Presentation of Idaho reports on Idaho Public Television is made possible through the generous support of the Laura Moore Cunningham Foundation, committed to fulfilling the Moore and Bettis family legacy of building the great state of Idaho.

With additional major funding provided by the estate of Darrell Arthur Kammer in support of independent media that strengthens a democratic and just society.

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By the Friends of Idaho Public Television.

The Corporation for Public Broadcasting.

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Thank you.

we had great input and lawmakers listened to us.

Now it seems like they don't care.

In a legislative session defined by difficult budget decisions, some Idahoans are begging the state not to cut Medicaid any more than it already has.

I’m Melissa Davlin.

Idaho Reports starts now.

Hello, and welcome to Idaho Reports.

This week, I sit down with Idahoans who rely on Medicaid services to hear their thoughts on this legislative session’s proposed budget cuts.

Then, members of the Joint Finance-Appropriations Committee join me to respond.

But first, the American Civil Liberties Union filed a class action lawsuit on Tuesday challenging actions taken by federal, state, and local law enforcement during an October raid on a horse racing arena in Wilder.

The lawsuit alleges that the defendants violated due process and equal protection rights, among others, when they used a warrant related to gambling as a general pretext to detain hundreds of people, including lawful permanent residents and U.S.

citizens, based solely on their ethnicity.

Jenn Rolnick Borchetta, deputy director of policing at the ACLU, said in a press release, quote, Our plaintiffs were treated as less than human because ICE and their willing partners think they can disregard fundamental rights if it gets them immigration arrests, unquote.

We'll have much more on this story next week.

On Tuesday afternoon, Division of Financial Management administrator Lori Wolff sent a letter to the Joint Finance-Appropriations Committee, outlining the potential impacts of the committee’s latest budget cut proposals of five percent for most agencies starting next fiscal year.

Among those impacts, according to DFM: Reducing $3.8 million in spending for treatment courts will result in increased crime and higher costs for corrections; Reducing $1 million in juvenile corrections will impact Community Youth Assessment Centers and Youth Substance Abuse mentoring, leaving vulnerable kids with reduced critical support.

commission budget by $900,000 will reduce the temporary tax season workforce, which will delay taxpayer refunds and could ultimately cost up to $7 million in increased interest payments for those refunds, not to mention the elimination of Fast Collection Services, which could reduce revenue collections by $20 to 50 million; A quarter of a million dollars in cuts to Child Welfare would reduce off-hours safety assessments, leaving children in danger.

$777,000 in cuts to mental health programs would leave Idahoans with mental health challenges, including kids, without timely care; and another quarter of $1 million in cuts to the Idaho Department of Lands would mean fewer seasonal firefighters.

Those are just some of the examples.

Wolff didn’t ask the budget committee to reconsider all five percent reductions – just the ones she cited in the five-page letter that would, quote, “jeopardize Idaho’s ability to keep up with population growth, service delivery, infrastructure, and economic development," end quote.

Now remember, this comes after Governor Brad Little's mid-year order to state agencies, except public schools, to reduce general fund spending by 3%.

Medicaid was spared from further cuts in this latest budget committee proposal, but Medicaid recipients are still worried, as Governor Little's own proposal to balance the state budget includes cuts to certain programs, including home and community based services and therapies, which help Idahoans with disabilities live independently.

This comes after an ongoing 4% reduction in Medicaid reimbursement rates for providers like in-home caregivers.

On Wednesday, I sat down with Kristyn Herbert, Julie McConnel, Ned Fowkes, and Dana Gover, four Idahoans who rely on Medicaid programs for themselves or their children.

Julie, I want to start with you.

Can you tell us about your family and what Medicaid services you use?

Yeah, I'm a mom of six.

My two youngest boys are ten-year-old twins, and they both have a diagnosis of Down syndrome.

We utilize Medicaid for a myriad of services, from everything medical with multiple specialists, dental, vision.

But also, we use the FDS waiver, the family directed services waiver, where they're able to access other types of therapies.

We have folks that we can hire, community support workers to help them.

We have interventionists.

