Narrator: 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.

By the Friends of Idaho Public Television and by the Corporation for Public Broadcasting.

Logan Finney: How we care for vulnerable people changed a lot during the pandemic.

And with the federal government reexamining how we pay for entitlement programs, more changes are on the way.

Filling in for Melissa Devlin I'm Logan Finney.

Idaho Reports starts now.

Finney: Hello and welcome to Idaho Reports.

This week we take a look at some of the big changes coming to Medicaid from both the state and federal level and how that affects Idaho families.

But first, the University of Idaho's McClure center for Public Policy Research released a new report this week on population change in the state.

And according to the census data, net migration to Idaho jumped to an estimated peak of about 52,000 people in 2021.

And it stayed around the pre-pandemic high since then.

On Friday morning, I asked Liz Bageant, the McClure center economist, what we know about the segments of the population who rely on the social safety net.

Liz Bageant: In Idaho, we see these trends where there are fewer younger people, more older people.

And that's despite all of this migration.

So the migration is sort of younger people is pushing back against that trend, but it's still happening.

Well, I would also add, aging of the population is also driven by lower birth rates.

So the birth rates discussion, people have fewer kids, fewer people have kids, there are fewer younger people sort of being born into the population.

We are getting a lot of young people, but it's not enough to turn the tide on the aging of the population.

Finney: You'll be able to find that full conversation with Liz Bageant, next week on the Idaho Reports YouTube channel, or wherever you listen to podcasts.

Back in September, the team visited working mother Randi LaSalle at her home in Twin Falls, where I asked her what life is like for her family living right at the income threshold for Medicaid.

Randi LaSalle: I have four kids.

Alex is 17.

Olivia is 11.

Gregory just turned 7 and Jason is 5.

The three younger ones live at their dad's half the week.

And then with me.

And then Alex was lives with me full time.

I work from anywhere from, 7 to 5 or 8 to 5.

But I also bring work home a lot.

It's very busy, and I try to get as much done as possible.

I pick up work wherever I can.

So if a yard needs done or if I can go DoorDash or anything like that to make a little bit of extra money., I will.

I make $20 an hour at my one job.

And if I relied just on that, after taxes and insurance and 401k, you know, all of that special stuff that comes out of a check, I'm lucky to bring home about $1,200 to $1,400 a month.

And that's based with overtime and things like that.

And I average about 10 to 15 hours of overtime a paycheck.

Before Covid and during Covid, we had Medicaid for everybody in my household.

We were fine.

We had everything.

You know, we didn't have any issues.

And then when Covid was over and the extra coverage ended, they dropped all of us.

My kids ended up going without insurance for eight months.

Because they dropped us in the worst time period of the year, right there, in I think it was the end of February, beginning of March, where you cannot renew or add anybody to your insurances.

And then you don't start to reenroll until October, and then it doesn't go into effect until December 1st.

So my kids ended up without insurance for that long.

I looked through the limits.

You know, how much I made and at the time, how much my ex-husband made.

And we for a six person household, we made $400 under the limit.

But they told me that I made $75 over the limit and that I couldn't.

We couldn't recertify.

Once I was able to get my kids onto my work insurance, it was $450 a paycheck.

Give or take a little bit here and there.

So I was paying about $900 a month for insurance.

There have been days where we choose between gas and food.

Since I got a little bit of a raise at work, it's getting a little bit better.

I have a little bit to save, but it's still a little bit.

You know, what am I going to do when I need new tires?

Insurance for cars don't pay for new tires.

They don't pay for oil changes.

What am I going to do when the kids need braces?

And Olivia needs braces.

You know, those aren't cheap.

And my insurance that I have her on doesn't cover braces.

You know, glasses.

We went and had eye appointments, it was $60 a person.

I had to save for that.

And then we had to pay for glasses for me and Olivia.

I went ten years without getting new glasses, just to make sure that everybody had what they needed, you know.

And it seems like it's not a big thing, but it is when you're driving down the interstate at 80 miles an hour trying to get somewhere in a snowstorm.

I think they need to go back to the drawing board.

And I think they need to consider that just because we make over a certain amount doesn't mean that we don't need it.

Find another structure.

Create a tier system.

Okay, so I make $75 over the limit.

