Severity of need and availability of other resources

The RMS determines eligibility and authorizes services for certain Medicaid Services, including Personal Care Services (PCS), HCBS Waiver for the Aged and Disabled (a variety of services are available including attendant care, homemaker, chore, adult day care, home delivered meals, personal emergency response system, specialized equipment/supplies); Katie Beckett or Home Care for Certain Disabled Children; Nursing Facility Care; ICF/MR Care; Residential and Assisted Living Services and Certified Family Homes; Case Management; Private Duty Nursing. These services are available to Medicaid recipients who are determined to need these services. The RMS enrolls providers of these services, provides consultation, and conducts quality assurance and improvement surveys. The Healthy Connections program is also part of the RMS.

**Personal Care Services (PCS): If the medical condition requires 16 hours or less per week, the service is a regular Medicaid benefit under Personal Care Services. If the medical condition requires more than 16 hours, then the individual may be eligible for one of the Home and Community Based Waivers. Under the waiver program, the cost of care at home cannot exceed the cost for a nursing home or intermediate care facility. The Regional Medicaid Unit must authorize all services in advance.

**Home Care for Certain Disabled Children, also known as the "Katie Beckett" program, is a Medicaid program for children under 18 years of age who are not eligible for Medicaid through any other Medicaid programs. Children must have income of less than $1,520 (1999 limit) and assets of $2,000 or less. Parents' income and assets are not counted towards these limits.

** Adult Developmental Disability (DD) Care Management oversees services for persons 18 years of age and older and persons on the ISSH waiver (15-18) . Services that are covered under DD Care Management are Developmental Disabilities Agency services DD/ISSH waiver services and service coordination. These services are being overseen by the DD Care Managers in each region. These positions are located in the Regional Medicaid Services unit.

Regional Medicaid Services is administered by the Division of Medicaid Services.

*My Voice My Choice is the name of Idaho's self-directed option for Medicaid services.

Medicaid financial eligibility plus individual program requirements. Contact office for specific details.

The RMS determines eligibility and authorizes services for certain Medicaid Services, including Personal Care Services (PCS), HCBS Waiver for the Aged and Disabled (a variety of services are available including attendant care, homemaker, chore, adult day care, home delivered meals, personal emergency response system, specialized equipment/supplies); Katie Beckett or Home Care for Certain Disabled Children; Nursing Facility care; ICF/MR Care; Residential and Assisted Living Services and Certified Family Homes; Case Management; Private Duty Nursing. These services are available to Medicaid recipients who are determined to need these services. The RMS approves providers of these services and conducts quality assurance and improvement surveys. The Healthy Connections program is also part of the RMS.

**Personal Care Services (PCS): If the medical condition requires 16 hours or less per week, the service is a regular Medicaid benefit under Personal Care Services. If the medical condition requires more than 16 hours, then the individual may be eligible for one of the Home and Community Based Waivers. Under the waiver program, the cost of care at home cannot exceed the cost for a nursing home or intermediate care facility. The Regional Medicaid Unit must authorize all services in advance.

**Home Care for Certain Disabled Children, also known as the "Katie Beckett" program, is a Medicaid program for children under 18 years of age who are not eligible for Medicaid through any other Medicaid programs. To meet criteria for this program,children must have a severe disability that significantly impairs their functioning and meets Social Security Disability criteria. The child must require the kind of care given in a medical institution, such as a hospital, nursing home or intermediate care facility for the mentally retarded. Children must have income of less than $1911. (2008 limit) and assets of $2000. or less. Parent's income and assets are not counted towards these limits.

** Adult Developmental Disability (DD) Care Management oversees services for persons 18 years of age and older and persons on the ISSH waiver (15-18) . Services that are covered under DD Care Management are Developmental Disabilities Agency services DD/ISSH waiver services and service coordination. These services are being overseen by the DD Care Managers in each region. These positions are located in the Regional Medicaid Services unit.

Regional Medicaid Services is administered by the Division of Medicaid Services.

*My Voice My Choice is the name of Idaho's self-directed option for Medicaid services.