Of course, they receive special education services that are funded by Medicaid.

They receive different types of therapy, speech, OT, PT, those sort of things.

So it's a whole host of things that support them.

How are you worried that these services might be affected if some of these proposed cuts go into effect?

Well, I'm concerned about all of them.

I mean, the therapies have been absolutely instrumental in their lives since they were babies.

Teaching them the most foundational skills from eating, walking, crawling, speaking, holding a pencil correctly, everything.

And they continue to be of great value for them as they continue to grow and develop.

They're kind of on a little more scenic route.

So some of those things are taking a little longer, and they need that continued support.

So, losing those would be devastating for sure.

And then those home and community based services are the things that we're kind of able to customize to their needs.

Those are the things that allow them to learn skills that they need to be in their community.

Safety skills, basic living skills, those types of things, help them develop, just more skills like they have some alternative therapies that have taught them some bravery, just some being more adventurous.

Taught them how to swim.

Those type of things.

So they're really valuable, and to see them threatened would be, again, would just be really devastating.

It's services that have brought them to the place that they are now and will continue to support them.

Ned, you're also a caretaker for your daughter.

Can you tell me about your family?

Well, at this point, I'm not a direct caretaker.

My wife and I live in Boise, and our daughter lives in a supported living home four miles away.

And she receives community based services for resident, which includes direct care.

So we have a direct care agency, HISway, which provides staff that come to the house.

She requires 24-hour-a-day care.

Eva had a brain bleed near the time of birth.

And so her disability of cerebral palsy is quite serious.

So she requires 24 hour a day care, and she cannot get through the day at all without direct care helping her to do that.

So I am concerned because Eva has been in this supportive living arena, being cared for, the past 18 years.

And it's home for her.

It's a model that works.

She's safe.

People know her and know how to care for her.

There is no way that her mother and father, who are now in their late 70s, can care for her directly at home.

We cared for her for 21 years at home.

At this point, she's happy.

She's safe.

She has a quality of life that is unbelievably good at this point.

If these cuts go through, to reduce the rates for services to the agency, reimbursement rates excuse me, if those are cut any further.

They were cut earlier in this year.

It is having an effect on the agency.

Many of the staff have to work 90 to 100 hours a week to keep up the dedicated staff.

Staffing is very scarce at this point.

So if there are any further cuts, we'll start to see administrative cuts.

Program cuts.

And then the agency model itself would be on the ropes, Kristyn, you receive services through the developmental disability program.

Can you describe what those services are and what you're worried about?

I am on Medicaid's home and community based services.

I choose to self direct my services under the My Voice My Choice option.

Each year I get an individualized budget I use to recruit, hire, and manage a certain number of community support workers who provide round the clock support to me in my own apartment.

The support my staff provide includes helping me get in and out of bed, shower, use the restroom, get dressed, prepare my meals, drive me to appointments, help me get my groceries, and most importantly, they help me take my medications every day.

My staff do all these things at a fraction of the cost it would be for me to receive these same services in a nursing home.

I am worried that if home and community based services are cut, I will be homeless, because I refuse to go to a nursing home or an institution.

I'd rather die.

I don't have family that I can live with.

And I know that there's been a lot of concern in the legislature and around the country about fraud.

But there are layers of oversight that you go through every year to get your budget to spend on these services.

What are those layers of oversight?

For me.

you to be eligible for these services they must cost less than living in a nursing home to save the state money.

This means I get an annual budget determined through a state assessment process.

Every year I create a plan with the budget I am given that must be approved through the Division of Medicaid.

While I am considered nursing home level of care, and could live in a nursing home based on my needs, I will never make this choice because I refuse to live in an institution.

I want a life, and that is not possible in a nursing home.

People go there to die.

It's certainly more of a conversation than just costs at that point, absolutely.

Dana, I want to bring you into the conversation.

Can you describe the Medicaid services that you use and what your concerns are?

Thank you.

I'm on the aged and disabled waiver.

I have been since I was 18 due to a car accident.

I grew up in a really small community.

I grew up in a farming community.

My family are farmers, or were farmers.

