Idaho MMCP 2026: Medicare Medicaid Coordinated Plan Explained

If you're over 21 with Medicare Parts A, B and D and Idaho Medicaid enhanced plan benefits, Idaho's Medicare Medicaid Coordinated Plan (MMCP) puts both in one plan at no cost to you.1 Joining the MMCP is voluntary.1 In 2026 two companies offer the MMCP in many Idaho counties: Molina Healthcare of Idaho, and UnitedHealthcare Community Plan of Idaho, which began offering it on January 1, 2026.1 The alternative for Idaho dual eligibles, Idaho Medicaid Plus (IMPlus), covers Medicaid benefits only and makes no change to Medicare coverage.1

In This Guide

• Who Qualifies for Idaho's Medicare Medicaid Coordinated Plan?
• What the MMCP Covers, and What Stays With Idaho Medicaid
• What Does the MMCP Cost?
• MMCP vs. Idaho Medicaid Plus: Which One Fits?
• How to Enroll in the Idaho MMCP
• How Often Can You Change Plans?
• Where the MMCP Fits in Federal Medicare Rules
• What Changes for D-SNPs in 2027 and 2030?
• What Happens If Your Medicaid Lapses?
• Where to Get Free Help or File a Complaint
• Frequently Asked Questions
• Learn More

Who Qualifies for Idaho's Medicare Medicaid Coordinated Plan?

The Idaho Department of Health and Welfare (DHW) runs two managed care programs for Idahoans who have both Medicare and Idaho Medicaid.1 DHW defines a dual eligible member as someone over 21 who is enrolled in Medicare Parts A, B and D and has Idaho Medicaid enhanced plan benefits.1 Idaho Medicaid offers dual eligible members two managed care programs: the Medicare Medicaid Coordinated Plan (MMCP) and Idaho Medicaid Plus (IMPlus).1

DHW says the two MMCP companies offer the plan "in many of Idaho's counties," so ask either company whether the MMCP is available where you live before you count on it.1

If you aren't sure whether you have Medicaid enhanced plan benefits, our guide to Idaho Medicaid for seniors and families explains the programs, and our guide to dual eligibility covers how Medicare and Medicaid work together.

What the MMCP Covers, and What Stays With Idaho Medicaid

The MMCP combines all services covered under Medicare Parts A, B and D (prescription drug coverage) with all services in the Idaho Medicaid enhanced plan.1 DHW describes what that means for a member:

• One plan: Medicare and Medicaid coverage are integrated into one single plan.1
• One accountable company: The MMCP has one accountable entity to coordinate the delivery of services, and one care management team to coordinate care.1
• Extra benefits: The MMCP offers supplemental benefits over and above Original Medicare and Medicaid, and DHW tells members to contact the health plans for the full list.2

DHW says an MMCP member keeps using Idaho Medicaid, separate from the MMCP, for three benefits: developmental disability services, non-emergency medical transportation and dental benefits.1 The MMCP plans' own supplemental benefits are a separate list, so ask the plan whether its list includes any dental or transportation benefit.2

What Does the MMCP Cost?

DHW says there is no premium or cost to join either the MMCP or IMPlus.2 For MMCP members, Medicaid pays the member's Medicare premiums.1

DHW also says that if you already have a share of cost for waiver services, or pay a premium for Medicare Part D, those costs won't change when you join the MMCP or IMPlus.2 If you pay a Part D premium today and are weighing the MMCP, ask the plan before you enroll whether you will still owe it. If you're on the Idaho Aged and Disabled Waiver and pay a share of cost, plan on paying it after you join the MMCP. Our guide to Idaho Medicaid HCBS waivers explains how those waiver services work.

MMCP vs. Idaho Medicaid Plus: Which One Fits?

Idaho Medicaid runs both dual eligible programs as managed care programs, and both offer care coordination services.1,2 The difference is how much of your coverage each one takes over.

The table summarizes DHW's descriptions of the two programs.1,2 The one exception is the MMCP's "Changing companies" cell: DHW doesn't describe how an MMCP member changes plans, so that cell reflects the federal Medicare enrollment rules covered under "How Often Can You Change Plans?" below.4 IMPlus covers Medicaid benefits only, with no changes to your Medicare coverage, and DHW says a dual eligible member who lives in one of the mandatory counties and isn't enrolled in the MMCP can choose their own Medicare health plan.2 An IMPlus member may select Molina Healthcare of Idaho or UnitedHealthcare for the IMPlus plan and may change health plan provider once per month.2

DHW lists IMPlus as mandatory, for dual eligible members not enrolled in the MMCP, in these 34 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.2 That list is where IMPlus is required. It is not a list of where the MMCP is offered, so check MMCP availability with the plans.

