The following is a brief description of the Coverage Choice Waiver that the Idaho Department of Insurance intends to submit for
approval. To read a detailed synopsis, click on the
Idaho Coverage Choice Waiver Application.
Overview: The Idaho Department of Insurance will be applying to the Centers for Medicare and Medicaid Services (CMS) and
to the United States Department of the Treasury for a Section 1332 State Relief and Empowerment Waiver on or about July 15, 2019.
The purpose of the waiver, the Coverage Choice Waiver, is to allow individuals with
incomes from 100% to 138% of the Federal Poverty Level (FPL) the choice to receive help paying health insurance premiums while
enrolled in private health insurance coverage, while also allowing the choice to be enrolled in Medicaid. The proposed effective
date for the waiver is January 1, 2020.
Background: In November 2018, voters passed a proposition to expand Medicaid eligibility to individuals with incomes up
to 138% FPL. The Idaho legislature then passed SB1204aa, instructing the Department of Health and Welfare and the Department of
Insurance to seek a waiver from the federal government to give certain individuals eligible for Medicaid expansion the choice to
continue to receive a tax credit to purchase a qualified health plan through the Idaho health insurance exchange instead of
enrolling in Medicaid. Under current federal law, individuals who are eligible for Medicaid do not qualify for the tax credit.
What this means: Current federal regulations under the Affordable Care Act state that individuals who are eligible for
other minimum essential coverage (including Medicaid) are not eligible for a premium tax credit. Therefore, Medicaid eligibility
under current law always supersedes eligibility for a tax credit. To implement SB1204, Idaho needs approval of a 1332 waiver to
waive federal regulations under 36B of the IRS code so that households between 100 – 138% of FPL remain eligible for the premium
tax credit to enroll in a QHP. However, under the waiver, households with income of 100% of FPL or above may still choose
to enroll in Medicaid instead of receiving the advance premium tax credit to purchase a QHP.
Timelines: Idaho DHW begins renewals for all individuals enrolled in a QHP with a tax credit in October, in advance of
the annual November 1st Open Enrollment. Idaho DOI is hoping to have an answer on the waiver application by September 1, 2019 in
order to allow the roughly 20,000 individuals between 100%-138% of FPL to continue their current coverage. Without waiver approval
prior to January 1, 2020, this group will move to Medicaid coverage and not be able to continue in their current QHP coverage.