Skip to main content

Search

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.