How Medicaid Can Help Pay for Long-Term Care in Idaho

Q: Why might I qualify for Idaho's A&D Waiver but not regular AABD Medicaid?

Because they count spousal income completely differently. The A&D Waiver only counts the applicant's own income, excluding a non-applicant spouse entirely. AABD Medicaid counts both spouses' combined income even when only one applies. A couple with $1,600/month combined income could qualify for the A&D Waiver (applicant's own income might be just $800) but fail AABD Medicaid ($1,600 exceeds its $1,511 combined limit).

Q: Does Idaho offer a spend-down option for long-term care income above the limit?

No — Idaho does not offer a medically needy spend-down for long-term care. Anyone over the $3,002 limit must establish a Qualified Income Trust (Miller Trust) and fund it every month; a trust that exists but isn't funded monthly doesn't satisfy the requirement.

Published August 28, 2026 How we keep this accurate

This page is Idaho-specific. Medicaid long-term care rules vary significantly by state. See our national Medicaid Waivers Explained guide if you're elsewhere.

A real example worth understanding before you assume anything

Idaho's Aged and Disabled (A&D) Waiver and regular AABD Medicaid count a married couple's income in genuinely different ways — and this difference can determine which program you actually qualify for.

A concrete example: a couple with $1,600/month combined income, where the applicant spouse's own income is $800/month, could qualify for the A&D Waiver (which only counts the applicant's $800, well under the $3,002 limit) but fail AABD Medicaid (which counts the full combined $1,600, over its $1,511 limit). Same couple, same income, two different outcomes depending on which program is being evaluated.

Why Idaho's limit is $3,002, not the more common $2,982

Idaho applies a $20 general income disregard on top of the standard 300% federal benefit rate calculation used by most states, resulting in a slightly higher $3,002/month limit for the A&D Waiver and nursing home Medicaid.

The two programs, side by side

	A&D Waiver / Nursing Home	AABD Medicaid (not LTC)
2026 income limit	$3,002/month (applicant only)	$1,047 single / $1,511 combined
Counts non-applicant spouse's income?	No	Yes, even if only one spouse applies
Covers long-term care?	Yes	Limited — personal care assistance, adult day care only

Source: Idaho Department of Health and Welfare; figures effective 2026.

No spend-down alternative — the QIT is required

Unlike several other states, Idaho does not offer a medically needy spend-down for long-term care. If your income exceeds $3,002/month, a Qualified Income Trust (Miller Trust) is the only route in — and it must be funded every single month. A trust that exists on paper but isn't actively funded doesn't satisfy Idaho's requirement.

A medical nuance worth knowing

Qualifying for the A&D Waiver requires a Nursing Facility Level of Care (NFLOC) determination based on Activities of Daily Living, Instrumental Activities of Daily Living, and cognitive/behavioral evaluation. An Alzheimer's or dementia diagnosis alone does not guarantee this designation — the functional assessment determines eligibility, not the diagnosis itself.

Spousal protections, where they apply

Community Spouse Resource Allowance: up to $162,660, with a floor of $32,532 if 50% of joint assets falls below that amount.

Spousal Income Allowance: $2,705 to $4,066.50/month, depending on the community spouse's shelter and utility costs.

How to actually start

Contact the Idaho Department of Health and Welfare to determine which program — A&D Waiver or AABD Medicaid — actually fits your household's specific income situation, given how differently they count spousal income.

If your income is over $3,002/month, set up a Qualified Income Trust before applying, and confirm it's funded every month — see Questions to Ask an Elder Law Attorney for help getting this structured correctly.

Common Questions

Why might I qualify for Idaho's A&D Waiver but not regular AABD Medicaid?

They count spousal income differently — the A&D Waiver only counts the applicant's income, while AABD Medicaid counts both spouses' combined income.

Why is Idaho's long-term care income limit $3,002 instead of $2,982?

A $20 general income disregard is added to the standard 300% federal benefit rate calculation.

Does Idaho offer a spend-down option for long-term care income above the limit?

No — a Qualified Income Trust, funded monthly, is the only route for income above $3,002.