And I was in a car accident, and I moved to Boise to go to rehab, at the Elks back then.

That was back in 1979.

So, I use Medicaid.

I have two other insurances that will not cover home and community based services.

I have people, I also self direct.

We do not get a budget on a A&D waiver.

It's a totally different ran program, but I do have people that come into my home twice a day.

They help me get up, help me go to the bathroom.

I have a job.

I've always worked, and I volunteer.

Without those services, I would not be independent.

Medicaid is like, it's my independence, right?

It helps me be free, be able to contribute to the community.

I do a lot of volunteer work.

I work with the Idaho Access Project, and some other different organizations, where we go out and help businesses, government entities, people with disabilities, understand how to make our communities accessible.

And by doing that, we bring in economic development, because people with disabilities contribute to society.

With the cuts, I'm very, very concerned.

The people that help me only get paid 14 bucks an hour.

They have no benefits.

No vacation.

Really nothing.

They do it because they care about me.

And the beauty of being on a self-directed program is I could hire who I want.

And like Kristyn, I would never go to a nursing home.

I'd rather die.

Ned, you touched on this earlier, too, that you and your wife are older.

Your daughter is an adult who needs people to help her, as she takes care of herself.

What are some of those unique challenges that aging caregivers face as they're trying to take care of their adult children?

Well, as they age.

In our case, when she was small, you know, you can carry around and do all these things, and cared for her for 21 years.

My wife has had three hip replacements.

One failed.

I've had a stroke.

So, we're aging.

We cannot care for her.

Even with this level of care that she needs, it's impossible.

She needs, and she can't- She needs to have someone who can understand her, because she's non-verbal.

But yet she has full understanding.

And she can communicate her needs in other ways.

But as an aging parent, we've done what we can do.

The model of care that has come along has been miraculous for us.

It's saved our lives, and provided Eva with a quality of life that's important.

So we put our eggs in this basket, and it's been performing well.

It's cost effective, but without that she cannot survive.

So what can we, what can a parent do at this point?

We don't have enough funds to provide 24 hour a day staff for our daughter for the rest of her life.

She's likely to outlive us, for sure.

She's healthy.

But what else can we do?

She could become homeless at some point if things completely fell apart.

She cannot care for herself.

She requires this level of care.

Julie, as you listen to this, your boys are still young.

They're ten years old.

What are your concerns about their future?

It's everything that Ned has said.

That, you know, I'm going to age as well.

And there'll probably come a day when I'm going to need care.

You know, so I won't be available to provide care for them.

And, I want a good life, a good future for my boys.

I want them to live.

I don't want them to just exist.

I want them to live a life where they have- They're integrated in their community.

They have relationships.

They have opportunities.

They can go to school if they want to go to school.

They can hold a job, and just have very meaningful life, and give back in the same way that Dana was saying.

And so that, there needs to be a scaffolding around them that gives them that support, so that they can continue to do that.

And right now, it's pretty much my full time job to maintain that, with the services that we have now.

And if I'm not able to do that, of course I'm concerned about who will fill that role, who will love them the way that I do, and provide it for them with the same heart that I do.

Kristyn, I know that your caregiver, one of your caregivers has been with you for 20 years, and both you and Dana mentioned that you don't want to go into a nursing home.

That's not an option for you.

Absolutely not.

Some lawmakers have brought up the possibility of community volunteers or churches stepping in to fill this role.

Dana, is that a viable alternative?

What do you think?

Actually, no, it's not.

You know, it's a great concept.

You know, since I've been hurt, I have heard this concept so many times from legislators over the years.

But when it comes down to it, let's be real.

So on the aged and disabled waiver, there's over 25,000 people on the waiver.

Right?

And I have three people who help me.

And okay, so we take three, so that you need- and that's per week.

So how many people would it take for volunteers?

And how many volunteers are going to come in that are consistent, that know your personal care needs?

Because like, it's like, it's not just like coming in and you know, "Hey, get dressed."

They actually have to physically help me get dressed, physically help me go to the bathroom.

If they don't come in, I don't get up.

