Program Description
The Medicare Medicaid Coordinated Plan (MMCP), as the name suggests, coordinates both Medicare and Medicaid services for dual eligible Idaho residents. A “dual eligible” individual is a recipient of both Medicare (Parts A, B, & D) and Medicaid coverage. While this program is available to adults 21 years of age and older, this program is most relevant to seniors.
MMCP is intended to coordinate one’s Medicaid and Medicare benefits into one system, streamlining the process of receiving services, as well as managing the costs of services. A number of benefits, such as medical, behavioral health, dental, and prescription drugs, are available via MMCP, as well as long-term care services, such as adult day care, chore / homemaker services, respite care, etc., via Idaho’s Home and Community Based Services Aged and Disabled Waiver.
Unfortunately, MMCP is not currently available statewide. The counties in which it is available are listed under the Eligibility Guidelines section below. Depending on the county in which one resides, one’s health plan benefits are available through one of the private health care institutions contracted with the state.
Eligibility Guidelines
In order to be eligible for MMCP, the following requirements must be met:
General Requirements
- Be a resident of Idaho
- Be 21 years of age or older (note that unless one is disabled, the Medicare age requirement is 65)
- Receive Medicare Parts A, B, & D
- Receive Medicaid coverage
- Must live in one of the following counties: Ada, Adams, Bannock, Benewah, Bingham, Blaine, Boise, Clark, Bonner, Cassia, Clearwater, Bonneville, Boundary, Canyon, Elmore, Fremont, Gem, Gooding, Jefferson, Jerome, Kootenai, Latah, Lincoln, Madison, Minidoka, Nez Perce, Owyhee, Payette, Power, Shoshone, Twin Falls, Valley, and Washington.
Financial Requirements
Medicaid eligibility is complicated, but generally speaking, senior Idaho residents must meet income and asset qualifications.
Income Limits
As of 2023, those who are 65 years of age and older, blind or disabled have an income limit of $967 a month. Couples are allowed $1,391 a month For those who require long-term care services via the Aged and Disabled Waiver, the income limit is higher at $2,762 a month, as of 2023. The couple limit is $5,504.
Asset Limits
Assets are limited to $2,000 for individuals and $3,000 for couples, but several assets are exempt, meaning they do not count toward Medicaid’s asset limit. Examples include one’s home, given the applicant lives in the home (or a non-applicant spouse lives in the home) and his / her equity interest is not over $750,000, household items, personal effects, and an automobile.
Benefits and Services
Through the Medicare Medicaid Coordinated Plan, care coordination is provided, in addition to all services available under Medicare Part A, Part B, and Part D, as well as a variety of Medicaid services. Below is a list of services one might receive via MMCP.
- Hospital / Medical Care
- Personal Care Services
- Aged & Disabled Medicaid Waiver Services (long-term home and community based services / supports)
- Behavioral Health Services
- Nursing Home Care
- Community Based Rehabilitation Services
- Dental Care
- Prescription Drugs
- Medical Transportation
In addition to these services, supplemental services are also available based on one’s health plan. These services might include vision exams, nurse advice lines, non-medical transportation, nutrition counseling, over-the-counter medications, gym membership, transitional meal services, and podiatry care.
How to Apply / Learn More
Applicants not currently on Medicaid must first apply for Medicaid. One can do so through several options:
For additional information on the Idaho Medicare Medicaid Coordinated Plan, click here.