Idaho Medicaid's managed care report on 2023 described how the mandatory side works: a participant who did not actively select a plan was automatically enrolled with one of the participating plans, and the participant's choice of Medicare coverage was not affected.2

The MMCP fits someone who wants one plan and one care management team for both programs. IMPlus suits someone who wants to keep their current Medicare arrangement, such as Original Medicare with a Part D plan, or a Medicare Advantage plan whose doctors they already use. Before you choose, check that your doctors, pharmacy and any long-term care providers work with the plan.

How to Enroll in the Idaho MMCP

1. Call a plan. DHW tells members to call Molina Healthcare of Idaho at 866-403-8293 or UnitedHealthcare Community Plan of Idaho at 877-370-1131 to enroll in the MMCP or get more information.2
2. Ask about your county and your providers. DHW says the MMCP is offered in many Idaho counties, so confirm it's offered where you live.1 Ask the plan for its full list of supplemental benefits while you're on the phone.2
3. Compare first if you're unsure. The Medicare Plan Finder shows the Medicare plans offered at your address, and SHIBA counselors can walk through the choice with you for free (see below).

To enroll in IMPlus instead, call DHW toll free at 888-528-5861, or complete the IMPlus Enrollment Form that comes with your IMPlus Selection Notice and mail it back in the envelope provided.2

How Often Can You Change Plans?

Full dual eligibles don't have to wait for Medicare's fall open enrollment. Under the contract year 2025 Medicare Advantage and Part D final rule, a person with full Medicare and full Medicaid gets a once-per-month "integrated care" special enrollment period to enroll in an aligned integrated dual eligible special needs plan (D-SNP), meaning a fully integrated, highly integrated or applicable integrated plan.4 The contract year 2025 Medicare Advantage and Part D final rule also lets dual eligibles and people with Extra Help choose a stand-alone Part D prescription drug plan in any month, except while they are identified as a potential at-risk or at-risk beneficiary under a Part D drug management program.4

On the Medicaid side, an IMPlus member may change health plan provider once per month.2 Our guide to Medicare special enrollment periods lists the other times you can change Medicare coverage.

Before leaving the MMCP, remember that IMPlus is mandatory in DHW's listed counties for dual eligibles who aren't enrolled in the MMCP, so in those counties expect your Medicaid benefits to go through an IMPlus plan afterward.2 A SHIBA counselor can help you line up the Medicare side.

Where the MMCP Fits in Federal Medicare Rules

Medicare plans built for dual eligibles are called dual eligible special needs plans (D-SNPs), and they come in levels of integration with Medicaid: coordination-only, highly integrated (HIDE) and fully integrated (FIDE).5 The Medicare Payment Advisory Commission (MedPAC) calls FIDE SNPs the most integrated type, and reported that in 2024 only 3 percent of dually eligible beneficiaries nationwide were in one.5

The Centers for Medicare & Medicaid Services (CMS) contract year 2026 integration-status file lists Idaho among the states with FIDE SNPs, with two Idaho FIDE plan packages, and does not list Idaho among the states with highly integrated (HIDE) SNPs.1 CMS's contract year 2026 integration-status file also lists two other Idaho D-SNP packages, from the same two CMS-named sponsors, as coordination-only, the least integrated level.1 CMS's file names the Idaho sponsors by legal-entity names (UnitedHealthcare of the Rockies, Inc. and Molina Healthcare of Utah, Inc.) that differ from the plan names DHW uses, so the CMS file doesn't by itself tell you which package is the MMCP. When a company offers you a "dual" plan in Idaho, ask whether it is the MMCP.

For contract year 2027, CMS addressed its integrated model materials (member handbook, ID card, and provider and pharmacy directory) to applicable integrated plan D-SNPs in 23 states and territories, Idaho among them.6 For how the federal categories differ, see our guide to fully integrated dual eligible SNPs.

What Changes for D-SNPs in 2027 and 2030?