I don't eat, and I don't go to the bathroom, and then I don't go to work.

I don't volunteer.

I don't have a life.

Our full interview with Kristin, Julie, Ned and Dana is online.

You can find it on our YouTube channel, youtube.com.

Slash Idaho reports.

Joining me to discuss the broader budget is House Appropriations Chairman Josh Tanner, Senate Finance Chairman Scott Grow, and committee members Reps.

Rod Furniss and Brooke Green.

Representative Tanner, I want to start with you.

Can you walk us through the reasoning for additional proposed cuts from what the governor initially proposed, that 3% versus an ongoing 5%?

So one of the things that when the governor presented his budget was an ongoing aspect is what we looked at.

And that's really your stability, so your long term stability, that's what you look at for that stability aspect.

And what we noticed when we first got this, got the governor's budget, was we were in a negative ongoing balance in 2026.

And then when you got down to 2027, we were in a negative.

But we weren't just in a negative, we were in a significant negative.

We were looking at $107 million negative in there.

So they were using one time abilities to prop up the budget, to make the bottom line in the very end kind of come out.

The word I would hope everyone would remember is uncertainty, because that's what we're dealing with.

We have an increase of revenue number by 100 million or so, over what the governor projected.

There's no certainty that that will come in.

And the governor's budget, there are also some policy bills that other committees would have to pass, over $50 million worth.

And that impacts what we're going to have happen in JFAC.

The other thing that is uncertain, he talked about the one time versus ongoing money.

We look at the bottom line, which is the end after all the revenue less all the expenses.

And what's left?

Last year when left the Senate, when we left the legislature, we had $430 million left on the bottom line.

And that's essentially gone now.

the governor has his 3% hold backs.

That does affect Medicaid.

And the 1% and 2% that we've added here for 2026 and '27, we are not increasing any cuts to Medicaid.

So we're leaving all of that intact.

Now, the other thing that they need to understand is the governor worked with his staff, the executive branch and those departments and agencies.

They made decisions where they were going to cut.

That's their first cut.

We, as the Joint Finance-Appropriation Committee, have an opportunity to look at that again.

And so we have different workgroups, specialists around, who have an opportunity to look at what has been cut by the department.

The health and welfare department.

And they can make modifications if they choose to.

So that's not the end game.

But I want your viewers to understand that we are not doing any additional cuts to Medicaid.

And since you brought up <edicaid, I want to remind viewers of the conversation we had earlier with the four Medicaid recipients or Idahoans whose children are on Medicaid.

And they had some real concerns about existing proposals from the governor's office.

Let's take a look.

Okay.

Staffing is very scarce at this point.

Without that kind of care, my daughter cannot survive.

I am worried that if home and community based services are cut, I will be homeless, because I refuse to go to a nursing home or an institution.

I'd rather die.

The ability to find caregivers that are willing to work for you, for the low wages that you have and the lack of benefits.

There's no health insurance.

There's no 401K, there's nothing.

And you, with caregiving, it's not a job that just anyone can fill.

I really wish that before they start cutting programs, they would sit down and talk to us, and look at what we can do to fix the programs and not totally cut the programs.

So we have two parallel conversations here.

We have the numbers and the bottom line, and then we have how it affects Idahoans.

And one of the things that one of our guest, Kristyn, wanted me to ask was, "What would you do if you were in my shoes?"

Is the legislature listening to the concerns of Idahoans who are affected by these cuts?

We have received emails, phone calls, text, people have come into our offices asking for changes.

We hear very clearly a lot of concerns have been expressed.

And that's why, again, within the Joint Finance-Appropriations Committee, we will have those a work group that will look specifically at that.

And if there are tweaks or changes that need to be made within what the governor's recommended, that work group can bring that forward to the whole Joint Finance Appropriation Committee and we'll vote on it.

I absolutely have an opinion here.

So one of the things is that JFAC, because of the way it's set up, doesn't have public hearings.

Oftentimes those take place in the germane committees.

We have been asking in this particular case to be able to have some type of hearing.

