Idaho Medicaid Provider Handbook, Home Health and Hospice Services § 4.7.2

Medicaid participants residing in a nursing facility or intermediate care facilities for individuals

with intellectual disabilities (ICF/IID) must contribute toward the cost of room and board,

when applicable and not otherwise exempt. The amount of each participant’s monthly liability

(the contribution toward the cost of care) will be determined under the same rules that are

currently applied to all other Medicaid nursing facility residents. Medicaid hospice participants

will be notified when they must pay a contribution. The hospice can request from the nursing

facility the Authorization for Nursing Facility Payment form, which shows the participant’s

liability amount. See the Share of Cost section of the General Information and Requirements

for Providers, Idaho Medicaid Provider Handbook for more information.

(a)

References: Patient Liability

(i) Federal Regulations

Limitations on Premiums and Cost Sharing, 42 CFR §447.56(a)(1)(ix) (2024). Government

Printing Office, https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-

447/subpart-A/subject-group-ECFRa3c17d28ea07411/section-447.56.

“State Option for Alternative Premiums and Cost Sharing” Social Security Act, Sec.

1916A(b)(3)(A)(iii) (1935). Social Security Administration,

https://www.ssa.gov/OP_Home/ssact/title19/1916A.htm.

“State Option for Alternative Premiums and Cost Sharing” Social Security Act, Sec.

1916A(b)(3)(B)(iv) (1935). Social Security Administration,

https://www.ssa.gov/OP_Home/ssact/title19/1916A.htm.

“Use of Enrollment Fees, Premiums, Deductions, Cost Sharing, and Similar Charges” Social

Security Act, Sec. 1916(a)(2)(E) (1935). Social Security Administration,

https://www.ssa.gov/OP_Home/ssact/title19/1916.htm.

“Use of Enrollment Fees, Premiums, Deductions, Cost Sharing, and Similar Charges” Social

Security Act, Sec. 1916(b)(2)(E) (1935). Social Security Administration,

https://www.ssa.gov/OP_Home/ssact/title19/1916.htm.

(ii)

State Regulations

“Hospice: Patient Liability.” IDAPA 16.03.26, “Medicaid Plan Benefits,” Sec. 660.

Department of Administration, State of Idaho,

https://adminrules.idaho.gov/rules/current/16/160326.pdf.