MEDICAL ASSISTANCE IN ADA COUNTY

Idaho law states that citizens should be responsible for paying for their own medical care. To the extent that is not possible, the county and the state are required to offer some assistance.

What is the Indigent Assistance Program?

Indigent Assistance is a program created and controlled by state law designed to help Ada County residents in paying hospital and medical bills in limited situations.

Am I eligible for assistance?

You must be a legal resident of the State of Idaho and Ada County.

You will be considered a resident of the State if:

a. You have actually lived in Idaho for a consecutive period of thirty (30) days; and

b. You do not live in the State on a temporary basis.

You will be considered a resident of Ada County if:

a. You have actually maintained a residence in Ada County for six (6) consecutive  months or longer within the past five (5) years preceding the date of your application for assistance and

b. You do not live in Ada County on a temporary basis.

You must be “medically indigent”.

This means that your income and resources available to you are not sufficient to pay the medical bills if payments were spread out over a period of 5 years.

 

Your income and resources include:

All property, whether tangible or intangible, real (for example: land, house, building) or personal, liquid or nonliquid, including, but not limited to, all forms of public assistance, crime victim’s compensation, worker’s compensation, veteran’s benefits, Medicaid, Medicare, and any other property from any source for which you may be eligible or in which you may have a vested interest.

 

Which medical services are covered?

To qualify for assistance, your medical services must be deemed as a “necessary medical service” under Idaho law. Your medical records will be reviewed by the county’s Medical Director (a physician) to make this determination.

 

Which medical services are NOT covered?

• Service provided merely for your convenience or the convenience of the provider;

• Inpatient services that reasonably could have been provided on an outpatient basis
• Services not provided in accordance with generally accepted standards of medical or surgical practice in this community;
• Services not consistent with the symptoms, diagnosis or treatment of your condition, illness or injury;
• Bone marrow transplants, and any related services or prescription drugs;
• Organ transplants;
• Elective, cosmetic and/or experimental procedures;
• Normal, uncomplicated pregnancies, excluding caesarean section, and childbirth well-baby care;
• Medicare or Medicaid co-payments and deductibles;
• Services provided by, or available to you from state, federal and local health programs;
• Non-emergency voluntary mental health services.
• Drugs, devices or procedures primarily utilized for weight reduction and complications directly related to such drugs, devices or procedures.

How do I apply for assistance?

Any person seeking assistance with payment of medical bills must do so by completing and filing an approved application form. You can access the form by clicking on the link in this paragraph. You can also obtain a form at any hospital or at the Ada County Indigent Services office at 252 E. Front St., Suite 199; two buildings east of the Ada County Courthouse in Boise. Please use black or blue ink if filling out application in your own hand writing.  Your signature on the application must be notarized. Failure to have your signature notarized may result in your application being denied. Your signature can be notarized at the Ada County Indigent Services office.

What do I do after I fill out my application?

After you have completed your application:

• You must, without delay, bring your completed application to Indigent Services Office located at 252 E. Front St., Suite 199, Boise, ID between the hours of 8:00 a.m. and 3:30 p.m. (no applications will be accepted after 3:30 p.m.), Monday - Friday.  At that time a Service Worker will review your application to decide whether to conduct an interview immediately or to schedule an interview for a later date.  You should plan on staying for a 1-hour interview just in case.  You may be scheduled for a later interview after you've had a chance to gather some important financial documents and other information. 

• Please be advised that except in cases of an emergency room visit, it is important that your application be filed 10 days prior to any medical services being provided to you.  Otherwise, your application may be denied because it is untimely.

• Please do not call our office to schedule an interview.  Interviews will NOT be scheduled over the phone.  If you have questions before you bring your completed application to the office please call us at 287-7960.

• You must bring your completed application with you to the interview.

• An interview will not be conducted unless you have the completed application with you.

• You will not be allowed to use the interview time to complete your application.
  

What will the Service Worker do during the investigation?

The law requires that the Service Worker review your medical bills to ensure that the services, procedures and medicines are covered for payment under the indigency statutes. The Service Worker will also ensure that your application is complete, was filed timely, and then review all your available resources that could be used to pay for your medical bills.

When do I need to file my application?