I'll pay $10 a month per kid.

$300 over the limit.

I'll pay $25 a month per kid.

It's still cheaper than private insurance.

And it covers absolutely everything.

They need to understand what it's like to be poor.

And I'm not talking, you know, shackle house falling apart poor.

I'm talking paycheck to paycheck, barely making ends meet.

Shopping at the dollar store for three pieces of baloney poor.

They need to understand that.

Because if they can understand that, they'll understand that their Medicaid bill should have been thrown out while they had good intentions.

They need to try harder.

Finney: Back in Washington, DC, the US Senate could spend much of June making its mark on President Trump's so-called big beautiful bill, which we told you about the House of Representatives passing last week.

The package could cut the country's Medicaid program by as much as $800 billion over the next decade.

Idaho's US Senator Mike Crapo, chairman of the Senate Finance Committee, signaled his support for the president's agenda last week, saying, quote, the Senate will continue working through its process to make Trump's tax cuts permanent and deliver additional tax relief for American workers and families.

And I look forward to continued coordination with our House colleagues.

Logan Finney: Medicaid is of course, a state and federal partnership.

And the Idaho Department of Health and Welfare has to get permission from the feds and the legislature to make changes to the program.

Last November, IDHW notified lawmakers that it planned to end a program called Family Personal Care Services, which allows parents and spouses to receive payments for providing in-home health care for their family members.

The program started during the Covid 19 pandemic to address the shortage of direct care workers, as well as to stall the spread of the virus.

Before the pandemic, state and federal law prevented family members from receiving payments for providing personal care services.

In a November letter to state lawmakers, Health and Welfare Director Alex Adams cited a growing caseload in the program and costs nearly quadrupling between 2022 and 2024.

Adams also expressed concern about fraud from some using the system, telling lawmakers of an audit that found parents sharing information on how to manipulate assessments to receive maximum payments, triple or double billing, or logging more than 24 hours of care in a single day.

As the Idaho Capital Sun reported earlier this year, the federal government extended the overall program while considering a medicaid waiver change for Idaho.

Earlier in May, the department notified families the program would be ending in about two months.

Joining me to talk about all of this is Kyle Pfannenstiel, a reporter for the Idaho Capital Sun.

Kyle, thanks for joining us.

Kyle Pfannenstiel: Thanks for having me, Logan.

Finney: So, Kyle, what is special about this family care program?

We've, of course, been covering the direct care worker shortage for a long time.

But what was unique to this program, the other direct care didn't offer.

Pfannenstiel: So right now in Idaho, with this program in place, there's there's two ways that two main ways that families get caregiver services for their loved ones who have disabilities.

So there's the typical route, which is direct care workers there.

There are people who are, who are who are trained and paid and, professionally employed by a direct care agency to go work as, caregivers.

The catch is that Idaho and a bunch of other states have had a really bad shortage of these workers, and that's led to, families in need of caregiver services, really struggling to find caregivers who can meet the hours they need.

And this program, was created during the pandemic, this family caregiver program.

And it let, family members, parents and spouses specifically, be allowed to be paid as caregivers.

And this was meant to deal with, you know, this was during the pandemic.

So it was meant to reduce the spread of Covid.

These are a lot of medically vulnerable people who need who need care.

And introducing another person to the home represents more risk.

And, and then it's also meant to deal with this, shortage of direct care workers and, and, excuse me.

So, so families, families really appreciated film is that I talked to really appreciated this program because, a lot of them talked about how difficult it was to to really get consistent direct care workers.

I've covered direct care, issues in the direct care workforce for years, and I've heard stories of direct care workers being, showing up late, late, late to their shifts, which means for some people who have, disabilities that limit their movement, they can't get out of bed.

And some only stay on the job for a couple weeks and leave, and that barely leaves them.

Time to get trained up to people's individual needs to provide caregiver services.

And so families really appreciated this, this option, this family caregiver program to to let family members who know more about, about their loved ones care needs people to provide that care and get paid for it.

Finney: And so this was a pandemic era program like we've referenced.

Why is why is the Idaho Department of Health and Welfare looking to wrap this up a couple months early, before the feds even intended to?

Pfannenstiel: So, yeah.

So it's important to note this this program was already set to expire in March of this year.

