Table of Contents
WELCOME TO THE IDAHO MEDICAID HEALTH PLAN ......................................... 1
WELCOME ..................................................................................................................................... 1
DISCLAIMERS ................................................................................................................................ 1
PRIVACY NOTES ............................................................................................................................ 2
INFORMATION TO REMEMBER ....................................................................................................... 2
WHAT ARE MY RESPONSIBILITIES? .................................................................... 3
HOW DO I APPLY FOR MEDICAID? ...................................................................... 3
GETTING AN APPLICATION ............................................................................................................ 3
COMPLETING YOUR APPLICATION ................................................................................................. 4
TURNING IN YOUR APPLICATION ................................................................................................... 4
HOW TO GET IDAHO MEDICAID FOR WORKERS WITH DISABILITIES ............................................... 5
HOW DO I ACCESS WOMEN'S HEALTH CHECK FOR BREAST AND CERVICAL CANCER SCREENING? .. 5
WHAT DO I NEED TO KNOW ABOUT MY IDAHO MEDICAID IDENTIFICATION
CARD? ................................................................................................................... 6
WHAT DO I NEED TO KNOW ABOUT IDAHO MEDICAID BENEFIT PLANS? ......... 7
MEDICAID VS. MEDICARE ............................................................................................................. 8
IDAHO MEDICAID HEALTH PLAN - THE BASIC PLAN ...................................................................... 9
IDAHO MEDICAID HEALTH PLAN - THE ENHANCED PLAN............................................................. 17
IDAHO MEDICAID HEALTH PLAN - THE MEDICARE-MEDICAID COORDINATED PLAN .................... 19
HEALTHY CONNECTIONS PRIMARY CARE PROGRAM .................................................................... 20
REFERRALS................................................................................................................................. 22
EMERGENCY CARE ...................................................................................................................... 25
CRISIS SERVICES ......................................................................................................................... 25
POISON CONTROL ....................................................................................................................... 26
URGENT CARE ............................................................................................................................ 26
EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT (EPSDT) .............................. 26
PRIOR AUTHORIZATION .............................................................................................................. 27
WHAT DO I NEED TO KNOW ABOUT PAYING FOR SERVICES? ......................... 28
COPAYMENTS .............................................................................................................................. 28
NO SHOW OR MISSED APPOINTMENTS ........................................................................................ 29
PREMIUMS.................................................................................................................................. 29
NON-COVERED SERVICES ........................................................................................................... 29
WHAT OTHER INFORMATION DO I NEED TO KNOW? ...................................... 30
OTHER MEDICAL INSURANCE ..................................................................................................... 30
HEALTH INSURANCE PREMIUM PAYMENT PROGRAM ................................................................... 30
YOUR RIGHTS .............................................................................................................................. 31
FRAUD, ABUSE, AND MISUSE ...................................................................................................... 34
ESTATE RECOVERY ..................................................................................................................... 34
WHO CAN I CALL IF I HAVE QUESTIONS OR NEED INFORMATION? ................ 36
LOCAL HEALTHY CONNECTIONS OFFICES .................................................................................... 38
REGIONAL PROGRAM OFFICES .................................................................................................... 40