About Medicaid for Adults

Medicaid is a government program that provides health insurance coverage to eligible low-income adults, including those with disabilities, in Idaho. The Idaho Department of Health and Welfare administers the Medicaid program, which offers a range of benefits, including:

• Doctor visits
• Hospital stays
• Prescription medications
• Mental health and substance abuse treatment
• Dental and vision care

To be eligible for Medicaid as an adult in Idaho, you must meet certain income and eligibility requirements, which include:

• Being a U.S. citizen or qualified alien
• Being a resident of Idaho
• Having a Social Security number
• Meeting income guidelines, which vary based on family size and other factors
• Not being eligible for other health insurance, such as through an employer or the Health Insurance Marketplace

Idaho Medicaid also offers additional programs and services for adults, including:

• Medicaid Expansion: provides coverage to adults with incomes up to 138% of the federal poverty level
• Medicaid for People with Disabilities: provides coverage to adults with disabilities, including those with intellectual disabilities, physical disabilities, and mental health conditions
• Medicaid for Pregnant Women: provides coverage to pregnant women with incomes up to 138% of the federal poverty level

You can apply for Medicaid online, by phone, or in person at your local Idaho Department of Health and Welfare office. If you are found eligible, you will be able to choose from a range of Medicaid health plans and providers to get the care you need.

The Idaho Medicaid program has contracted with Medical Transportation Management, Inc. (MTM) to provide non-emergency medical transportation (NEMT) services to Medicaid eligible members who have no other means of transportation. This program covers transportation to and from healthcare services covered under the Medicaid program, both in-state and out-of-state.

To request transportation, members can call MTM at 877-503-1261, visit their website, or use their Transport Service Management Portal. Requests must be made at least two business days before the appointment. MTM will review the request and determine if Medicaid will cover the transportation, based on the least expensive option and the closest available Medicaid provider.

Members can also participate in a mileage reimbursement program if they have a vehicle to transport themselves or family members to appointments. If a member is referred for medical care outside their community, MTM may require a referral from their doctor before scheduling transportation.

MTM provides language assistance at no cost to members who need it, and can be reached through an interpreter at 888-561-8747. Members also have the right to file an appeal or grievance if they have questions or concerns about the transportation services. This can be done by calling 866-436-0457 or completing the MTM “contact us” online form.

The Idaho Medicaid NEMT Team, which oversees the contract with MTM, can be contacted for questions or feedback through an online form, email, or phone at 800-296-0509. The team is responsible for ensuring that Medicaid members have access to reliable and affordable transportation to their medical appointments.

Overall, the Idaho Medicaid NEMT program is designed to provide transportation assistance to Medicaid eligible members who need it, and to ensure that they have access to necessary medical care. By contracting with MTM, the program aims to provide efficient and cost-effective transportation services to members across the state.