Idaho expanded Medicaid in 2020, and in 2026 the program covers low-income adults, children, pregnant individuals, seniors, and people with disabilities. Understanding where the income cutoffs fall for each category is the first step to knowing whether you qualify. This guide covers the 2026 income limits for every major Idaho Medicaid program, what documents you need, and how to apply.
Who Runs Idaho Medicaid
The Idaho Department of Health and Welfare (IDHW) administers Medicaid in Idaho under the name "Healthy Connections." In 2026, Idaho transitioned from a primary care case management model to a managed care delivery system, which took effect January 1, 2026. Existing members kept their coverage through this transition.
The program is jointly funded by Idaho and the federal government. Eligibility rules and income limits follow federal guidelines but Idaho has flexibility on some optional coverage groups.
2026 Income Limits by Program
Income limits update each January based on the new Federal Poverty Level (FPL) guidelines. The figures below reflect 2026 FPL calculations from the Idaho Department of Health and Welfare.
Adult Medicaid (Expansion)
Idaho expanded Medicaid under the Affordable Care Act. Adults aged 19 to 64 who are not receiving Medicare are covered up to 138% FPL. There is no asset test and no premium for this group.
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|
| 1 | $1,836 | $22,032 |
| 2 | $2,489 | $29,868 |
| 3 | $3,142 | $37,704 |
| 4 | $3,795 | $45,540 |
| 5 | $4,449 | $53,388 |
| Each additional person | +$654 | +$7,848 |
Children's Medicaid
Children under age 19 qualify under either Medicaid or CHIP depending on family income. Children ages 0 to 5 qualify at higher income levels than older children.
| Age Group | FPL Threshold | Household of 2 (Monthly) | Household of 4 (Monthly) |
|---|
| Ages 0 to 5 | Up to 142% FPL | approximately $2,538 | approximately $3,876 |
| Ages 6 to 18 | Up to 138% FPL | $2,489 | $3,795 |
Children with family incomes above the Medicaid threshold but below 200% FPL may qualify for Idaho's CHIP (Children's Health Insurance Program), which has a separate rate table.
CHIP (Children's Health Insurance Program)
| Household Size | Monthly Income Limit |
|---|
| 2 | $3,427 |
| 3 | $4,328 |
| 4 | $5,225 |
| 5 | $6,126 |
| Each additional person | +$900 |
Pregnancy Coverage
Pregnant individuals qualify for Medicaid to cover prenatal care, delivery, and postpartum care. The unborn child counts as a household member for income calculations. Coverage extends 12 months postpartum.
| Household Size | Monthly Income Limit |
|---|
| 2 (pregnant individual + unborn) | $2,489 |
| 3 | $3,142 |
| 4 | $3,795 |
| Each additional person | +$654 |
Aged, Blind, and Disabled (AABD) Medicaid
Seniors and people with disabilities who meet SSI-related criteria fall under AABD Medicaid. This program has both income and asset limits.
| Household Status | Monthly Income Limit | Asset Limit |
|---|
| Individual | $1,047 | $2,000 |
| Married Couple | $1,511 | $3,000 |
Certain income types may be excluded or disregarded when calculating eligibility under AABD rules.
Long-Term Care Medicaid (Nursing Home)
Idaho residents who need nursing home or long-term care services are subject to different income and asset rules. This program serves individuals who require a nursing level of care.
| Applicant Type | Monthly Income Limit | Asset Limit (Individual) |
|---|
| Individual (nursing home) | $3,002 | $2,000 |
| Couple (one applying) | $3,002 (applicant) | $2,000 to $148,620 (community spouse) |
The community spouse resource allowance protects a portion of assets for the spouse living at home.
Home and Community-Based Services (HCBS)
HCBS waiver programs allow eligible individuals to receive long-term care services at home rather than in a nursing facility.
| Status | Monthly Income Limit | Asset Limit |
|---|
| Individual | $3,002 | $2,000 |
| Couple | $5,984 | $2,000 per person |
Medicaid for Workers with Disabilities (MWD)
This program allows working adults with disabilities to earn more income while retaining Medicaid coverage. It uses a premium sliding scale.
| Income as % of FPL | Monthly Income Range | Monthly Premium |
|---|
| 0% to 133% FPL | $0 to $1,789 | $0 |
| 133% to 250% FPL | $1,789 to $3,345 | $10 |
| 250% to 500% FPL | $3,345 to $6,670 | $10 to $200 |
Medicare Savings Programs
These programs help Medicare beneficiaries pay for Medicare premiums and cost-sharing. They have separate income limits.
| Program | FPL Range | Monthly Income Limit (Individual) |
|---|
| Qualified Medicare Beneficiary (QMB) | Up to 100% FPL | $1,350 |
| Specified Low-Income Medicare Beneficiary (SLMB) | 100% to 120% FPL | $1,616 |
| Qualifying Individual (QI) | 120% to 135% FPL | $1,816 |
Katie Beckett Program
This program covers children with significant disabilities who live at home. Eligibility is based on the child's own income and assets, not the family's. The child's income must be under $3,002 per month and resources under $2,000.
Youth Empowerment Services (YES)
The YES waiver serves youth with serious emotional disturbances. Income limits are based on family size.
| Household Size | Monthly Income Limit |
|---|
| 4 | $8,250 |
| Each additional person | +$1,420 |
What Does NOT Count as Income
Idaho uses Modified Adjusted Gross Income (MAGI) methodology for most Medicaid programs. Under MAGI rules, the following are generally excluded from income calculations:
- Child support received
- Gifts and inheritances
- Veterans benefits
- Workers compensation
- Some student financial aid
AABD and long-term care programs use non-MAGI rules and have different income disregards.
