Idaho Medicaid reassessment: what actually happens

Idaho's two adult home-care waivers are reassessed by different people, with different paperwork. Here is what each one looks at, what you have to produce, and what you control — with the state's own documents linked and dated at the bottom.

This is the Idaho companion to our general guide on records for a Medicaid reassessment. That page covers what documentation helps anywhere. This one covers who actually shows up in Idaho, what they use, and the one big difference between the two waivers: the DD side tells you what to bring, and the A&D side does not.

Two waivers, two assessors

	DD waiver	A&D waiver
Who assesses	Liberty Healthcare, the state's contracted assessor	The Department itself: a Bureau of Long Term Care (BLTC) nurse reviewer, an Idaho-licensed RN
How often	Every year	At least every year
What they use	An interview, a Medical, Social, Developmental Summary (MSDA), the SIB-R answered by a "respondent" who knows you well, and a needs inventory	The Uniform Assessment Instrument (UAI): a scored home-visit interview covering daily activities, household tasks, and behavior and cognition
Medical paperwork	Yes. A history and physical within the last year, usually the Adult DD Medical Care Form completed by your doctor	None published. No required physician form
Records you may be asked for	Medication lists, seizure logs, incident reports, therapy evaluations, IEP eligibility reports	Nothing is required. Medical records and family input "may be used when available"

If you are not sure which waiver a person is on, the plan developer, case manager, or whoever did the last assessment knows. Everything below is split by track.

The DD waiver: Liberty Healthcare and the Medical Care Form

Adult developmental disability services in Idaho are assessed by Liberty Healthcare, the state's contracted assessor, and Liberty publishes the whole process. At the scheduled interview a Liberty assessor completes a Medical, Social, Developmental Summary (MSDA) with you and the person you bring, completes the Scales of Independent Behavior–Revised (SIB-R) "with a person who knows you very well" (Liberty calls that person the respondent), and conducts a needs inventory [1]. Liberty's own advice is to make sure a guardian, a friend, or someone who knows you very well is present [2].

The paperwork

Idaho rule requires, for adult DD services, "a history and physical … within the year prior to the initiation of service and updated annually, by the medical provider" [3]. Liberty's FAQ puts the same thing in plainer terms: "a history and physical that has been completed within the last 365 calendar days (may include the medical care form)" [1].

The medical care form is the Adult DD Medical Care Form, current revision 10.20.25 [4]. Your doctor fills it out, not you. The form's header reads "Please Complete This Form and Return to Participant", and Liberty's FAQ says they "will have already provided you with an Adult DD Medical Care Form that you can take to your doctor to fill out and return" [1]. It asks the physician for the medication list, health issues, diagnoses, relevant history, vision and hearing, equipment needs, and whether the participant can self-administer medication, and it runs out one year from the date of examination [4]. Your job is getting it to the doctor and back before the assessment.

Then there is the line that matters if you keep records. Liberty's FAQ says "you may also be asked to provide medication lists, seizure logs, incident reports, speech evaluations, occupational therapy reports, School IEP eligibility reports, etc." [1], and its program page adds a current list of medications, including dosage, and the names of any treatment providers [5].

What to have ready

1. The Medical Care Form, completed and signed by the doctor, dated within the last year. Book the appointment early. If the doctor cannot finish it at the visit, the form itself gives a fax number for returning it to Liberty later [4].
2. A current medication list with doses, plus the names of the prescribers and other treatment providers.
3. Dated logs of the things Liberty names: seizures, incidents, as-needed medication, ER visits. A year of dated entries carries more weight than a summary written the night before.
4. The right respondent. The SIB-R is answered by someone who knows the person's day-to-day functioning across the whole year. Choose the person who actually sees the hard parts, and hand them the record so they answer from it rather than from memory.
5. Therapy evaluations, IEP eligibility reports, and diagnosis documentation you already have.

The A&D waiver: the nurse reviewer and the UAI

The Aged and Disabled waiver is different in almost every mechanical way. Rule says "the Department administers the assessment and develops the initial individual service plan" [3]: no contractor. In practice that is a Bureau of Long Term Care nurse reviewer, an Idaho-licensed registered nurse, who administers the Uniform Assessment Instrument "upon initial application and thereafter yearly at reassessment" [6]. The reassessment is a home visit, face to face by default. The state's waiver application allows telephone assessments only "during periods of high work volume and/or staffing shortages", and only when the previous assessment was face to face and no significant change was reported in the plan year [6].

