Idaho lawmakers approved a targeted reduction to disability home care programs this year, rejecting broader Medicaid cuts proposed by the governor in January. The state’s decision coincides with a significant shift in federal policy under the Trump administration, raising concerns among advocates about the future of community-based services for thousands of Idahoans.
In January, the governor outlined several options to decrease Medicaid spending, including substantial reductions to home and community-based services (HCBS). Legislators opted for a narrower cut rather than adopting the more aggressive proposal. Earlier this year, state officials estimated that HCBS cost Idaho taxpayers more than $176 million in general funds.
More than 16,000 residents utilized these services at least once annually. The majority of users are aging seniors who own homes and require assistance to remain living independently rather than moving into facilities.
Federal Policy Shifts on Integration
The state’s budget adjustments come as the federal government reinterprets long-standing disability rights mandates. In June, the U.S. Justice Department issued a memo seeking to reinterpret the Supreme Court’s 1999 ruling in Olmstead v. L.C.
The memo stated that neither the Americans with Disabilities Act nor the Rehabilitation Act imposes an integration mandate on states for individuals with mental disabilities. The Justice Department argued that the Supreme Court did not require states to treat mentally disabled patients in the most integrated setting appropriate to their needs.
Christine Pisani, executive director of the Idaho Council on Developmental Disabilities, said the memo signals that the Justice Department will no longer enforce or investigate challenges related to integration. This marks a reversal from more than a year ago, when the Biden administration’s Justice Department warned Idaho officials about violating the Americans with Disabilities Act by unnecessarily institutionalizing people with physical disabilities.
Advocates Warn of Institutional Risks
Disability rights advocates argue that reducing home care funding could force vulnerable residents into institutions. A joint statement from Idaho and surrounding state advocates said the federal memo ignores the risks of shifting people to institutional settings.
“It is silent on the fact that institutional placements are the most expensive placements,” the joint statement read.
Advocates noted that Idaho already lacks sufficient institutional capacity to care for people with disabilities if home services are cut. Retired attorney Jim Baugh stated there is insufficient infrastructure to support a shift toward institutional care.
Baugh described past institutional experiences as horrific, citing abuse and neglect as standard operations in those facilities. He warned that states will be reluctant to replace shrinking federal funding with state dollars, tempting them to reduce HCBS further.
“When (states’) federal funding shrinks, they’re going to be reluctant to replace it with state funding, and so they will be tempted to try to reduce funding for home community-based services,” Baugh said.
Federal Medicaid cuts were enacted in President Donald Trump’s One Big Beautiful Bill Act. Advocates worry there are no alternative plans for people who lose or have reduced home care services as federal funding shrinks.
The Justice Department could not be immediately reached for comment regarding the impact of these policy changes on Idaho residents.