Idaho Medicaid is administered by the Idaho Department of Health and Welfare (IDHW), Division of Medicaid, and the program is in the middle of a structural transition. Healthy Connections, Idaho's longstanding primary-care case-management program for the general Medicaid population, ended December 31, 2025, along with its narrower value-based-care layer, Healthy Connections Value Care; no comparable statewide primary-care coordination program has replaced it for that population. Idaho Medicaid Plus (IMPlus) became the state's primary delivery framework for dual-eligible members on January 1, 2026. A separate, larger effort (full comprehensive managed care for the general Medicaid population, directed by 2025 state legislation) is years away: IDHW is targeting a January 1, 2030 launch with three managed care organizations, no vendor has been selected, and the state does not expect to release its RFP until 2027. Idaho adopted federal Medicaid expansion work requirements effective January 1, 2027, announced by IDHW in July 2026.
Idaho does not currently have capitated managed care for its general Medicaid population. Historically, most members were served through Healthy Connections, a primary-care case-management (PCCM) program that ended December 31, 2025 with 250,506 members enrolled in 2024, its last full year of operation; IDHW has not put a replacement primary-care coordination structure in place for the general population since. The state's move toward comprehensive managed care is 2025 legislation directing IDHW to contract with three managed care organizations; that program is not yet operational, and IDHW's current timeline targets a January 1, 2030 launch, following an RFP not expected until 2027. The only capitated managed care Idaho Medicaid currently operates is for dual-eligible members, through Idaho Medicaid Plus and the Medicare-Medicaid Coordinated Plan (MMCP), covering roughly 20,000 members combined.
Long-term services and supports are integrated into managed care only for dual-eligible members, through Idaho Medicaid Plus and MMCP. For the rest of the Medicaid population, LTSS is delivered fee-for-service, coordinated through two active Section 1915(c) HCBS waivers: the Adult Developmental Disabilities Waiver and the Aged and Disabled Waiver.
Partially integrated into managed care
Behavioral health is carved out statewide to the Idaho Behavioral Health Plan (IBHP), administered by Magellan Healthcare, Inc. (branded Magellan of Idaho), covering both Medicaid and non-Medicaid behavioral health funding under one integrated benefit. Magellan holds the IBHP contract through February 2028. IBHP covered 286,845 members in 2024, Idaho Medicaid's single largest program by enrollment.
Carved out
Dental coverage is carved out statewide to MCNA Dental (Managed Care of North America, Inc.), branded Idaho Smiles, covering all Idaho Medicaid members regardless of which delivery model covers their other benefits. MCNA covered 308,110 members in 2024.
Prime Therapeutics is Idaho Medicaid's Pharmacy Benefit Administrator.
MTM manages Idaho Medicaid's statewide non-emergency medical transportation network for members with no other way to reach covered services. MTM covered 308,110 members in 2024, the same population Idaho Smiles covers.
Gainwell Technologies currently operates Idaho Medicaid's MMIS claims-processing system and provider fiscal-agent functions. The state has awarded the next MMIS contract to Acentra Health, but litigation over the award has stalled the transition, and Gainwell continues operating the system in the meantime.
Last updated: Aug 29, 2026
39 agency updates tracked for Idaho. Available with Pro.
See them with ProGet the daily briefing.