For an Idaho dual eligible, the 2027 rule turns on one question: does the company behind your Medicare D-SNP also run your Medicaid managed care plan? In Idaho, Molina Healthcare of Idaho and UnitedHealthcare offer both the MMCP and the IMPlus Medicaid plans,1,2 and CMS lists coordination-only Idaho D-SNP packages from the same two CMS-named sponsors alongside the FIDE ones.1 An MMCP member already has Medicare and Medicaid coverage integrated into one plan with one accountable entity, DHW says.1

The federal aligned-enrollment rule at 42 CFR 422.514(h), as CMS's April 2026 questions and answers explain it, works like this:7

• 2027: Under 42 CFR 422.514(h), a D-SNP whose company (or a company under the same parent) also contracts with the state as a Medicaid managed care organization enrolling full dual eligibles in the same service area may only take new enrollees who are in, or enrolling in, that affiliated Medicaid plan.7
• 2027 to 2030: An existing member of a D-SNP covered by the 42 CFR 422.514(h) limits who isn't in the affiliated Medicaid plan may stay in that D-SNP until 2030.7
• 2030: From 2030, a D-SNP covered by the 42 CFR 422.514(h) limits may only enroll or keep members who are also in its affiliated Medicaid plan, and its company must disenroll members who aren't.7
• Not covered: A D-SNP whose company doesn't run a Medicaid managed care organization serving full dual eligibles in the state is outside the 42 CFR 422.514(h) aligned-enrollment limits, which otherwise apply to all types of D-SNPs, coordination-only ones included.7
• Fee-for-service exception: Where a state doesn't require Medicaid managed care for all full dual eligibles and the state Medicaid agency's contract allows it, a covered company may still enroll full dual eligibles who are in Medicaid fee-for-service in a coordination-only D-SNP or HIDE SNP, but not people in a Medicaid plan run by an unaffiliated company. This exception continues in 2030 and beyond unless the state changes to require aligned enrollment through mandatory Medicaid managed care.7

Neither DHW nor CMS, in the sources this guide relies on, says how Idaho's IMPlus contracts are treated under 42 CFR 422.514(h), so this guide doesn't predict how the rule lands for any one Idaho plan. If you're in IMPlus with one company and a non-MMCP D-SNP from the other, or you're in Medicaid fee-for-service rather than IMPlus, ask SHIBA before 2027 whether your D-SNP is affected and whether the fee-for-service exception applies.

What Happens If Your Medicaid Lapses?

The MMCP is open only to Idahoans with Idaho Medicaid enhanced plan benefits,1 so a missed Idaho Medicaid renewal can put MMCP membership at risk. Federal rules give special needs plans a cushion. Under 42 CFR 422.52(d), when a special needs plan finds that an enrollee no longer qualifies but can reasonably be expected to qualify again within six months, the enrollee is deemed to stay eligible for at least 30 days and no more than six months.8 CMS's contract year 2027 guidance says each special needs plan picks the length of its deemed continued eligibility period, from one to six months, as long as it applies the same policy to all members and tells them what it is.8

• If you don't requalify in time: A special needs plan member who doesn't requalify within the plan's deemed continued eligibility period is expected to be disenrolled at the end of it, and the plan should send a disenrollment notice at least 30 days before.8
• Your enrollment window: A person who loses special needs plan eligibility gets a special enrollment period that starts the month the status changes and ends three calendar months after the disenrollment takes effect.8

Ask your MMCP plan how long its deemed continued eligibility period is, and answer Idaho Medicaid's renewal paperwork as soon as it arrives. Our guide to Idaho Medicaid recertification and renewal covers how DHW's renewal works.

Where to Get Free Help or File a Complaint

Idaho SHIBA (Senior Health Insurance Benefits Advisors), a service of the Idaho Department of Insurance, is Idaho's State Health Insurance Assistance Program. SHIBA gives free, unbiased Medicare information and counseling, and it doesn't sell insurance or recommend specific insurance products.3 Call the SHIBA Medicare Helpline at 1-800-247-4422 before you join or leave the MMCP.3 Our guide to free Medicare counseling through SHIP explains what a session covers.

DHW publishes the plan and IMPlus numbers on its Medicare Medicaid Members page,2 and the SHIBA number comes from the Idaho Department of Insurance.3

If something goes wrong with an MMCP or IMPlus plan, DHW's Bureau of Long Term Care runs an online Complaint Submission System, open to anyone, that routes each complaint to DHW's triage team and the health plan.2 The link is on DHW's Medicare Medicaid Members page. For a Medicaid decision you disagree with, see Idaho Medicaid appeals and fair hearings.

Learn More

Find personalized help deciding between Idaho's MMCP and IMPlus at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.