That's when our federal approval, allowing for this program, to be in place would have ended.

And so the Idaho Department of Health and Welfare last November announced that we're going to seek to end it early.

They said that that cost was spiking.

Enrollment was spiking in this program much faster than they predicted it would.

And, they also they also found a number of fraud instances.

And you outlined them pretty well.

Of of where they believe that there were some instances of fraud and abuse of the program's benefits, and they didn't have enough safeguards in the program to make sure that it was being overseen in a way that protected taxpayer funds.

And that also protected the health and safety of children.

Like, I think you talked about, double and triple billing for for caring for the same kid at the same time.

And, and also also working other jobs while you're doing this.

They talked about like, some parents were, were billing services, for caring for a child while while, while also working, a rideshare service.

And and so that that those are those are the main reasons why health welfare sought to to end this program.

The federal centers for Medicare and Medicaid Services recently approved that an ending of the program.

And, and and obviously that that the health welfare submitted a plan for other options that families have as well.

Finney: And so you've talked to disability advocates in your reporting on this issue.

What sort of concerns are you hearing from them as this program has ended?

Pfannenstiel: Well, they they they're deeply concerned about the end of this program.

Health and welfare has had has cited some, some statistics.

They've seen a, a 10% increase in direct care workforce.

And, they feel pretty confident that, that other options can fill families needs.

But but families I've talked to don't really feel that way.

Because because they talk about all the issues we talked about just a few minutes ago, all these issues in the direct care workforce and the kind of churn of workers that that leaves families in this position where where they're constantly dealing with new faces in their household and, and also they worry that, you know, some families say that they know their kid best, or their spouse best.

And it's important to note that this, this, this family caregiver program was just allowing, parents and spouses to be paid caregivers.

So, so other family members are currently, even after this program and still allowed to be paid caregivers like cousins, aunts, uncles, grandparents.

Finney: Grandma and grandpa aren't always available, though.

Pfannenstiel: And these can also be physically demanding job sometimes if people have, people have disabilities that affect their movement, this requires, you know, oftentimes use, kind of machinery to help, but they help lift people out of bed, help them use the bathroom and bathe.

So these can be demanding jobs, and they're often pretty low paid.

Last time last I heard was these these jobs are typically paying around the same price as you can get to go work at a fast food restaurant.

And they're they're pretty demanding and they have high, high turnover rates.

Finney: And so this program, the family services program isn't meant to be supplemental income, right?

It's supposed to be paying the parents to provide this care.

If health and welfare was having trouble managing this program or making sure there wasn't cost overruns or fraud and abuse happening, why not invest more in managing the program rather than ending this?

The service for families who arguably really need it?

Pfannenstiel: Well, a few reasons.

When they did announce they were going to, they were going to seek to end the program early.

They also announced, a range of different programs, safeguards, I think like multiple, multiple different checks for, for, for compliance with the program.

And, but but it's also worth noting that investing more in the program would, would have required legislative approval in, in and if they also were to seek to end the program or to seek to extend the program, that that would have also likely required legislative approval.

So so the health and welfare was kind of in a, in a tough position of where they would have has to have to ask the legislature to do that in an environment where, you know, we saw budgets this year have have a very tough time making it out of the floor.

Finney: So as this specific family caregiver program is ending, you you referenced a little bit that health and wealth, health and welfare has given families some options.

But what what sort of programs, what sort of other options are available for these families.

Pfannenstiel: So there are a few options.

Health and welfare outline.

You know, work with direct care director agencies that families have worked with in the past.

Try to see if if workers can fill the hours that your family members need.

And and also there are, you know, other family members who aren't, this this program was specifically for what's called legally responsible individuals.

That's parents and spouses to be paid caregivers.

But like the talked about, other family members can still serve as paid caregivers in Idaho, even when this program ends.

And that's still an option in, in parents and spouses who became direct care workers, are still able to go provide direct care services, just just not to their family member, that that's their, that's their child or their spouse.

So they can go work for another family.

But but families I've talked to again say that these options are enough, and they're, they're very concerned that that kids will be able to get the care they need without this program because of the shortages.

Finney: And what is what could happen to those kids if they're not able to get care from a family member or an in-home direct care worker?

