SIZE MONTHLY INCOME
2 $3,123
3 $3,937
4 $4,750
5 $5,564
6 $6,378
7 $7,192
8 $8,006
Each additional member (+)$814

Disabled Children: Income and resource guidelines for disability are best explained by staff, so please contact us. 

For more eligibility information and instructions on how to apply, visit CHIP.

Your Health Idaho Income Limits 2023 for Workers with Disabilities

Effective January 2023

 INCOME  RESOURCES
INCOME LEVEL INDIVIDUAL  COUPLE INDIVIDUAL  COUPLE
Between 0-133% $0-1,636
$0 Premium
$0-2,206
$0 Premium
$10,000 $15,000
Between 133-250% $1,636-3,058
$10 Premium
$2,206-4,129
$10 Premium
$10,000 $15,000
Between 250-500% $3,058-6,095
$10-200 Premium depending on income
$4,129-8,237
$10-270 Premium depending on income
$10,000  $15,000

For more eligibility information and instructions on how to apply, visit Medicaid for Workers with Disabilities

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Idaho Medicaid Income Limits 2023 Long Term Care (Nursing Home Coverage)

Effective January 2023

   INCOME  RESOURCES
PROGRAM INDIVIDUAL  COUPLE INDIVIDUAL  COUPLE
Long-Term Facility Care $2,762 $5,504 $2,000  $2,000 (ea)**

For more eligibility information and instructions on how to apply, visit Nursing Home Coverage

Idaho Medicaid Income Limits 2023 Aid to the Aged, Blind, and Disabled (AABD Cash & AABD Medicaid)

Effective January 2023

  INDIVIDUAL COUPLE
INCOME LIMIT $967 $1,391*
RESOURCE LIMIT $2,000 $3,000

*For AABD income limit, “Couple” includes Single plus essential person, as well as married couple.

Program Income
RUF (Jan 2023) $914 SSI Single
Minus $125
$789 to Provider

Your Health Idaho Income Limits 2023 Youth Empowerment Services (YES)

Effective March 2023

HOUSEHOLD SIZE MONTHLY INCOME
2 $4,930
3 $6,215
4 $7,500
5 $8,785
6 $10,070
7 $11,355
8 $12,640
Each additional member + $1,285

About Idaho Medicaid Income Limits 2023 for Children

Medicaid provides health coverage for children who meet certain eligibility criteria. There are several different Medicaid programs available to address specific circumstances and needs of children. 

ALERT: Medicaid members have been involved in two data breaches this year.

Medicaid programs

Medicaid offers different programs to provide health coverage for children in Idaho:

  • Children with income under 190 percent of the federal poverty level (FPL)
  • Children with disabilities
  • Children with behavioral health needs

If you or someone in your family needs healthcare, you should apply for Medicaid even if you are not sure you qualify. Some income and resources are not counted when determining your eligibility. For example, owning your home might not prevent you from getting Medicaid.

Children with household income over 138 percent of FPL may qualify for the Children Health Insurance Plan (CHIP).  See more information about CHIP under Medicaid programs. 

Medicaid plans available

  • Basic Plan – This plan provides health, prevention, and wellness benefits for children who do not have special health needs. This plan includes annual physicals, well-child checkups, immunizations, most prescriptions, doctor and hospital visits, and more.
  • Enhanced Plan – This plan is for individuals with disabilities or special health needs. This plan has all the benefits of the Basic Plan, plus additional benefits. Most of the time, individuals will need to be referred by a doctor to become eligible for the enhanced plan.

What’s covered Idaho Medicaid Programs

Medicaid and CHIP will pay for a number of services, such as prescriptions and dental care. While it is possible to have Medicaid and private health insurance, children who have private health insurance cannot qualify for CHIP.