Severity of need and availability of other resources

The RMS determines eligibility and authorizes services for certain Medicaid Services, including Personal Care Services (PCS), HCBS Waiver for the Aged and Disabled (a variety of services are available including attendant care, homemaker, chore, adult day care, home delivered meals, personal emergency response system, specialized equipment/supplies); Katie Beckett or Home Care for Certain Disabled Children; Nursing Facility Care; ICF/MR Care; Residential and Assisted Living Services and Certified Family Homes; Case Management; Private Duty Nursing. These services are available to Medicaid recipients who are determined to need these services. The RMS enrolls providers of these services, provides consultation, and conducts quality assurance and improvement surveys. The Healthy Connections program is also part of the RMS.

**Personal Care Services (PCS): If the medical condition requires 16 hours or less per week, the service is a regular Medicaid benefit under Personal Care Services. If the medical condition requires more than 16 hours, then the individual may be eligible for one of the Home and Community Based Waivers. Under the waiver program, the cost of care at home cannot exceed the cost for a nursing home or intermediate care facility. The Regional Medicaid Unit must authorize all services in advance.

**Home Care for Certain Disabled Children, also known as the "Katie Beckett" program, is a Medicaid program for children under 18 years of age who are not eligible for Medicaid through any other Medicaid programs and have a diagnosis that requires nursing home level of care. Children must have income of less than $1,520 (1999 limit) and assets of $2,000 or less. Parents' income and assets are not counted towards these limits.

** Adult Developmental Disability (DD) Care Management oversees services for persons 18 years of age and older and persons on the ISSH waiver (15-18) . Services that are covered under DD Care Management are Developmental Disabilities Agency services DD/ISSH waiver services and service coordination. These services are being overseen by the DD Care Managers in each region. These positions are located in the Regional Medicaid Services unit.

Regional Medicaid Services is administered by the Division of Medicaid Services.

Severity of need and availability of other resources.

The RMS determines eligibility and authorizes services for certain Medicaid Services, including Personal Care Services (PCS), HCBS Waiver for the Aged and Disabled (a variety of services are available including attendant care, homemaker, chore, adult day care, home delivered meals, personal emergency response system, specialized equipment/supplies); Katie Beckett or Home Care for Certain Disabled Children; Nursing Facility Care; ICF/MR Care; Residential and Assisted Living Services and Certified Family Homes; Case Management; Private Duty Nursing. These services are available to Medicaid recipients who are determined to need these services. The RMS enrolls providers of these services, provides consultation, and conducts quality assurance and improvement surveys. The Healthy Connections program is also part of the RMS.

**Personal Care Services (PCS): If the medical condition requires 16 hours or less per week, the service is a regular Medicaid benefit under Personal Care Services. If the medical condition requires more than 16 hours, then the individual may be eligible for one of the Home and Community Based Waivers. Under the waiver program, the cost of care at home cannot exceed the cost for a nursing home or intermediate care facility. The Regional Medicaid Unit must authorize all services in advance.

**Home Care for Certain Disabled Children, also known as the "Katie Beckett" program, is a Medicaid program for children under 18 years of age who are not eligible for Medicaid through any other Medicaid programs. Children must have income of less than $1,520 (1999 limit) and assets of $2,000 or less. Parents' income and assets are not counted towards these limits.

** Adult Developmental Disability (DD) Care Management oversees services for persons 18 years of age and older and persons on the ISSH waiver (15-18) . Services that are covered under DD Care Management are Developmental Disabilities Agency services DD/ISSH waiver services and service coordination. These services are being overseen by the DD Care Managers in each region. These positions are located in the Regional Medicaid Services unit.

Regional Medicaid Services is administered by the Division of Medicaid Services.

Severity of need and availability of other resources

The RMS determines eligibility and authorizes services for certain Medicaid Services, including Personal Care Services (PCS), HCBS Waiver for the Aged and Disabled (a variety of services are available including attendant care, homemaker, chore, adult day care, home delivered meals, personal emergency response system, specialized equipment/supplies); Katie Beckett or Home Care for Certain Disabled Children; Nursing Facility Care; ICF/MR Care; Residential and Assisted Living Services and Certified Family Homes; Case Management; Private Duty Nursing. Adult Developmental Disabilities are available to Medicaid recipients who are determined to need these services. The RMS enrolls providers of these services, provides consultation, and conducts quality assurance and improvement surveys. The Healthy Connections program is also part of the RMS.

