Promoting and protecting the health and safety of all Idahoans

Medicaid Expansion

Idaho's Coverage Choice Waiver

The following is a brief description of the Idaho Coverage Choice 1115 Waiver application that the Idaho Department of Health and Welfare (IDHW) intends to submit for approval to the Centers for Medicare and Medicaid Services (CMS). To read a detailed synopsis, click on the Idaho Coverage Choice Waiver Application.

Background

In November 2018, voters passed a proposition to expand Medicaid eligibility to individuals with incomes up to 138% FPL. In response, the Idaho legislature passed SB1204, instructing the IDHW to seek waivers from the federal government to allow for certain individuals eligible for Medicaid expansion to receive a tax credit to purchase a qualified health plan (QHP) through the Idaho health insurance exchange (Your Health Idaho) instead of enrolling in Medicaid. Under current federal law, individuals who are eligible for Medicaid cannot qualify for the tax credit.

Overview

The Idaho Department of Health and Welfare will apply to the Centers for Medicare and Medicaid Services (CMS) for a Section 1115 demonstration waiver on or after August 12, 2019. The Idaho Coverage Choice Waiver shares the same goal as the Section 1332 waiver sought by the Department of Insurance (DOI).  The purpose of both waivers is to provide Idahoans with incomes between 100% and 138% of the federal poverty level the option to choose the healthcare coverage that is right for them – whether that is a plan available through Your Health Idaho or coverage through the Medicaid program. The proposed effective date for the Idaho Coverage Choice Waiver is January 1, 2020.

What this means

Current federal regulations under the Affordable Care Act state that individuals who are eligible for Medicaid are not eligible for a premium tax credit. To allow individuals  between 100% and 138% of the federal poverty level to remain eligible for the tax credit and stay enrolled in their qualified health plan, Idaho needs approval from the federal government. Without this waiver, individuals between 100%-138% of the federal poverty level will be required to enroll in Medicaid and lose their private insurance coverage.

Public input

The Idaho Department of Health and Welfare is requesting public comment through public hearings, email, or traditional mail regarding a draft Section 1115 Waiver application. Public comments will be accepted until August 9th. IDHW will carefully review and consider all public comments received related to the coverage choice policy, whether formally submitted through the Section 1332 waiver application process or this Section 1115 waiver application prior to submitting the full application for review and approval.

Timelines

Idaho must have approval of a Coverage Choice waiver by Dec. 31, 2019. Without waiver approval prior to January 1, 2020, this group will move to Medicaid coverage and will not be able to continue in their current qualified health plan coverage.