  • Annual physicals
  • Counseling and mental health services
  • Dental (dental services)
  • Doctor visits
  • Durable Medical Equipment
  • Emergency Medical Transportation
  • Early Periodic Screening, Diagnostic and Treatment (must be pre-authorized)
  • Home health care (doctor prescribed)
  • Immunizations
  • Inpatient and outpatient hospital care
  • Lab tests
  • Medical equipment and supplies
  • Medical transportation services
  • Prescriptions
  • Primary Care Case Management
  • Prosthetics/orthotics
  • Substance Abuse Treatment
  • Smoking Cessation
  • Vision (vision services)
  • Weight loss
  • X-rays

Children’s Wellness Benefit

The Children’s Wellness Benefit provides parents with children on the Children’s Health Insurance Program (CHIP) an additional benefit for keeping their children up to date on well-child checks and immunizations. Every child current on their well-child checkups and immunizations is eligible to receive a $10 deduction for their monthly CHIP premiums. 

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Age to have a Well-Child CheckUP

Babies under 1 year old:

  • 3 to 5 days old
  • 1 week to 1 month 
  • 2 months 
  • 4 months 
  • 6 months 
  • 9 months 

Toddlers 1-3 years old:

  • 12 Months 
  • 15 Months 
  • 18 Months 
  • 24 Months 
  • 30 Months 

Children 3-19 years old:

  • Children ages 3-19 need a checkup once a year.

Please ask your doctor which immunizations your child needs, and ask your doctor to enter the immunization record into IRIS – Idaho’s Immunization Registry. If you don’t have a doctor for your child, use the Find a Provider tool or call the Healthy Connections Unit at 888-528-5861.

Preventative Health Assistance (PHA) benefit

The Weight Management benefit (WM) is designed to help eligible participants and their families improve their lifestyle through:

  • Physical fitness
  • Balanced diet
  • Personal health education 

Qualifying participants can earn up to $200 each year to help pay for services offered by PHA providers such as participation in the National Diabetes Prevention Program, fees for a weight management program, a gym membership, healthy lifestyle classes, or nutrition classes or services. Any additional fees are the participant’s responsibility.

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WM qualification guidance: 

  • Participants must have full Basic or Enhanced Medicaid coverage to qualify.
  • Participants must also meet the following criteria by age:
    • Children (5 to 21 years old): a body mass index (BMI) that falls in either the overweight or the underweight category according to the CDC Child and Teen BMI Calculator.
  • Participants on the Home Care for Certain Disabled Children Program (Katie Beckett) and Medicare-Medicaid Coordinated Plan participants are not eligible for these benefits.

About Idaho Medicaid Income Limits 2023 for Adults

Medicaid offers healthcare coverage for adults that address a variety of health needs, including coverage for low-income adults, pregnant women, the elderly, and people with disabilities who meet certain income criteria. 

ALERT: Medicaid members have been involved in two data breaches this year.

Idaho Medicaid programs

Medicaid offers different programs to provide healthcare coverage for adults in Idaho:

  • Adults with income under 138 percent of the federal poverty level (FPL)
  • Pregnant women with income under 138 percent of FPL
  • Women diagnosed with breast or cervical cancer through Women’s Health Check.
  • People aged 65 or older who meet income requirements 
  • People who are blind or disabled (using Social Security criteria)
  • Medicare Savings Program

Idaho Medicaid plans available

  • Basic Plan – This plan provides health, prevention, and wellness benefits for adults who do not have special health needs. This plan includes annual physicals, immunizations, most prescriptions, doctor and hospital visits, and more.
  • Enhanced Plan – This plan is for individuals with disabilities or special health needs. This plan has all the benefits of the Basic Plan, plus additional benefits. Most of the time, individuals will need to be referred by a doctor to become eligible for the enhanced plan.
  • Medicare-Medicaid Coordinated Plan – Designed for people who are eligible and enrolled in both Medicare and Medicaid, (also known as dual eligibles). This plan has all the benefits of the Enhanced Plan, plus allows people to enroll in a managed care plan to help coordinate Medicare and Medicaid benefits. There are many advantages to enrolling in managed care, one of the most valuable is access to a care coordinator who helps people with complex medical conditions to achieve better health.