So the Democrats took it upon ourselves to host a two, three hour forum where we invited, you know, the public to come and tell us, and to share with their stories.

We had three overflow rooms full of people who, just like the people who were on speaking to us a moment ago, this is real life.

This is their reality.

Are we listening to them?

Absolutely.

Are we all getting phone calls?

Absolutely.

But are we able to address their needs, with the way the system has been put in place this session?

No!

Just a little bit about the mechanics of JFAC and what we're dealing with.

So, we voted for the first 2026 vote, right, which was that 3% and then the 1%.

That's the fiscal year we're currently in.

Yes.

That had the 3% hold back last year and an additional 1% hold back after the vote.

Yes.

And part of that 3% was the 4% to the providers.

And then furthermore, you move into 2027 where we see additional cuts.

We have made permanent those 4% provider cuts.

what we are seeing in some of the cuts, especially in mental health, we're seeing cuts that we're losing federal dollars match because of those cuts, in some places.

We're also seeing increased pressure on the sheriffs and ER, because when you cut mental health, you have more people that go to the jails, you have more people that go to the ER, and we're seeing that increase.

We also had a program where it's called ACT where they take the top 400 individuals in the state that need mental help, and they monitor those almost 24/7.

We've had two suicides from them already.

And what we really need to do is look at the long term, make sure we maximize our federal dollars if that's the case, and then make sure that we don't put pressure back on the property taxpayers.

you really have to look at Medicaid as a whole.

And you know I've been very critical of Medicaid throughout the entire time I've been in legislature, because I am a numbers guy.

I sit down, I look through it.

And just from a fiscal standpoint, it is unstable.

Part of the problem is that the legislature itself, the state of Idaho does not have the control mechanisms within it.

The federal government gives us these massive levers to pull, and that's pretty much what they give us.

Within that, we get certain ones we can play around with, which is what you kind of saw the governor give that proposal of what he's looking at.

Now, a lot of people that are the most scared of, the ones with the home and community based services, which, talking with both health welfare committees, is not one that is even being looked at.

But there are a lot of people out there that are really driving up this committee.

I mean, we saw what the Democrats did, bringing a lot of people together, trying to trying to create this fear aspect of what is going on, when some of the areas that they're really fearful of are not even areas that are going to get looked at.

And so it is frustrating, that part is frustrating.

Provider rate aspects, we gave large provider rate increases just a few years back.

And it was a tough thing.

I advised against it at that point in time.

This last year we were passing the Medicaid budget out.

I pushed for a provider rate cut at that point in time because we needed stability within that, in those numbers, because otherwise we do hit a point to where all of a sudden you're cutting some of those programs that will be large cost drivers, just from a cash flow standpoint.

And those are sometimes those are hard decisions.

We look at Medicaid expansion.

To me, I think the areas you want to look at to protect the most are the children, the disabled and the elderly.

We do have a large population of able bodied working adults that get service.

It's supposed to be $400 million.

Now it's at $1.3 billion.

You said that you were previously opposed to rate provider increases.

You support the 4% ongoing cut to those Medicaid reimbursement rates.

And at the same time, you're also saying that the most vulnerable need to be protected.

Well, they're the ones who are telling us that they are the most impacted by those rate provider cuts.

How do you make those two truths mesh for you in this budget?

To me, it's going through and looking at which services and which programs that are out there, that are the ones.

I mean, if we are looking at certain ones, like I said Medicaid expansion is one, it'd be an easy one for me to check off.

Thanks so much to the lawmakers for joining us.

So you can find the rest of our much longer conversation online at youtube.com.

Slash Idaho reports.

And thank you for watching.

We'll see you here next Thursday.

Presentation of Idaho reports on Idaho Public Television is made possible through the generous support of the Laura Moore Cunningham Foundation, committed to fulfilling the Moore and Bettis family legacy of building the great state of Idaho.

With additional major funding provided by the estate of Darrell Arthur Kammer in support of independent media that strengthens a democratic and just society.

And by the Hansberger Family Foundation.

By the Friends of Idaho Public Television.

The Corporation for Public Broadcasting.

And donations to the station from viewers like you.