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UnitedHealthcare Community Plan — Idaho Medicaid Plus (IMPlus)
Medicaid
The Idaho Department of Health and Welfare has partnered with UnitedHealthcare Community Plan to administer the Idaho Medicaid Plus (IMPlus) program, which covers most Medicaid services and provides members with a care specialist called a Care Coordinator. The Care Coordinator serves as a single point of contact to assist participants in navigating their Medicaid services.
The Idaho Medicaid Plus (IMPlus) program is for Dual Eligible participants who are 21 years of age or older and are eligible and enrolled in both Medicare (Parts A, B, and D)
This plan is available in the following counties:
Ada, Adams, Bannock, Benewah, Bingham, Blaine, Boise, Bonner, Bonneville, Boundary, Canyon, Cassia, Clark, Clearwater, Elmore, Fremont, Gem, Gooding, Idaho, Jefferson, Jerome, Kootenai, Latah, Lincoln, Madison, Minidoka, Nez Perce, Owyhee, Payette, Power, Shoshone, Twin Falls, Valley, and Washington.
- UnitedHealthcare Community Plan — Idaho Medicaid Plus (IMPlus)
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Benefits & features
A Care Coordinator, sometimes referred to as a Care Specialist, is a person who helps you set up and schedule your care.
You will get a Care Coordinator when you enroll. Your Care Coordinator will contact you after you enroll, to talk about your healthcare needs.
Your Care Coordinator will review this information with you each time they visit you. Please call your Care Coordinator if you have any needs or questions between your care-planning meetings.
If you do not have your Care Coordinator’s telephone number, please call 1-866-785-1628, TTY 711. The call center representative will help.
If you are experiencing a behavioral health crisis, it is important to get help right away. For assistance with a mental health crisis please call or text 988. Remember, you should always call 911 if you are experiencing a medical, police and/or fire emergency situation.
An emergency is a sickness that is sudden and puts your life in danger or can cause harm to you if not treated right away. In an emergency, it is very important to get care right away.
If you have an emergency, call 911 or go to the nearest emergency room. You have the right to go to any hospital emergency room or other setting for emergency services, such as an urgent care center when your doctor’s office is closed. Not all health problems are an emergency. Some reasons to call 911 or go to the emergency room include:
• Sudden loss of feeling, or not being able to move
• Chest pain
• Severe pain in your stomach area
• Poisoning
• A serious accident
• Severe shortness of breath
• Severe burns
• Severe wound or heavy bleeding
• Damage to your eyes
• Severe spasms/convulsions
• Broken bones
• Choking or being unable to breathe
• Throwing up (vomiting) blood
• Strong feeling that you might hurt yourself or another person
• Faint or pass out for no reason (will not wake up)
• Danger of losing life or limb
• Loss of speech
• Assault
Covered services include:
• Basic fertility screenings
• Counseling and education on birth control, sexual health and pregnancy planning
• Birth control pills, condoms, diaphragms, IUDs and other contraceptives
• Emergency contraception
• Sterilization services (Limitation: Only available to those who are at least 21 or older)
Covered services include:
• Treatment planning
• Psychotherapy (group and family)
• Occupational therapy
• Partial care treatment
• Behavioral health nursing
• Drug screening
• Peer support/family support
Home health
These services and supports are designed to help members reside successfully in their own homes, with their families or in certified family homes.
Members may get help with tasks such as:
• Laundry
• Essential errands
• Meal preparation
• Other routine housekeeping duties if there is no one else in the household capable of performing these tasks
Emergency transportation
Emergency care and transport is available 24 hours a day, 7 days a week. Call 9-1-1 or your local emergency number.
As soon as you are able, call your PCP and your Care Coordinator. If you cannot call, have a friend or family member call. If you live in a nursing or an assisted living facility, let staff know. They will arrange for emergency care and transport for you.
Hospital services
Whether it is for a procedure that is done the same day (outpatient) or includes an overnight stay (inpatient), hospital services are covered.
Language and cultural services
At UnitedHealthcare Community Plan of Idaho, we celebrate people, ideas and experiences by creating a culture where all members are appreciated, valued, and able to contribute to their full potential.
Clear communication is important to get the health care you need. UnitedHealthcare Community Plan of Idaho provides member materials to you in a language or format that may be easier for you to understand. We also have interpreters for you to use if your doctor or service provider does not speak your language. If your doctor or service provider does not understand your cultural needs, we can help. We will work with your doctor or service provider or help you pick a new doctor or service provider.
Long-Term Care
Medically focused services for people who have special physical or functional needs.
Prior authorization is required.
Medical equipment and supplies
Specialized medical equipment and supplies
Equipment and supplies may include:
Devices, controls or appliances that help with daily living
Items needed for life support
Durable and non-durable medical equipment
Durable medical equipment and related supplies
Members can get help with medical transportation, durable medical equipment (DME) and home visits if needed.
In-network cost: $0 copay for Medicaid- covered durable medical equipment.
A valid prescription from your physician is required. Prior authorization is required for items and rentals that are $1,000 or more.
Skilled nursing services
A supervised nursing service provided daily by a licensed care facility. The service may help with rehabilitative care and daily living needs.
Such care must be provided by a licensed registered nurse, or licensed practical nurse under the supervision of a registered nurse, licensed to practice in Idaho. These services are not appropriate if they are less cost effective than a home health visit.
Nursing facility care services must have prior authorization before payment is made.
Pharmacy
Getting prescription medications is an important part of your health care. If your PCP or specialist prescribes a medicine that’s listed on your plan’s preferred drug list (PDL), it’s covered, less any possible copay (this list is also known as a formulary.) If your medication is not listed on the PDL, your care provider may request an alternative medication for you that is listed on the PDL. UnitedHealthcare Community Plan covers medicines on this list and may pay for other medicines with prior approval. You can get your prescriptions filled at any pharmacy in our network. Many are available 24 hours a day, 7 days a week. For a list of pharmacies or to look up medications on the Preferred Drug List, use your provider directory or go to myuhc.com/CommunityPlan.
Non-medical transportation services
This service allows a members to gain access to waiver and other community services and resources for non-medical reasons.
In-network cost:
$0 copay for Medicaid-covered non-medical transportation
Prior authorization required?
Yes. A valid Notice of Decision authorizing services is required.
This benefit is only available to those members receiving Aged & Disabled waiver services.
Urgent and after-hours care
If you need help finding an urgent care center or you cannot contact your PCP, call Member Services at 1-866-785-1628, TTY 711 or go to the UnitedHealthcare Community Plan website at UHCCommunityPlan.com to locate the nearest urgent care center.