What’s covered Idaho Medicaid programs

Medicaid will pay for a number of services, such as:

  • Annual physicals
  • Counseling and mental health services
  • Dental (dental services)
  • Doctor visits
  • Durable Medical Equipment
  • Emergency Medical Transportation
  • Home health care (doctor prescribed)
  • Hospice care
  • Immunizations
  • Inpatient and outpatient hospital care
  • Lab tests
  • Medical equipment and supplies
  • Medical transportation services
  • Nurse midwife
  • Pregnancy and family planning services
  • Prescriptions
  • Primary Care Case Management
  • Prosthetics/orthotics
  • Substance abuse treatment
  • Smoking Cessation
  • Vision (vision services)
  • Weight loss
  • X-rays 

About Idaho Medicaid for Elderly or Adults with Disabilities

Medicaid covers adults with intellectual and development disabilities as well as adults with physical disabilities. Medicaid also covers elderly individuals who may need additional services to help them live as independently as possible. The goal of the Medicaid program is to get the right care at the right place at the right cost with the right outcomes. After Medicaid eligibility is determined, and individual will have an assessment regarding the level of care required to help meet individuals needs and care.

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Overview of Idaho Medicaid Programs

Individuals who are elderly or live with a disability can be eligible for Medicaid coverage if they meet the following criteria:

  • Live in Idaho
  • Be a U.S. citizen or eligible non-citizen
  • Have a disability diagnosis under the Social Security Act (or)
  • Be over the age of 65 years
  • Meet certain income and resource guidelines

Those with Developmental Disabilities can receive services specific to their disability when they meet certain criteria.

Idaho Medicaid/Medicare Participants

A dual eligible beneficiary is someone over the age of 21, has Medicare A, B, and D and is eligible for enhanced Medicaid. There are two programs available for dual eligible beneficiaries, Medicare Medicaid Coordinated Plan and the Idaho Medicaid Plus Program. For more information, visit the Medicaid/Medicare Participants page.

FAQ’s-Idaho Medicaid Income Limits 2023

Q: What is the income limit for Idaho Medicaid in 2023 for a household with 2 members?

Ans: The income limit for Idaho Medicaid in 2023 for a household with 2 members is $3,123 per month.

Q: How much can a household with 3 members earn and still qualify for Idaho Medicaid in 2023?

Ans: A household with 3 members can earn up to $3,937 per month and still qualify for Idaho Medicaid in 2023.

Q: What is the income limit for a family of 4 to be eligible for Idaho Medicaid in 2023?

Ans: The income limit for a family of 4 to be eligible for Idaho Medicaid in 2023 is $4,750 per month.

Q: If a household has 5 members, what is the maximum monthly income they can have to be eligible for Idaho Medicaid in 2023?

Ans: A household with 5 members can have a maximum monthly income of $5,564 and still qualify for Idaho Medicaid in 2023.

Q: What is the income threshold for a family of 6 to qualify for Idaho Medicaid in 2023?

Ans: The income threshold for a family of 6 to qualify for Idaho Medicaid in 2023 is $6,378 per month.

Q: How much can a household with 7 members earn each month and still be eligible for Idaho Medicaid in 2023?

Ans: A household with 7 members can earn up to $7,192 per month and still be eligible for Idaho Medicaid in 2023.

Q: What is the income limit for a family of 8 to qualify for Idaho Medicaid in 2023?

Ans: The income limit for a family of 8 to qualify for Idaho Medicaid in 2023 is $8,006 per month.

Q: How much is the additional income allowed for each extra member beyond 8 in a household applying for Idaho Medicaid in 2023?

Ans: For each additional member beyond 8 in a household applying for Idaho Medicaid in 2023, an additional income of $814 per month is allowed.

Conclusion:-Idaho Medicaid Income Limits 2023

Access to healthcare is a fundamental right, and Idaho Medicaid is designed to ensure that low-income individuals and families have the opportunity to receive necessary medical services. Understanding the income limits based on household size is crucial for determining eligibility and accessing this essential healthcare coverage. As the Idaho Medicaid program’s income limits may change over time, it’s advisable to regularly check for updates to ensure you meet the eligibility criteria and can access the healthcare services you need.

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