• If the medical service is not an emergency,  you must file your application no later than ten (10) days prior to receiving services.

• If the medical service is an emergency,  you must file your application within thirty-one (31) days beginning with the first day of the provision of the medical service.

• If you will need additional treatment related to an original diagnosis in accordance with a preapproved treatment plan, you must file your application ten (10) days prior to receiving the services.

• A delayed application for necessary medical services may be filed up to one hundred eighty (180) days beginning with the first day of the provision of necessary medical services provided that written documentation is included with the application or no later than forty-five (45) days after an application has been filed showing that a bona fide application or claim has been filed for Social Security Disability Insurance, Supplemental Security Income, third party insurance, Medicaid, Medicare, crime victim’s compensation, and/or worker’s compensation.

If I qualify, how much will the Indigent Program pay?

• The County Indigent Program will pay for medical services not to exceed the aggregate amount of eleven thousand ($11,000) dollars per applicant for any twelve (12) month period.

• The Indigent Program will submit to the State Catastrophic Health Care Cost Program any bills above eleven thousand ($11,000) dollars.

• Payment made by the Indigent Program to a provider is considered by the law to be payment in full for the debt and the provider is not authorized to seek additional payment from the applicant.

Do I have to pay back the county for money spent on my behalf?

• State law provides that if a county or the state provides any financial assistance to pay for medical services, the applicant shall be obligated to reimburse the county and the State Catastrophic Health Care Cost Program for such reasonable portion as the Board of County Commissioners may determine the applicant is able to repay over a reasonable period of time. Please click on this link, Liens and Reimbursement for more information.

Is a Lien placed against my property?

• YES. Idaho law provides that:

Upon application for financial assistance…an automatic lien shall attach to all real and personal property of the applicant and on insurance benefits to which the applicant may become entitled. The lien shall also attach to any additional resources to which it may legally attach not covered above.

If my application is denied, can I appeal?

• YES. You may appeal a denial of your application by filing a written Notice of Appeal with the Board of County Commissioners (this can be filed in the office of Indigent Services). Your Notice of Appeal must be filed within twenty-eight (28) days of the date of the initial determination. If you do not file this appeal timely, the decision of the Board is final. There is no cost to file an appeal.

• Please be advised that the provider (doctor or hospital) has the legal right to file an appeal on its own behalf if your application is denied and they may pursue the appeal, even if you choose not to.

• If an appeal is timely filed, a hearing will be scheduled before the Board of County Commissioners and you will receive a notice from this office giving you the time, date and place of the hearing. You have the right to appear at the hearing and be heard by the Board regarding the denial of your application.

 

Violations and Penalties

It is a misdemeanor (crime) if an applicant or obligated person:

• Willfully gives false or misleading information to a hospital, a county or an agent thereof, or to any individual in order to obtain necessary medical services as or for a medically indigent person; or

• Obtains necessary medical services as a medically indigent person who fails to disclose insurance, worker’s compensation, resources, or other benefits available to him or her as payment or reimbursement of such expenses incurred.
  

You must cooperate in the application and investigation process!

Idaho law provides that:

Any applicant who fails to cooperate with a county or makes a material misstatement or material omission to a county in an application pursuant to this chapter shall be ineligible for non-emergency assistance under this chapter for a period of two (2) years

AND

Any application or request which fails to meet the provisions of this section, and/or other provisions of this chapter [law] shall be denied

AND

Failure by the patient and/or obligated persons to complete the application process…shall result in denial of the county assistance application.

If my application is approved, how soon will my doctor and hospital be paid?

State law requires payment within sixty (60) days of Board of Ada County Commissioners approval.

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Please arrive 20 minutes prior to your appointment and plan for a one-hour interview.

If you need to reschedule your appointment, contact our receptionist at 287-7960 at least 24 hours prior to your appointment, and you will be given another appointment date. Your appointment will not be re-scheduled a third time. Failure to keep your appointment, or failure to cooperate with our investigation of your application will result in denial of your application.

Parking is available on the East side of the County Courthouse in a Public Parking lot.  The first hour of parking is free and a cost of $1.00 per hour thereafter.  No parking validation is offered. Please enter this facility from Front Street and Avenue A.