Medicaid for nursing home and home care in Idaho

Who qualifies

You need to pass three tests:

• Care need: DHW must find that you need the level of care given in a nursing home. This is called a Level of Care Determination. DHW sets it up after it decides you meet the money rules.
• Income: your monthly income is at or below the limit in the table.
• Assets: your countable assets are at or below the limit.

You must also live in Idaho and be a U.S. citizen or an eligible non-citizen.

These limits are higher than the income limit for regular AABD Medicaid ($1,047 a month for one person). So you may qualify for long-term care even if your income is too high for regular Medicaid.

What counts and what does not

Income that counts includes Social Security, SSI, pensions, interest, wages and payments from trusts or annuities.

How income is split between spouses. DHW must decide how much income belongs to each spouse.

• In most cases DHW uses the "name on the check" method. Income paid in your name is yours. Income paid in both names is split in half.
• The other way is the community property method. The couple's total income is added up and half is counted for each spouse. With this method only one spouse can get Medicaid.

Assets that do not count:

• Your home, as long as one spouse still lives there or you plan to return home
• Burial plots
• Up to $1,500 set aside for the burial of each spouse
• Cash value of life insurance, if the face value of all policies is not more than $1,500 for each spouse

Home equity. Under federal rules for 2026, a state's home equity limit for long-term care can be no lower than $752,000. Ask DHW for Idaho's exact figure.

Gifts and transfers. Giving away money, property or income can delay or stop your Medicaid. DHW says to contact it before you make any transfer.

If your spouse stays at home

Federal rules protect the spouse who stays at home. For 2026:

• Assets: states must let the spouse at home keep at least $32,532 and may allow up to $162,660.
• Income: after you are approved, the spouse at home may be able to keep some of your income. The goal is to bring their income to at least $2,705 a month, and up to $4,066.50 in some cases.

DHW figures these amounts for each couple. Ask DHW how it figures yours.

What Medicaid pays for

Nursing home care

Medicaid pays the nursing home for care around the clock. Depending on your income, you may have a share of cost. This is the part of your income you pay toward your care each month. DHW sends you a notice with the amount. Part of your income is kept for your personal needs. Ask DHW for the current amount.

Care at home and in the community

Idaho's Aged and Disabled waiver pays for home and community based services for people who would otherwise need a nursing home. Services are approved based on your needs and may include:

• Case management and service coordination
• Homemaker help, personal care and a home health aide
• Adult day health
• Respite care for family caregivers
• Home-delivered meals, skilled nursing and personal emergency response systems

Care can also be given in an assisted living home (DHW calls these residential assisted living facilities) or a certified family home, where you live with a caregiver in a family setting.

Moving out of a nursing home

Idaho Home Choice helps people move from a nursing home back to a home or apartment. You must have lived in the nursing home for at least 45 days in a row, be eligible for Medicaid when you leave, and qualify for the Aged and Disabled waiver. Call (208) 455-7118 or email [email protected].

How to apply

1. Apply for Medicaid. Choose one way:
   • Online at idalink.idaho.gov
   • By phone at 877-456-1233, or in person at a DHW field office (an interview is done by phone or in person)
   • On a paper application, sent by email to [email protected], by fax to 1-866-434-8278, or by mail to Self Reliance Programs, PO Box 83720, Boise, ID 83720-0026
2. Have these ready: proof of identity (such as a driver's license), your household's income, your household's resources, your monthly expenses, and immigration papers if they apply to you.
3. Watch your mail. One notice tells you if you qualify for Medicaid. DHW may ask for more papers.
4. Do the Level of Care Determination. A DHW worker contacts you to schedule it after your eligibility is decided.
5. Read your share-of-cost notice if you are approved.

DHW's pages do not say how long a decision takes.

After you apply

• Renewal: Medicaid is reviewed every year. DHW mails you a notice with instructions.
• Appeals: If you disagree with a decision about your Medicaid eligibility, you have 30 days from the date on the notice to ask for a fair hearing. For decisions about your level of care or services, you have 28 days. Send the Fair Hearing Request form or a letter to Self-Reliance Programs, P.O. Box 83720, Boise, ID 83720-0026, by email to [email protected] or by fax to 866-434-8278. You can also call 877-456-1233.
• Keeping benefits during an appeal: In some cases your benefits can continue while you wait. You must ask within 10 days of the date on the notice. If you lose, you must repay those benefits.

Things people miss

• Being over the regular Medicaid limit does not rule you out. The long-term care income limit is much higher.
• Talk to DHW before moving money. A gift made to "get under the limit" can delay coverage.
• Estate recovery. After death, Idaho may seek repayment from the estate of a member who was 55 or older, or who lived in a nursing home long term at any age. It does not collect while a spouse is alive, or from a child under 21 or a blind or disabled child. Call the Estate Recovery Office at 866-849-3843.

Free help

• Idaho Commission on Aging: 1-877-471-2777 or (208) 334-3833. It can connect you with your Area Agency on Aging.
• SHIBA (Senior Health Insurance Benefits Advisors): free Medicare counseling, 1-800-247-4422.
• DHW Self-Reliance: 877-456-1233 for questions about your application.

For other programs, see all benefits in Idaho. For a family guide to costs, see paying for a nursing home. If you also have Medicare, see Medicare.

Phone numbers: Free help lines for Idaho agencies

Check what you may qualify for