Clause in bill that cuts Idaho Medicaid costs eliminates program doctors say is critical for patient care

IDAHO FALLS – A new bill that reduces the cost of Medicaid eliminates a program doctors use to coordinate the healthcare needs of their patients and replaces it with managed care. Doctors say the change will have a detrimental effect on their ability to treat patients.

House Bill 345, which was signed into law by Gov. Brad Little on March 19, aims to strengthen Idaho’s Medicaid program and ensure its longterm sustainability, according to its statement of purpose. It requires legislative oversight to “balance healthcare access with financial accountability.”

“We want Idahoans to become as self-sufficient as possible. House Bill 345 reinforces that goal while reasonably reeling in Medicaid spending so taxpayers are not overly burdened by this program in the outyears,” Little said in a written statement.

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The bill went into effect immediately through an emergency clause.

While the idea of cutting costs is appealing to many Idaho voters, another clause within the legislation has pediatricians concerned. It calls for the dismantling of the Idaho Healthy Connections Program.

“The department shall discontinue contracting and reimbursing as part of the healthy connections value care program through value care organizations and the healthy connections primary care case management program by January 1, 2026,” the bill says.

The Idaho Healthy Connections Program, created about 20 years ago, allows patients to connect with a primary care provider. Clinics use it to coordinate their patients’ healthcare needs. In an email to EastIdahoNews.com last month, Dr. Ty Webb at Idaho Falls Pediatrics, which utilizes this tool in its practice, explained how it benefits patients.

“The Idaho Healthy Connections program was designed to tie patients to a primary care provider who they could call on … (for) preventative medicine and overall health and wellness,” Webb writes. “We strive to … know who each of those kids are and (meet their needs).”

Sen. Julie VanOrden, R-Pingree, who co-sponsored the bill, says it costs around $22.5 million annually to fund this program, which is why it was eliminated. A combination of federal and state dollars makes up that amount.

The bill calls for Idaho to shift management of all Medicaid benefits to private companies, a practice called managed care that is used by most states’ Medicaid programs. It requires the Idaho Department of Health and Welfare to have a proposal ready for approval by July 1, 2027.

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Once it is approved, Idaho health officials say managed care will not take effect until 2029, resulting in a three-year gap between the dismantling of the Healthy Connections program and managed care.

It’s that transitory gap that doctors are concerned about, and local pediatricians we spoke with would like to see the Healthy Connections program get reinstated until a managed care plan is approved.

Dr. Brian Fulks with Pocatello Children’s Clinic is among those who feel that way.

“I understand the Legislature’s goal was to reduce the Medicaid budget by focusing on those individuals that were able to work and could get off Medicaid. Unfortunately, the cuts they made disproportionately targeted Idaho children. The only solution I can think of is providing some kind of exemption for pediatric care until a new proposal is ready to go,” Fulks tells EastIdahoNews.com.

What doctors are saying

Webb provides his perspective on why eliminating the Healthy Connections program is a bad thing.

“One of the most significant changes is that it no longer ties patients to a primary care provider who gets to know them and their individual needs. It also removes a significant amount of funding that has been critical for us to be able to provide this extra care and coordination that goes into being a medical home,” Webb explains.

Clinics that use this resource qualify for a certain amount of funding every year based on certain criteria. Idaho Falls Pediatrics serves roughly 6,500 patients, and the Healthy Connections program accounts for about 30% of its annual revenue.

Webb says this will have a significant negative impact on the clinic’s ability to treat patients.

“Those funds will no longer be provided to us, the healthcare professional who knows these kids, and will instead be transitioned to a managed care organization where this will be run by two insurance companies,” says Webb. “Insurance companies … have never looked at me or any of my patients as the people we are, or the needs we have.

Idaho Falls Pediatrics isn’t the only clinic that will be negatively affected by this bill. The impact extends to at least 23 clinics across the state, which in turn affects more than 350,000 patients.

Dr. Fulks, Dr. Webb, and Dr. Kelly Anderson at the Pediatric Center in Idaho Falls say the elimination of the Healthy Connections program will force them to reduce the number of hours and employees.

“We don’t have deep pockets or big healthcare dollars to fund a loss like this. It will make things very difficult to continue to provide these services as they presently stand,” Webb says.

Local clinics are joining forces to raise awareness. In a letter to EastIdahoNews.com last month, Fulks said the cost of running the Healthy Connections program is only a small fraction of the state’s overall Medicaid budget. Nearly 50% of Idaho’s children are on Medicaid, he says, and its elimination “will have an outsized, negative impact on pediatric care.”

“The political climate has been really focused on … taking money out of government hands and giving it back to the people. The elimination of the Healthy Connections program is essentially the opposite of that trend. It is taking money from Idahoans who see, care for, and truly love our little patients, and sending those funds to a healthcare bureaucracy that does not know your child, their needs, their wants, or their desires,” Webb says.

What legislators are saying and how you can help

Throughout this conversation, doctors we spoke with said it is not their goal to bad mouth Idaho legislators. They appreciate all they do to make Idaho a great place to live and say it’s possible the elimination of this program is a consequence they did not foresee.

They’ve been in contact with Sen. Kevin Cook, R-Idaho Falls, who voted in favor of this bill. After bringing this issue to his attention, doctors say he’s since been working with them to address their concerns.

EastIdahoNews.com has been unsuccessful in speaking with Cook after multiple attempts to reach him, but he did leave us a message explaining his position.

“Yes, I do believe we have a problem,” Cook said. “Many of these clinics do everything they can to help parents with their kids, and on Jan. 1, they’re apt to lose $800,000. That’ll be a 20% hit on (their income).”

As VanOrden worked with legislators in drafting this legislation, she says it was the rising cost of Medicaid and work requirements that drove the conversation, including among the medical community. She says the elimination of the healthy connections program was never brought up among advocacy groups.

Idaho Healthy Connections qualifies as a managed care program, VanOrden says, and she’s surprised it wasn’t a focus.

VanOrden says providers can still use the program after January 1 — they just won’t have any state or federal funding for it.

“If you have a great program, you better start looking for other ways to fund it,” VanOrden says. “If you’ve looked at the makeup of the legislature lately, there’s going to be a lot more cuts in funding that come.”

She encourages those who are concerned about the elimination of the healthy connections program to lobby their legislators. Getting it reinstated would require new legislation with a fiscal note specifying the amount needed to fund it. It likely wouldn’t be addressed until the legislature reconvenes in 2026.

“Getting it reinstated before January 1 would require a special session and there’s no appetite for that,” says Van Orden.

Meanwhile, the Idaho Medical Association is partnering with the Protect Our Healthcare Coalition on a national texting campaign opposing cuts to Medicaid. It’s not related to the Idaho Healthy Connections Program. Doctors are urging people to get involved.

To get involved or learn more, click here.