Senate Bill 1205 Summary

• Clarifies medical assistance eligibility for persons with disabilities or special health needs and establishes eligibility standards for low-income individuals under 65 years old with modified adjusted gross income at or below 100% of the federal poverty level.

• Establishes a separate benchmark plan for low-income adults (ages 19-64) earning 100-133% of federal poverty level, with the state providing premium assistance to purchase qualified health plans through the Idaho health insurance exchange.

• Defines specific health benefits for each eligibility category, including services for children, pregnant women, persons with disabilities, and Medicare-eligible individuals, with varying cost-sharing requirements.

• Requires the Department of Health and Welfare to implement personal accountability requirements for low-income adult participants, reimburse the catastrophic health care cost fund for claims from July 1, 2016 forward, and pursue federal waivers for coverage expansion.

• Makes the act contingent on federal approval of necessary waivers and state plan amendments, with provisions making it void if the Centers for Medicare and Medicaid Services does not approve required amendments or if federal funding commitment drops below 90%.