RESIDENTIAL CARE SERVICES PROVIDER IN IDAHO

OFFERING SUPPORTIVE HOUSING SOLUTIONS FOR INDIVIDUALS NEEDING 24-HOUR ASSISTANCE IN A COMMUNITY-BASED SETTING

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

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.

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 a Residential Assisted Living Facility (RALF) License through IDHW

• Enroll as a Medicaid provider through Idaho Medicaid Provider Enrollment

• Maintain general liability, professional liability, and workers’ 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

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 REQUIREMENTS

Role: Administrator / Residential Program Manager

Requirements: Completion of Idaho Administrator Certification Program for RALFs; experience managing residential care services; 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

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

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

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/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — IDAHO RESIDENTIAL CARE SERVICES PROVIDER

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

​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

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.