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Get Idaho Medicaid Application Form

PO Box 70082 Boise, ID 83707 Fax: 1 (877) 517-2041 Electronic Funds Transfer Agreement Form instructions are on the pages immediately following. An * indicates required fields. Current Provider Record Information* 1. Provider ID Number NPI Idaho Medicaid ID# 2. Provider s Name For individual providers, enter your name in the form of Last Name, First Name. For Group enrollment or Facility/Agency/Organization enrollment, provide the name of the organization. Last Name: First Name: Organi.

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As of January 2023, around 145,000 Idaho residents are enrolled in Medicaid Expansion. These are individuals who have a monthly income of $1,563 or less, or a family of four with a monthly income of $3,192 or less.

To be eligible for Idaho Medicaid, you must be a resident of the state of Idaho, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

After submission, application processing may take up to 45 days. We will let you know if additional documentation is needed. Other Medicaid programs (EPSDT, Katie Beckett, YES, and Children's Developmental Disabilities) require additional forms to be completed.

Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your coverage when you're temporarily visiting another state, unless you need emergency health care.

Medicaid offers different programs to provide healthcare coverage for adults in Idaho: Adults with income under 138 percent of the federal poverty level (FPL) Pregnant women with income under 138 percent of FPL.

Contact Details Organization Type:State Medical Assistance OfficeAddress:3232 Elder Street Boise ID 837054711Information:Toll Free: (877) 456-1233 Local: (208) 334-6700 Fax: (208) 334-6912 Web Site: https://healthandwelfare.idaho.gov/medical/medicaid/tabid/123/default.aspx Hours: 8:00am-5:00pm MT3 more rows

Medicaid Program Income Limits HOUSEHOLD SIZEINCOME1$1,6772$2,2683$2,8594$3,4505 more rows

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232