Idaho State Statutes - Idaho Attorney Directory

As used in this chapter, the terms defined in this
section shall have the following meaning, unless the context clearly indicates
another meaning:
(1) "Medically indigent" means any person who is in need of necessary
medical services and who, if an adult, together with his or her spouse, or
whose parents or guardian if a minor, does not have income and other resources
available to him from whatever source sufficient to pay for necessary medical
services. Nothing in this definition shall prevent the board of county
commissioners and administrator from requiring the applicant and obligated
persons to reimburse the county and the catastrophic health care costs
program, where appropriate, for all or a portion of their medical expenses,
when investigation of their application pursuant to this chapter, determines
their ability to do so.
(2) "Hospital" means a facility licensed and regulated pursuant to
sections 39-1301 through 39-1314, Idaho Code, excluding state institutions.
(3) "Dependent" means any person whom a taxpayer could claim as a
dependent under the income tax laws of the state of Idaho.
(4) "Applicant" means any person who is or may be requesting financial
assistance under this chapter.
(5) "Reimbursement rates" means the unadjusted medicaid rate of
reimbursement for medical charges allowed pursuant to title XIX of the social
security act, as amended. For long-term care facilities, maximum
"reimbursement rates" means the unadjusted medicaid rate of reimbursement
allowed pursuant to the medical assistance program as determined by chapter 1,
title 56, Idaho Code, or the unadjusted medicare rate of reimbursement
established under title XVIII of the social security act, as amended,
whichever is greater.
(6) "Board" means the board of county commissioners.
(7) "Obligated persons" means those persons who are legally responsible
for an applicant.
(8) "County hospital" means any county approved institution or facility
for the care of sick persons.
(9) "Administrator" means the board of the catastrophic health care cost
program, as provided in section 31-3517, Idaho Code.
(10) "Catastrophic health care costs" means all necessary medical expenses
for services which are incurred by a recipient for which the reimbursement
rate exceeds in aggregate the sum of ten thousand dollars ($10,000) in any
twelve (12) consecutive month period.
(11) "Recipient" means an individual determined eligible for necessary
medical services under this chapter.
(12) "Resident" means a person with a home, house, place of abode, place
of habitation, dwelling or place where he or she actually lived for a
consecutive period of thirty (30) days or more within the state of Idaho. A
resident does not include a person who comes into this state for temporary
purposes, including, but not limited to, education, vacation, or seasonal
labor. Entry into active military duty shall not change a person's residence
for the purposes of this chapter. Those physically present within the
following facilities and institutions shall be residents of the county where
they were residents prior to entering the facility or institution:
(a) Correctional facilities;
(b) Nursing homes or residential or assisted living facilities;
(c) Other medical facility or institution.
(13) "Emergency service" means a service provided for a medical condition
in which sudden, serious and unexpected symptoms of illness or injury are
sufficiently severe to necessitate or call for immediate medical care.
(14) "Provider" means any person, firm, or corporation certified or
licensed by the state of Idaho or holding an equivalent license or
certification in another state, that provides necessary medical services as it
appears on an application for assistance pursuant to this chapter.
(15) "Third party applicant" means a person other than an obligated person
who completes, signs and files an application on behalf of a patient.
(16) "Clerk" means the clerk of the board or his or her designee.
(17) "Resources" means all property, whether tangible or intangible, real
or personal, liquid or nonliquid, including, but not limited to, all forms of
public assistance, crime victim's compensation, worker's compensation,
veterans benefits, medicaid, medicare and any other property from any source
for which an applicant and/or an obligated person may be eligible or in which
he or she may have an interest. Resources shall include the ability of an
applicant and obligated persons to pay for necessary medical services over a
period of up to five (5) years. For purposes of determining approval for
medical indigency only, resources shall not include the value of the homestead
on the applicant or obligated persons' residence, a burial plot, exemptions
for personal property allowed in section 11-605(1) through (3), Idaho Code,
and additional exemptions allowed by county resolution.
(18) A. "Necessary medical services" means a requested or provided medical
service required in order to identify or treat a medically indigent
person's health condition, illness or injury and is:
(a) Consistent with the symptoms, diagnosis or treatment of the
medical indigent's condition, illness or injury;
(b) In accordance with generally accepted standards of medical or
surgical practice then prevailing in the community where the services
were provided;
(c) Furnished on an outpatient basis whenever it is safe, efficient
and reasonable to do so;
(d) Not provided primarily for the convenience of the medically
indigent person or the provider;
(e) The standard, most economical service or item that can safely,
reasonably and ethically be provided.
B. Necessary medical services shall not include the following:
(a) Bone marrow transplants;
(b) Organ transplants;
(c) Elective, cosmetic and/or experimental procedures;
(d) Services related to, or provided by, residential and/or shelter
care facilities;
(e) Normal, uncomplicated pregnancies, excluding caesarean section,
and childbirth well-baby care;
(f) Medicare copayments and deductibles;
(g) Services provided by, or available to an applicant from state,
federal and local health programs; and
(h) Medicaid copayments and deductibles.
Provided however, each board may determine, by ordinance or resolution
duly adopted in its county, to include as necessary medical services
additional services not covered in this section. Necessary medical services
provided by this option shall not be paid by the catastrophic health care
costs program, and shall remain the liability of the respective county.

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