Pfannenstiel: Well, I, I, I don't like to predict the future too much, but but these can be pretty tragic stories of, you know, I've heard stories of people where if direct care workers don't show up, they, they, they can't get out of bed, and they soil themselves some times and like, you know, their dignity is violated.

And, and, and, and families will need to, you know, if they don't have this income stream going in, like, they might have to make adjustments in their work, their work schedule, to go work at their jobs or something.

So, but but but health and welfare remains confident that that, that the options and the resources that that are out there besides this family caregiver program will be adequate to provide these services.

Finney: All right.

Well, I've got just about a minute left with you, Kyle.

As this program is ending and as we're moving forward into the rest of 2025, what are you going to be keeping an eye on as you keep reporting on this issue?

Pfannenstiel: Well, I think I'm very interested to see if if these other options, can, can fill the needs of kids because, we've had we've had a long standing direct care shortage workforce.

It was a really in-depth, report by the Office of Performance Evaluations on that.

We've reported on that.

And, I'm also interested in how, how these program fraud and abuse allegations shake out, seeing if, if there's any, if there's any accountability, for that or, or if there's any additional corroboration of these claims.

I think parents I've talked to, have expressed some frustration with with how little substantiation they've received of these claims from health and welfare.

And I'm also interested to see what the legislature does about this, because, Finney: All right.

Well, unfortunately, that is about all the time that we have for you, Kyle.

We're going to have to have you back to keep talking about this.

Kyle Pfannenstiel with the Idaho Capital Sun.

Thanks for joining us this week.

Pfannenstiel: Thanks for having me.

Finney: Last week, lead producer Melissa Davlin spoke with local mother Shannon French, as well as her children Ruby and Grady, about what losing access to this program means for their family.

Melissa Davlin: Shannon, thank you so much for joining us.

And thank you, Ruby and Grady, for joining us too.

How has this program helped you and your family?

Ruby French: Everything.

Shannon French: Everything.

Melissa: Everything.

Shannon: So, I think for us, I didn't really know this program existed.

But until I started doing it, I didn't have care for my kids in regards to their self care.

So I had, you know, my parents would watch them sometimes.

I had, not really friends.

I had a few babysitters.

But when you have kids that have needs that are.

She misses her grandparents.

My parents are both passed away.

So, but when you have kids with special needs, it's hard to find care.

It's a little more than just hiring a babysitter.

So this has allowed me, especially since I'm the one able to do it.

To be able to stay home, to help them with their self-care tasks.

And they've both grown quite a bit in the things that they're capable of doing and hopefully, if the program continues, that would continue for them to be more independent the older they get.

Melissa: Ruby, what do you like about your mom taking care of you?

Ruby: I think everything.

Shannon: Everything?

Ruby: Yeah.

Shannon: What do you like the best about me being home?

Ruby: Yeah.

When your home we can go swimming everyday.

Shannon: We can go swimming every day?

Not quite yet.

Grady French: Not every day.

I like the fact that we can go places like swimming.

I also like the fact that, my mom is the one who cooks for us and take care of us.

Takes care of us.

Because she's the one who knows us the best.

And we love her the most.

Shannon: Thank you.

Melissa: Now that the state has announced that this program is going away in two months, what are your concerns?

Shannon: I mean, gosh, there’s so much unknown.

You know, my kids are too old to go to a daycare.

And this program, you, if I find another provider, which they're 90% of families, there's about 1400 families on the program, and 90% of them have said in a January survey that they don't have a backup provider.

So, if I do find someone to come in and provide services, which I'm not opposed to, but I've checked with several agencies and they don't have extra workers.

They can come into my home, but it's not allowed to be like a daycare.

So I can't go to work and have someone in my home all day because that's against the kind of the rules.

Melissa: They’re not babysitters.

Shannon: Right, they're not babysitters.

And I have two kids.

So, somebody can only work with one at a time.

So when I'm, if I ever bill for Grady, we are we're not swimming, I should clarify.

You can't actually go swimming when you're doing this.

But it's me being at home helping him with those personal care tasks that he needs.

So, I can just.

It's okay.

It is fine to go swimming.

Grady: Yes.

Shannon: So I, you know, just work with him, or I just work with her.

And that would be, I can't imagine working a full time job where I'm going to put my where I'll put my kids, for starters.

