Section 16.03.10.078 - MANAGED CARE FOR DUALS: PARTICIPANT ELIGIBILITY AND ENROLLMENTIdaho Medicaid Plus will be made available to dual eligible participants over age twenty-one (21) who reside in a county with at least one (1) participating health plan.
01.Excluded Populations. Idaho Medicaid Plus is not available to the following populations:a. Dual eligible participants who have elected to enroll in the Medicare Medicaid Coordinated Plan as defined in IDAPA 16.03.17, "Medicare/Medicaid Coordinated Plan Benefits."b. Individuals enrolled in the Adult Developmental Disabilities 1915(c) waiver program as defined in Section 702 of these rules.02.Optional Populations. Tribal members and pregnant women who are dual eligible participants can elect to voluntarily enroll in Idaho Medicaid Plus if it is available in their county of residence. These participants retain the right to disenroll from Idaho Medicaid Plus at any time.03.Mandatory Enrollment. Dual eligible participants that are not members of an excluded population and reside in a county with two (2) or more participating health plans must select a health plan to administer their Idaho Medicaid Plus program. Mandatory enrollment procedures will occur in accordance with 42 CFR 438 Subpart B.04.Passive Enrollment. Dual eligible participants that are not members of an excluded population and reside in a county with only one (1) participating health plan will be enrolled into that health plan to administer their Idaho Medicaid Plus program unless they opt out by contacting the Department using the instructions on the enrollment notice. These dual eligible participants may opt out of Idaho Medicaid Plus at any time.Idaho Admin. Code r. 16.03.10.078