On scheduling, the Department's own page is blunt: "the assigned nurse reviewer will call you when he or she is able to do so. Our team schedules assessments in the order received. Repeated calls, messages, or emails will not expedite scheduling." [7]

There is no document checklist, and that is not an oversight

We looked hard: the current rule chapter, the 288-page provider handbook, the state's public document repository, and the full approved waiver application. Idaho publishes no list of documents an A&D participant must bring, and no physician form. The DD side's annual history and physical has no A&D counterpart in rule [3]. The state's UAI policy manual says the assessment "is completed during a face-to-face interview with the participant. Any other information from medical records, family members, etc., may be used when available. The preferred source of information is the participant." [8] The service plan is built from the UAI, "any other medical information that verifies the need for services", and the participant's choice of services [9].

So this page cannot tell you what to bring to an A&D reassessment. Nobody can, honestly. What it can tell you is what gets measured and what you control.

What the UAI measures

The UAI "measures deficits in Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), and Behavioral and Cognitive Functioning" [6]. The Department's case manager handbook lists the scored areas [10]: bathing, dressing, eating meals, emergency response, medication, mobility, night needs, personal hygiene, toileting, and transferring; then access to transportation, housework, laundry, preparing meals, and shopping. You can read the blank instrument yourself [12].

Each area is scored in three columns [10]: Assistance Required (the total help the person needs), Available Support (help already in place), and Unmet Needs (what is still needed after that support). Services are authorized against unmet need only. The handbook states that "any ADL identified with an Unmet Needs score of None is not approved" [10], and the score is calculated by the tool rather than tallied by hand [6].

Available support is defined more broadly than families expect. The UAI manual counts "existing supports; paid or unpaid", meaning help "that an agency or family/others has agreed to provide", and says plainly: "If a family member is providing services to the participant, he/she will be counted as an available support" [8]. Describe it accurately. Help that is committed and continuing is available support. Help that is occasional, exhausted, or ending should be described as exactly that.

Two areas are easy to under-describe: night needs and emergency response. If someone is up twice a night to reposition or help with the bathroom, that is an assessed need, but only if it gets said. The level-of-care threshold is also published: twelve points, with critical indicators worth twelve each, high six, and medium three [6].

What you control

1. Answer from the record, not from memory. The participant is the preferred source, and medical records and family input may be used when available [8]. Bring dated notes on the hard nights, the falls, and the as-needed medication, and offer them.
2. Sign the plan promptly. "The earliest services can be approved is on the date an individual service plan is signed by the participant or their designee." [3] An unsigned plan is care nobody is being paid for.
3. Sign your service records. Service delivery "is verified by the participant by signing a service record", and providers must keep those records accessible to you [3]. The handbook requires providers to give you a copy of service delivery documentation at least weekly [9].
4. Check what your agency has left in the home. At the annual reassessment the nurse reviewer checks that the current service plan is in the home, that it is signed by participant and provider, and compares it to the last year's progress notes [6]. Those are your provider's documents to leave, but it is your visit that goes badly if they are missing.
5. Do not let services lapse. "A participant who does not use a waiver service for thirty (30) consecutive days will be terminated from the waiver program unless services were inaccessible" [3].

Self-direction comes up at the assessment

"At the time of assessment or reassessment, Nurse Reviewers (NR) discuss the findings of the assessment and the services that were indicated, as well as inform the participant … about the various options available" [6]. So the reassessment is also the moment to raise self-direction. Under A&D it works through a fiscal intermediary: the participant, or a representative who may be a family member, is the "employer of fact" who hires, fires, and directs the worker, while a personal assistance agency acting as fiscal intermediary is the "employer of record" that bills, withholds taxes, and does the administration [3]. Seven services can be self-directed: attendant care, homemaker, chore, companion, consultation, skilled nursing, and transition services [6].

There is no individual budget to manage on the A&D side. The budget model, with support brokers and spending plans, is My Voice, My Choice, which Idaho describes as its self-direction program for people on the developmental disabilities waiver [11], and rule ties that option to DD eligibility [3].