**Personal Care Services (PCS): If the medical condition requires 16 hours or less per week, the service is a regular Medicaid benefit under Personal Care Services. If the medical condition requires more than 16 hours, then the individual may be eligible for one of the Home and Community Based Waivers. Under the waiver program, the cost of care at home cannot exceed the cost for a nursing home or intermediate care facility. The Regional Medicaid Unit must authorize all services in advance.

**Home Care for Certain Disabled Children, also known as the "Katie Beckett" program, is a Medicaid program for children under 18 years of age who are not eligible for Medicaid through any other Medicaid programs. Children must have income of less than $1,520 (1999 limit) and assets of $2,000 or less. Parents' income and assets are not counted towards these limits.

** Adult Developmental Disability (DD) Care Management oversees services for persons 18 years of age and older and persons on the ISSH waiver (15-18) . Services that are covered under DD Care Management are Developmental Disabilities Agency services DD/ISSH waiver services and service coordination. These services are being overseen by the DD Care Managers in each region. These positions are located in the Regional Medicaid Services unit.

Regional Medicaid Services is administered by the Division of Medicaid Services.

Severity of need and availability of other resources

The RMS determines eligibility and authorizes services for certain Medicaid Services, including Personal Care Services (PCS), HCBS Waiver for the Aged and Disabled (a variety of services are available including attendant care, homemaker, chore, adult day care, home delivered meals, personal emergency response system, specialized equipment/supplies); Katie Beckett or Home Care for Certain Disabled Children; Nursing Facility Care; ICF/MR Care; Residential and Assisted Living Services and Certified Family Homes; Case Management; Private Duty Nursing. These services are available to Medicaid recipients who are determined to need these services. The RMS enrolls providers of these services, provides consultation, and conducts quality assurance and improvement surveys. The Healthy Connections program is also part of the RMS.

**Personal Care Services (PCS): If the medical condition requires 16 hours or less per week, the service is a regular Medicaid benefit under Personal Care Services. If the medical condition requires more than 16 hours, then the individual may be eligible for one of the Home and Community Based Waivers. Under the waiver program, the cost of care at home cannot exceed the cost for a nursing home or intermediate care facility. The Regional Medicaid Unit must authorize all services in advance.

**Home Care for Certain Disabled Children, also known as the "Katie Beckett" program, is a Medicaid program for children under 18 years of age who are not eligible for Medicaid through any other Medicaid programs. Children must have income of less than $1,520 (1999 limit) and assets of $2,000 or less. Parents' income and assets are not counted towards these limits.

** Adult Developmental Disability (DD) services for persons with a qualifying developmental disability18 years of age and older and persons on the ISSH waiver (15-18) . Services that are authorized by RMS for Developmental Disabilities Agency services DD/ISSH waiver services and service coordination.

Regional Medicaid Services is administered by the Division of Medicaid Services.

*My Voice My Choice is the name of Idaho's self-directed option for Medicaid services.

Severity of need and availability of other resources.

The RMS determines eligibility and authorizes services for certain Medicaid Services, including Personal Care Services (PCS), HCBS Waiver for the Aged and Disabled (a variety of services are available including attendant care, homemaker, chore, adult day care, home delivered meals, personal emergency response system, specialized equipment/supplies); Katie Beckett or Home Care for Certain Disabled Children; Nursing Facility Care; ICF/MR Care; Residential and Assisted Living Services and Certified Family Homes; Case Management; Private Duty Nursing. These services are available to Medicaid recipients who are determined to need these services. The RMS enrolls providers of these services, provides consultation, and conducts quality assurance and improvement surveys. The Healthy Connections program is also part of the RMS.

**Personal Care Services (PCS): If the medical condition requires 16 hours or less per week, the service is a regular Medicaid benefit under Personal Care Services. If the medical condition requires more than 16 hours, then the individual may be eligible for one of the Home and Community Based Waivers. Under the waiver program, the cost of care at home cannot exceed the cost for a nursing home or intermediate care facility. The Regional Medicaid Unit must authorize all services in advance.

**Home Care for Certain Disabled Children, also known as the "Katie Beckett" program, is a Medicaid program for children under 18 years of age who are not eligible for Medicaid through any other Medicaid programs. Children must have income of less than $1,520 (1999 limit) and assets of $2,000 or less. Parents' income and assets are not counted towards these limits.

