Idaho families are facing increased uncertainty regarding Medicaid-covered therapies for children and adults with disabilities. New limits on the number of therapy visits took effect this month, and a proposal from Governor Brad Little could eliminate coverage for speech, occupational, and physical therapy altogether.
Therapy Access Already Limited
As of January 1st, Idaho Medicaid began capping therapy visits at 20 per year for patients receiving physical, speech, and occupational therapy. The Department of Health and Welfare (IDHW) announced the change in a letter to providers on January 8th, catching many off guard. Sarah Bergsma, co-owner of ‘We Are Better Together’ therapy clinic in Meridian, noted the short notice, stating, “We just had a meeting with them in December, and nothing was announced then…it seems a little shocking that we would get a letter and that it would be retroactive.”
IDHW stated the change aligns Idaho’s policy with those of Wyoming and Utah, which also require prior authorization after a certain number of visits. Additional visits beyond the initial 20 can be requested through a prior authorization process, requiring providers to demonstrate continued medical necessity.
Potential for Complete Elimination of Coverage
The new visit limits may be only the first step in a series of cuts. Governor Little’s proposed budget for fiscal year 2027, beginning in October, includes $45 million in Medicaid expenditure reductions. This proposal calls for the complete removal of Medicaid coverage for speech, occupational, and physical therapy services. The budget also outlines potential cuts to hospital rates, dental services, and other essential care.
Impact on Families
The potential cuts are causing significant concern for families who rely on these services. Julie McConnel, whose twin sons Charlie and Milo—who have Down syndrome—receive therapy at ‘We Are Better Together,’ expressed shock upon learning of the proposal. “I’m stunned. I can’t understand the rationale behind that,” she said. “I don’t understand why it’s some of the most vulnerable people in our communities that have to suffer when we’re looking to make cuts.”
McConnel emphasized the transformative impact of therapy for her sons, noting that it has boosted their confidence and improved their skills. She also highlighted the importance of the therapeutic relationship, stating her family travels from Nampa to Meridian specifically for the quality of care at ‘We Are Better Together.’ She fears her family, like many others, cannot afford to pay for these services out-of-pocket.
What’s Next?
Governor Little’s budget proposal is now before the Idaho Legislature. Lawmakers will ultimately decide whether to adopt the proposed cuts during the current legislative session. Providers and families are planning to advocate at the Capitol in the coming weeks. If the proposed cuts are approved, access to vital therapy services could be significantly reduced or eliminated for many Idahoans on Medicaid. It is possible that the legislature will modify or reject the governor’s proposal, but the outcome remains uncertain.
Frequently Asked Questions
What changes have already been made to Medicaid therapy coverage?
As of January 1st, Idaho Medicaid is capping the number of physical, speech, and occupational therapy visits at 20 per year. Additional visits require prior authorization from IDHW.
What is Governor Little proposing?
Governor Little is proposing the complete elimination of Medicaid coverage for speech, occupational, and physical therapy services as part of a larger plan to reduce Medicaid expenditures by $45 million.
Who will decide the fate of these proposed cuts?
The Idaho Legislature will ultimately decide whether to adopt Governor Little’s budget proposal, including the proposed cuts to Medicaid therapy services.
How might these changes impact individuals with disabilities and their families in Idaho?
