BOISE, ID – In August, Jacque Poulsen’s business was in the red.

That’s partly because Medicaid doesn’t pay for all the work that the program requires.

Her personal care agency, ProHealth Professional HomeCare, serves people with disabilities across southern Idaho.

As she and other disability care providers warn that new cuts could push them over the edge, Idaho officials say the state is trying to carve out their services from Medicaid provider pay cuts.

Advocates say the cuts could have hampered access to disability care providers in Idaho — piling onto the state’s shortage of direct care workers, who work in relatively low-paid, demanding jobs that often require helping people with disabilities with day-to-day tasks.

She said people wouldn’t work in the jobs for $14 an hour, when they could work for a fast food restaurant for more.

But providers say they’re still in need of pay raises.

Idaho wants to exempt some services for personal agencies, family homes from Medicaid pay cuts

The Idaho Department of Health and Welfare announced 4% cuts to Medicaid provider reimbursement rates in late August. The move was in response to Gov. Brad Little’s order for mid-year budget cuts across state government to avoid a budget shortfall.

The Medicaid pay cuts are already in effect, sort of.

The state is paying providers the usual reimbursement rates. But once Idaho gets permission from the federal government, the state can claw back funds for the cuts.

Health and Welfare spokesperson Greg Stahl told the Idaho Capital Sun last week that the agency is asking the federal Centers for Medicare and Medicaid Services to let the state exempt services for personal care and certified family homes from the cuts.

“The requests held harmless personal care services and certified family homes from rate adjustments following the required access analysis and public comment,” Stahl said in an email. “The department will post an information release for providers in the coming weeks with more details.”

Idaho can’t afford to lose more providers, advocate says

Idaho Association of HomeCare Agency President Lindsey Hendricks said exempting disability care providers from the cuts doesn’t solve their financial issues.

“We’re still so far behind on where we should be with reimbursement rates,” she told the Sun.

If payments stay on track, about a quarter of Idaho personal care agencies are at risk of closing within the next year, according to a survey by the organization. And if the state’s cuts to Medicaid payments extend to disability care providers, even more agencies anticipate they’d be forced to make tough decisions, like closing their doors, cutting staff pay or services.

In 2023, a report by the Idaho Office of Performance Evaluations estimated Idaho had a shortfall of 3,000 direct care workers. But by 2023, the report projected the shortfall would more than triple — to 9,500 workers.

Idaho can’t afford to lose any more providers, said Idaho Council on Developmental Disabilities Executive Director Christine Pisani.

“We are well on our way of having a complete void of service providers as a result of not addressing the direct care workforce crisis in Home and Community-Based Services,” she told the Sun. “So, who’s really going to get hit hard are our seniors, people with disabilities and families. And our rural areas have already been left behind. … So anything they do have, I think is going to be lost.”

Most of the home care providers in the Idaho Health Care Association already don’t take Medicaid — because the program’s reimbursement rate hasn’t kept up with costs, said the group’s Executive Director Robert Vande Merwe.

Exempting them from the cuts, he said, “keeps them at status quo, which is still not enough.”

“We’re urging the Legislature not to cut taxes again, unless they have a plan to stabilize the budget,” Vande Merwe said.

He thinks the governor may need to cut spending more “just to stay whole from the last year’s tax cuts,” he said. “If they cut taxes again this session, boy, there’s going to be dramatic cuts in services.”

This story first appeared on Idaho Capital Sun.