** Adult Developmental Disability (DD) Care Management oversees services for persons 18 years of age and older and persons on the ISSH waiver (15-18) . Services that are covered under DD Care Management are Developmental Disabilities Agency services DD/ISSH waiver services and service coordination. These services are being overseen by the DD Care Managers in each region. These positions are located in the Regional Medicaid Services unit.

Regional Medicaid Services is administered by the Division of Medicaid Services.

Senior citizens and families of seniors

SHIBA is part of a network of state health insurance programs (SHIP) across the United States and its territories. In Idaho, SHIBA is funded by the Centers for Medicare and Medicaid Services (CMS), the federal agency which administers the Medicare program, and the Idaho Department of Insurance.

SHIBA is a part of the Department of Insurance, Consumer Affairs, which:

Investigates claims and insurance fraud
Provides advocacy services for consumers
Provides assistance with insurance problems or questions on life, disability, long term care, property, casualty, and health insurance
We offer free and unbiased information, counseling, and assistance regarding senior health insurance. We do not sell insurance, recommend policies, agents, or specific companies. It is our goal to provide you with up-to-date and objective information to assist you in making informed buying decisions.

Also known as SHIP - Senior Health Insurance Program.

BOISE
Toll Free 1-800-247-4422

COEUR D'ALENE
Local phone number (208) 666-6847
Toll Free 1-800-247-4422

POCATELLO
Local phone number (208) 236-6044
Toll Free 1-800-488-5764

Contact for specific information.

The department handles all insurance complaints as well as information on all Insurance companies in the state of Idaho.

Fighting insurance fraud is a high propriety of the Idaho Department of Insurance. If you suspect insurance fraud, call the department at the number listed.

Senior Health Insurance Benefits Advisor (SHIBA) has information on Medicare.

Your Health Idaho is a marketplace which provides a way to get health insurance coverage for Idahans who are not offered affordable insurance through an employer - www.yourhealthidaho.org

Contact for specific information.

Provides Social Security benefits-retirement, survivors benefits, disability and Medicare, plus Supplemental Security Income (SSI).

Supplemental Security Income pays monthly checks to people who are blind, or have a disability, or 65 or older and who are low income.

For Extra Help or Low Income Subsidy contact (800) 772-1213.

Contact for specific information.

Provides Social Security benefits-retirement, survivors benefits, disability and Medicare, plus Supplemental Security Income (SSI).

Supplemental Security Income pays monthly checks to people who are blind, or have a disability, or 65 or older and who are low income.

For Extra Help or Low Income Subsidy contact (800) 772-1213.

Contact for specific information.

Provides Social Security benefits-retirement, survivors benefits, disability and Medicare, plus Supplemental Security Income (SSI).

Supplemental Security Income pays monthly checks to people who are blind, or have a disability, or 65 or older and who are low income.

For Extra Help or Low Income Subsidy contact (800) 772-1213.

Contact for specific information.

Provides Social Security benefits-retirement, survivors benefits, disability and Medicare, plus Supplemental Security Income (SSI).

Supplemental Security Income pays monthly checks to people who are blind, or have a disability, or 65 or older and who are low income.

For Extra Help or Low Income Subsidy contact (800) 772-1213.

Contact for specific information.

Provides assistance with Medicare enrollments and administers Social Security benefits including Retirement, Survivors, Disability, and Supplemental Security Income (SSI).

SSI pays monthly checks to people with limited income and resources who are disabled, blind, or are age 65 and older.

For Medicare Prescription Drug Coverage, Extra Help or Low Income Subsidy contact (800) 772-1213.

Contact for specific information.

Provides Social Security benefits-retirement, survivors benefits, disability and Medicare, plus Supplemental Security Income (SSI).

Supplemental Security Income pays monthly checks to people who are blind, or have a disability, or 65 or older and who are low income.

For Extra Help or Low Income Subsidy contact (800) 772-1213.

Address for the Ontario office is: 908 SE 5th Ave Ontario Oregon 97914

Contact for specific information.

Provides Social Security benefits-retirement, survivors benefits, disability and Medicare, plus Supplemental Security Income (SSI).

Supplemental Security Income pays monthly checks to people who are blind, or have a disability, or 65 or older and who are low income.

For Extra Help or Low Income Subsidy contact (800) 772-1213.