Two things family caregivers should know before that conversation. First, a spouse, legal representative, or designee can help direct services but, in the handbook's words, "cannot provide any A&D case management, companion, homemaker, chore services, skilled nursing, consultation, attendant care, or transition services" [9]. Second, the Family Personal Care Services program, which allowed a parent of a minor child or a spouse to be the paid caregiver, "has terminated effective July 15, 2025", and the Department's page says legally responsible individuals "are no longer allowed to be the paid caregiver" [7].

If things change mid-year

The provider handbook says A&D eligibility is redetermined "at least annually, or sooner at the request of the participant, Self Reliance, a provider agency, or medical provider" [9], and the state's manual describes a "Significant Change Assessment" for a major change in status that affects more than one area of functioning [8]. If the year turned, do not wait for the anniversary. Tell your case manager or provider and ask.

Records that help on either track

The general guide has the full table of what documentation commonly helps. For Idaho specifically, the records that map most directly onto what the assessors ask about are:

• A dated medication administration history, including as-needed doses and refusals. Liberty names medication lists outright; on the A&D side, medication is a scored area.
• Health events and incidents with dates: falls, seizures, ER visits, infections. Liberty names seizure logs and incident reports.
• Daily notes that say what help was actually given, especially at night. Night needs and emergency response are scored areas that get under-described from memory.
• A shift record showing when care actually happened. Not a timesheet, but a good answer to "how much help does this person get, and when".

If you keep paper, our printable medication log is free. If you keep it in LynCare, the same records export as PDF, CSV, or Excel when the visit comes around.

Where LynCare fits, and where it does not

LynCare is where a care circle keeps the day-to-day record: medications given, declines logged with the reason, PRN doses, daily notes with severity levels for health concerns, tasks, and a shift record each time someone clocks in and out. It is written as the work happens. When a Liberty assessor or a nurse reviewer is coming, you can build clean exports of medications, health events, notes, tasks, and shifts and hand them over.

Two limits, stated plainly. LynCare is not an electronic visit verification system, and its shift records do not replace any service record, timesheet, or attestation your program or fiscal intermediary requires. And whether any of this counts as documentation in your program is a question for your plan developer, case manager, or the Bureau of Long Term Care, not for us.

Sources

1. Liberty Healthcare, Frequently Asked Questions (PDF), Idaho developmental disabilities assessments. The 365-day history and physical, the Medical Care Form, the SIB-R respondent, and the "you may also be asked to provide" list.
2. Liberty Healthcare, Adult DD Application Packet (PDF, November 2025).
3. Idaho Administrative Code, IDAPA 16.03.26, Medicaid Plan Benefits (current rule; provisions stamped 7-1-26). Section 540 (employer of fact and employer of record), 541.06 (non-use), 543.01 (A&D assessment and plan; signature date), 543.02 (service records), 573.01 (adult DD history and physical), 800.01 (My Voice, My Choice requires DD eligibility). This chapter replaced IDAPA 16.03.10, which was voided on July 1, 2025; older pages that cite 16.03.10 are out of date.
4. Liberty Healthcare, Adult Developmental Disability Medical Care Form (PDF, rev. 10.20.25).
5. Liberty Healthcare, Child and Adult Developmental Disabilities (Idaho program page).
6. Idaho Department of Health and Welfare, Aged and Disabled Waiver application (CMS 1915(c) waiver #1076, approved effective July 29, 2024), Appendices B-6 (assessor qualifications, reevaluation schedule, level-of-care scoring), D-1 and D-2 (annual reassessment, home visit, what the nurse reviewer checks), and E-1 (self-direction).
7. Idaho Department of Health and Welfare, Long-Term Care Provider Enrollment and General Information. The scheduling paragraph.
8. Idaho Department of Health and Welfare, UAI Policy Manual v2.6 (PDF, April 2019). The oldest source on this page; the definitions are still the ones the Department publishes.
9. Idaho Medicaid, Home and Community-Based Services and Long-Term Support Services provider handbook (PDF, August 17, 2026 edition), sections 4.2, 4.3, 4.5, and 4.7.
10. Idaho Department of Health and Welfare, Case Manager Handbook v1.1 (PDF, 2025), pages 6 to 8.
11. Idaho Department of Health and Welfare, Medicaid Self-Directed Services (My Voice, My Choice).
12. Idaho Department of Health and Welfare, UAI Paper Assessment (Word document, c. 2019). The blank instrument.