Idaho Administrative Code
Title IDAPA 16 - Health and Welfare, Department of
Rule 16.03.18 - MEDICAID COST-SHARING
Section 16.03.18.300 - PARTICIPANTS EXEMPT FROM COPAYMENT
Universal Citation: ID Admin Code 16.03.18.300
Current through August 31, 2023
01. Exempt Participants. Certain participants are exempt from copayments for services described in Section 320.03 through 320.10 of these rules. Exempt participants include: (3-15-22)
a. A child
under the age of nineteen (19) with family income less than or equal to one
hundred and thirty-three percent (133%) of the current federal poverty
guidelines (FPG); (3-15-22)
b. An
individual age of nineteen (19) or older with family income less than or equal
to one hundred percent (100%) of the current federal poverty guidelines (FPG);
(3-15-22)
c. A pregnant or
post-partum woman when the services provided are related to the pregnancy;
(3-15-22)
d. An inpatient in a
hospital, nursing facility, intermediate care facility for persons with
intellectual disabilities (ICF/IID), or other medical institution, who is
required to pay all but a nominal amount of their income to the institution for
their care; (3-15-22)
e. An adult
participant who receives services provided under a waiver of Section
1915c of the Social Security Act
(SSA); (3-15-22)
f. A participant
who has other health care coverage that is the primary payor for the services
provided; (3-15-22)
g. A
participant receiving hospice care; (3-15-22)
h. A child in foster care receiving aid or
assistance under the Social Security Act (SSA), Title IV, Part B;
(3-15-22)
i. A participant
receiving adoption or foster care assistance under the Social Security Act
(SSA), Title IV, Part E, regardless of age; and (3-15-22)
j. A woman eligible under the breast and
cervical cancer eligibility group. (3-15-22)
02. Notification of Copayment. The Department will provide notification to each participant who is not exempt from the copayment requirements in Subsections 320.03 through 320.10 of these rules. (3-15-22)
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