Your Health Idaho was established by state law in 2013 to provide an online marketplace where Idaho families and small businesses can go to compare and purchase health insurance. Your Health Idaho is the only place where Idahoans can receive a monthly tax credit to help offset the cost of coverage.

Your Health Idaho Appeals process:

https://www.yourhealthidaho.org/enrollment-resources/appeals/

Eligibility for the Self-Reliance programs is based on an individual or family's income and resources

Applications may be requested in person or by telephone, but must be submitted in writing. Call the 2-1-1 Idaho CareLine to have an application packet mailed (dial 2-1-1 or 1-800-926-2588). Self-Reliance programs include:

**Cash Assistance (TAFI, Temporary Assistance for Families in Idaho) provides cash assistance to low income families with children. Adults have a 24-month lifetime limit. Adult participants must seek employment, training, or educational opportunities as a condition of eligibility. Pregnant women with no other children will be eligible for TAFI only if there is a medical condition that prevents work and they are in the last trimester of pregnancy. Unmarried minors with children will be required to live at home with the minor's parents unless good cause exists.

** Food Stamps provide food benefits necessary for good health and nutrition to low-income households and to stabilize seasonal and low-income labor markets.

**Child Care. The Idaho Child Care Program (ICCP) subsidizes child care costs of low-income families who are working, looking for work, attending training or educational programs, or need preventive services. Qualifying families will then be directed to the ICCP referral program, to be linked with a licensed childcare provider. Dial 2-1-1 or 1-800-926-2588. Benefits are based on a sliding-fee scale.

**Idaho Medicaid Benefit Plans. Medicaid now does more to improve your health, find new health problems early, and manage current health problems. If you are eligible for Medicaid, you will get benefits based on your health needs. The following are the plans available and benefits that you will receive with each one of them.
- Medicaid Basic Plan. - it is for healthy low-income children and adults with eligible dependent children. This plan provides complete health, prevention, and wellness benefits for children and adults who don't have special health needs. Most Medicaid participants will be enrolled in this benefit plan.
- Medicaid Enhanced Plan. - It is for individuals with disabilities or special health needs. This plan includes all the benefits in the Basic Plan, plus additional benefits.

Existing programs will continue to remain in place after July, 2006:
1. The Pregnant Women and Children (PWC) plan provides medical assistance for qualifying women with medically verified pregnancy.
2. ''CHIP'' as a benefit plan (both CHIP A and CHIP B) is no longer a current name. Children who are eligible for the new plans because they fall within the income brackets for the State Children's Health Insurance Program (Title XXI), will be enrolled in Idaho Medicaid and one of the two above mentioned benefit plans.
3. Qualified Medicare Beneficiary Plan (QMB) limited to Medicare paid services only.

**The Children's Access Card is a premium assistance program administered in partnership with Idaho insurance carriers. An eligible child qualifies for up to $100 per month in premium assistance or up to $300 per month for families with three or more children.

**Aid to the Aged, Blind, and Disabled (AABD) provides cash assistance and medical coverage to Idahoans with low-income who are 65 years of age or older, or are blind or disabled (disability must be verified by the Social Security Administration).

**Telephone Assistance. A program for the elderly, low income, or disabled (based on income) which helps pay telephone installation costs and monthly telephone service. To apply, you must complete an application at your local Health and Welfare office or Community Action Agency.

**Emergency Assistance (EA)--Provides help for individuals (with a child in the home) in need of work related services which could include tools, expenses related to transportation, clothing, etc.

**Quest Card/EBT (Electronic Benefits Transfer)--Food Stamps and Welfare Cash Payments run through the Quest card.

The Self-Reliance Program is administered by the Division of Welfare.

**Long Term Care Unit - Statewide consolidated unit.

Anyone looking for health insurance under the Affordable Care Act (ACA). Specifically for those who currently don't have health coverage or looking to change plans.

A new way to find health coverage that fits the individual's budget and needs. With one application, the individual can see all options and enroll. Open enrollment runs from November to December; please see the website for specific dates.COVID-19 UPDATE: Check with health insurance company for specific benefits and coverage for COVID-19. Login to update marketplace application if COVID-19 impacts income or household. May be able to change plan if certain situations apply.

• General Health Insurance Information/Counseling