During the COVID-19 pandemic, Medicaid Protection allowed individuals to remain enrolled in Medicaid coverage who otherwise would have been ineligible, but this protection has recently ended. The Idaho Department of Health and Welfare (IDHW) is reevaluating Medicaid eligibility. Beginning April 2023, individuals who no longer meet Medicaid eligibility rules will be removed from Medicaid. Here are some common questions and answers about this change.
As IDHW reviews Medicaid eligibility, individuals will receive one of the following notices:
If IDHW determines you are no longer eligible for Medicaid, you may still be eligible for an advance premium tax credit (APTC). An APTC is a subsidy that can be used toward a premium for an Affordable Care Act (ACA) plan. ACA plans are available through Idaho’s online health insurance marketplace, Your Health Idaho. You can also find out if you are eligible for a tax credit through Your Health Idaho. Tax credits can only be used toward premiums for plans that are purchased through Your Health Idaho.
IDHW ended the Medicaid Protection on April 1. All Idaho Medicaid eligibility rules that were in place before the pandemic will be reinstated. IDHW began the reevaluation process for Medicaid eligibility on February 1 for renewals or terminations beginning on April 1. IDHW will reevaluate Medicaid eligibility in phases through fall 2023.
Individuals will have 60 days to complete a reevaluation. For example, if an individual is notified on February 1 to provide a reevaluation, they need to submit their reevaluation to IDHW by April 1.
If IDHW determines you are not eligible for Medicaid, you will have 60 days from the date your Medicaid coverage ends to enroll in a health insurance plan offered through Your Health Idaho through a Special Enrollment Period. To avoid a gap in coverage, you can enroll in a health plan before your Medicaid coverage ends.
You can find a new plan in a few ways:
Blue Cross of Idaho ACA plans are available on Your Health Idaho, and are eligible for premium tax credits. You will need to apply for a Blue Cross of Idaho ACA plan through Your Health Idaho to use a tax credit toward your plan’s premium.
If you qualify for a tax credit towards your premium, you may also qualify for extra savings (also called cost-sharing reductions). Cost-sharing reductions lower your out-of-pocket maximum, which can lower the amount you pay for healthcare services each year. You must enroll in a Silver plan to take advantage of these cost-sharing reductions.
Blue Cross of Idaho’s ACA plans through Your Health Idaho offer a variety of coverage levels to meet your personal and financial needs. There are three categories of ACA plans:
Visit IDHW’s website for more information on these changes.
Blue Cross of Idaho is providing this information for general informational purposes only. Do not act or refrain from acting based on this information without first seeking advice from the advisor of your choice to ensure this information and your interpretation of it is applicable or appropriate to your circumstances.
Blue Cross of Idaho is a tradename for Blue Cross of Idaho Health Service, Inc. All descriptions of coverage are subject to the provisions of our Member Contract/Enrollee Certificate. Please refer to your Member Contract/Enrollee Certificate for a complete description of benefits, exclusions and conditions of coverage. These plans are only offered/available to Idaho residents.
Posted: May 17, 2023