Residential Care Services in Idaho provide structured housing, personal care assistance, supervision, and support for individuals with disabilities, chronic illnesses, or aging-related needs. These services are authorized under Idaho’s Medicaid Home and Community-Based Services (HCBS) waiver programs and state-specific residential service systems, helping participants maintain independence while receiving the supports necessary for daily living.

1. Governing Agencies

Agency: Idaho Department of Health and Welfare (IDHW) — Division of Medicaid
Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Residential Care Services

Agency: Idaho Department of Health and Welfare (IDHW) — Residential Assisted Living Facilities (RALF) Licensing Program
Role: Licenses Residential Assisted Living Facilities (RALFs) and monitors compliance with residential care regulations

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Residential Care Services meet Medicaid HCBS quality and community integration standards

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2. Residential Care Service Overview

Residential Care Services in Idaho offer 24-hour support in licensed settings designed to provide assistance with personal care tasks and basic health-related services.

Approved providers may deliver:

• Assistance with Activities of Daily Living (ADLs) such as bathing, grooming, toileting, eating, and mobility
• Health monitoring and medication assistance (depending on staff qualifications and licensure)
• Meal preparation and nutritional support
• Housekeeping and laundry services
• Social, recreational, and therapeutic activities
• Supervision to ensure participant health and safety
• Community integration and transportation support for medical appointments and activities

Services must align with the participant’s Individualized Service Plan (ISP) or Plan of Care and emphasize person-centered, community-oriented living.

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3. Licensing & Provider Approval Requirements

Prerequisites:

• Register business with the Idaho Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Apply for and maintain Residential Assisted Living Facility (RALF) License through IDHW
• Enroll as a Medicaid provider through Idaho Medicaid Provider Enrollment
• Maintain general liability, professional liability, and worker’s compensation insurance
• Develop policies for resident intake, service delivery, medication assistance, safety, and emergency response

4. IDHW Provider Enrollment Process

Initial Interest and Application:

• Submit application for Residential Assisted Living Facility licensing through IDHW
• Submit Medicaid Provider Enrollment Application specifying Residential Care Services under appropriate HCBS waiver

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, facility floor plans, proof of insurance, staffing plans, service descriptions, and participant safety protocols
• Provide sample resident service plans, emergency plans, staffing schedules, and policies for medication administration

Licensure and Readiness Review:

• IDHW conducts a licensure survey/inspection to verify compliance with facility requirements
• Medicaid enrollment includes a readiness review for billing, participant protections, and service delivery compliance

Approval & Medicaid Enrollment:

• Upon approval, providers are assigned Medicaid billing codes for Residential Care Services under HCBS programs

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5. Required Documentation

• Articles of Incorporation or Business License (Idaho Secretary of State)
• IRS EIN confirmation
• NPI confirmation
• Residential Assisted Living Facility License (IDHW)
• Proof of general, professional, and worker’s compensation insurance

HCBS-Compliant Policy & Procedure Manual including:

• Participant intake, assessment, and service planning procedures
• Health monitoring, medication assistance, and personal care assistance protocols
• Facility safety, emergency response, and disaster preparedness plans
• Recreational programming and community integration guidelines
• HIPAA confidentiality, participant rights, and grievance handling policies
• Staff credentialing, background checks, and ongoing training documentation
• Medicaid billing, service authorization tracking, and quality assurance documentation

6. Staffing Requirement

Role: Administrator / Residential Program Manager
Requirements: Completion of Idaho Administrator Certification Program for RALFs, experience managing residential care services and background screening clearance

Role: Direct Care Staff / Residential Aides
Requirements: High school diploma or GED, CPR/First Aid certification, successful completion of medication administration training (if providing medication assistance), background screening clearance

Role: Licensed Nurses (optional, if offering enhanced health-related services)
Requirements: Active Idaho nursing license

All staff must complete:

• HIPAA confidentiality and participant rights training
• Abuse prevention, emergency preparedness, and fire safety training
• Medication assistance training (for staff providing medication-related services)
• Annual competency evaluations and continuing education

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7. Medicaid Waiver Programs

The following Idaho Medicaid programs and waivers authorize Residential Care Services:

• Aged and Disabled (A&D) Waiver
• Developmental Disabilities (DD) Waiver (in specialized residential settings)
• Medicaid State Plan Long-Term Services and Supports (LTSS) programs

Approved providers may deliver:

• 24-hour personal care assistance and supervision
• Medication assistance and health monitoring
• Recreational and social activities supporting community inclusion
• Assistance with accessing community resources and appointments

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8. Timeline to Launch

Phase: Business Formation and Licensing Application
Timeline: 2–4 months

Phase: Facility Setup, Staffing, and Program Development
Timeline: 2–3 months

Phase: Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days

Phase: Medicaid Billing System Setup and Claims Management
Timeline: 30–45 days

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9. Contact Information

• Idaho Department of Health and Welfare (IDHW) — Medicaid Division
  Website: https://healthandwelfare.idaho.gov/services-programs/medicaid-health
• Idaho Department of Health and Welfare (IDHW) — Residential Assisted Living Licensing
  Website: https://healthandwelfare.idaho.gov/providers/residential-assisted-living
• Centers for Medicare & Medicaid Services (CMS)
  Website: https://www.cms.gov/

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Waiver Consulting Group supports residential care agencies, assisted living operators, and community-based providers in launching Medicaid-compliant Residential Care Services under Idaho’s HCBS waiver programs.

10. Scope of Work

• Business registration and EIN/NPI setup
• Residential Assisted Living Facility licensing and Medicaid provider enrollment support
• Development of Residential Care Services Policy & Procedure Manual
• Staff credentialing templates and participant intake/service planning forms
• Medicaid billing system configuration and claims management
• Website, domain, and email setup
• Facility safety systems, incident reporting, and emergency preparedness protocols
• Quality assurance programs for service delivery and participant satisfaction tracking
• Community outreach and referral network development strategies

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