Residency and Other Requirements
Beyond income, Idaho Medicaid requires that applicants:
- Are Idaho residents (no minimum length of residency required)
- Are U.S. citizens or qualified immigrants
- Provide a Social Security number or apply for one
- Meet program-specific criteria (age, disability status, pregnancy, etc.)
Undocumented immigrants are generally not eligible for full Medicaid but may qualify for emergency Medicaid services.
How to Apply for Idaho Medicaid in 2026
Option 1: Apply Online (Fastest)
The Idaho Department of Health and Welfare recommends applying online through idalink. Most applicants finish in about 20 minutes.
- Go to idalink.idaho.gov
- Create a free account or log in if you have one
- Start a new application and select Medicaid
- Enter your household information, income details, and residency information
- Upload any required documents (most people can upload directly through the portal)
- Submit your application and note your confirmation number
Option 2: Apply by Phone
Call the Idaho Department of Health and Welfare at 1-877-456-1233. Representatives can help you complete an application over the phone, Monday through Friday during business hours.
Option 3: Apply In Person
Visit a local Health and Welfare office. To find the nearest office:
- Go to healthandwelfare.idaho.gov
- Navigate to "Contact Us" or "Find an Office"
- Enter your zip code to locate the closest location
In-person applications can be helpful if you have complex household situations or need help gathering documentation.
Option 4: Apply by Mail or Fax
Download the paper application from healthandwelfare.idaho.gov, complete it, and either:
- Fax to 1-866-434-8278
- Mail to your local Health and Welfare office
Documents to Have Ready
When applying, gather these documents:
- Proof of identity (driver's license, state ID, or passport)
- Social Security card or number for each household member
- Proof of Idaho residency (utility bill, lease, or mail with your address)
- Proof of income (pay stubs, tax returns, or self-employment records)
- Proof of citizenship or immigration status
- For disability programs: medical records and disability documentation
Processing Time
Standard Medicaid applications are processed within 45 days. Applications that require a disability determination may take up to 90 days. For pregnant individuals and children, decisions often come faster.
After You Apply
If approved, you will receive a Medicaid ID card and information about your managed care plan. Starting January 2026, Idaho members are enrolled in managed care organizations rather than the former Healthy Connections model.
If denied, you have the right to appeal within 30 days of the denial notice. The denial letter will explain the reason and the steps to request a fair hearing.
Not Sure If You Qualify?
Use our free eligibility screener to check whether you may qualify for Idaho Medicaid and other assistance programs in minutes. It covers income, household size, and state-specific rules without requiring you to create an account.
Check your eligibility now at /screener
You can also find more information about Idaho-specific programs on our Idaho benefits page.
Frequently Asked Questions
What is the income limit for Idaho Medicaid in 2026?
For adults aged 19 to 64, the income limit for Idaho Medicaid is 138% of the Federal Poverty Level. For a single adult that is $1,836 per month, and for a household of four it is $3,795 per month. Children, pregnant individuals, seniors, and people with disabilities have different limits depending on the specific program.
Does Idaho have Medicaid expansion?
Yes. Idaho expanded Medicaid in January 2020. Adults between ages 19 and 64 with incomes up to 138% FPL now qualify regardless of whether they have children or a disability.
Is there an asset test for Idaho Medicaid?
Most Idaho Medicaid programs, including adult expansion and children's coverage, have no asset test. They use MAGI methodology, which only looks at income. The Aged, Blind, and Disabled program and long-term care programs do have asset limits ($2,000 for individuals, $3,000 for couples).
How long does it take to get approved for Idaho Medicaid?
Most applications are processed within 45 days. Applications involving disability determinations can take up to 90 days. If you apply for a pregnant individual or child, decisions may come sooner.
Can I apply for Idaho Medicaid if I am self-employed?
Yes. Self-employed individuals can apply. You will need to document your income with profit and loss statements or recent tax returns. Net self-employment income after allowable deductions counts toward the income limit.
What changed about Idaho Medicaid in 2026?
The biggest change in 2026 is the transition from Healthy Connections, Idaho's former primary care case management system, to a managed care delivery model. This shift took effect January 1, 2026. Income limits and eligibility rules remain similar to prior years, with annual FPL adjustments applied in January.
Does Idaho Medicaid cover dental and vision?
Idaho Medicaid covers some dental and vision services, though the scope varies by program and member age. Children generally have more comprehensive dental coverage through CHIP and EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) services. Adults have limited dental coverage, typically for emergency dental care.
What if I was recently denied Idaho Medicaid?
You can request a fair hearing to appeal the decision. You must submit the appeal request within 30 days of receiving your denial notice. The denial letter will include instructions on how to request a hearing. You can also contact the Idaho Department of Health and Welfare at 1-877-456-1233 to ask about the reason for denial and whether any information is missing from your application.
Can immigrants qualify for Idaho Medicaid?
Lawfully present immigrants, including permanent residents, refugees, and certain visa holders, may qualify for Idaho Medicaid depending on their specific status and how long they have been in the U.S. Undocumented immigrants generally do not qualify for full coverage but may receive emergency Medicaid services for life-threatening conditions.
How do I report a change in income or household size?
Log in to idalink.idaho.gov and report the change through your account, or call 1-877-456-1233. Income and household changes can affect your eligibility and should be reported promptly. Idaho performs annual eligibility renewals and may also request information between renewals if circumstances change.