But then if I have somebody come in in the evening to help, I'm going to have two people in my house, and it just feels a little uncoordinated.

And there's such a shortage of workers.

So I do have a couple family members that might be able to help, but not as a full time job.

Melissa: And you mentioned you previously relied on grandparents to help out.

That's unfortunately no longer an option for you.

Shannon: Yeah, there's a lot of families that don't have other family members here.

We, both of my parents passed away and we've moved to Meridian now, so, we're away from the family, so it's not like somebody can come over every day.

And, you know, I do have a few family members, but they're far enough away that it's not reasonable for them to come over every day.

Melissa: What are you hearing from other families in similar situations?

Shannon: Everybody's sad, you know, angry, just because of the way that it happened.

But I think people are scared, you know, what's going to happen to their child?

A lot of people have more significant needs.

So they might have a child who's on a feeding tube, or in a wheelchair.

And they if they don't have this care in their home.

Grady: Or in like or, and like they or like a baby that cries a lot and that like, has special needs, maybe that would be worse.

Shannon: Yeah.

Grady: Like worse to have special needs when they're maybe sitting with the baby.

Melissa: There are a lot of people who have needs, right.

Shannon: Yeah.

And I just think there's a bigger risk of having to put family into a home.

If they don't have the resources to take care of them at home, they might have to put them into a facility.

Which is not great.

And then there's other families that, you know, they have income coming from this.

They may not be able to go get a job because they have to take care of their own child, for free now, and they will start relying on other like maybe food stamps, or you know, other services.

So, I don't know.

I think there's a whole gamut of families, but I know there's 1400 families on this program, and if 90% of them don't have a worker after July 15th, that's a big problem.

I don't have all the answers for sure.

I don't have any of the answers.

I don't even have the answer for myself yet.

Melissa: The department has outlined concerns of fraud from some who used the system.

There was the November letter to lawmakers that outlined examples of parents sharing information on how to manipulate assessments to receive maximum payments, or double or triple billing, or logging more than 24 hours of care in a single day.

What would you say to the department and lawmakers who are concerned about fraud in this program?

Shannon: I think there's, I think there's bound to be fraud in any program.

Like food stamps, or any assistance program, there's always fraud.

But, I think the bigger issue is that this program grew so quickly that they didn't have the infrastructure in place to supervise the program.

And so normally, if you identified fraud, you would put safeguards in place so that that doesn't continue to happen.

And then, you know, move forward.

But that isn't what happened.

And there was no, as far as I know, there was no communication with the agencies that things were happening.

I don't think people intentionally want to be fraudulent, but there's always some.

But I think a better option would be to address the problem rather than canceling the whole program.

I can’t imagine if we canceled food stamps.

Melissa: You mentioned that you didn't have all the answers, not even for yourself.

What are the possibilities on the table for what's next for you and your kids?

Shannon: I know that the work group, who had previously worked with health and welfare plans to continue to try to draft legislation so that in the next session we may be able to get a family plan back in place.

I'm not sure what I'm going to do.

I'm I've looked at, started looking at different jobs.

I mean, I had a career prior to being, providing these services for my own kids.

And I can go back and do that, it’s something I'm passionate about.

But I'm not sure where that leaves them.

They're not able to stay home all day by themselves.

And like I said, I have like a behavior worker and some other services that they have, but those people can't be a daycare.

So, I'm not really sure.

I'm fortunate that I have a partner that I live with and so I'm not going to be homeless.

You know, a year ago, if this had happened, I had my own house payment, I was single and I would have lost my house.

And I'm not sure what else would have happened.

Grady: Possibly us.

Shannon: Well I'm not going to lose you for sure.

Ruby: Yeah.

Grady: Well actually, if you don't, if you can't take care of us you will.

Shannon: I mean, that is like a valid concern though, for a lot of parents, is that if you can't provide the services in your own home, or there's nobody else that can provide them, then they may go have to go into a facility.

And that's a really scary reality for a lot of people.

Melissa: Well, Shannon, Ruby, Grady, thank you so much for joining us.

Shannon: Yeah.

Thank you for having us.

Kids: Bye.

Finney: This is our final show of the season, but we'll be back on the air this fall.

In the meantime, you can always find our ongoing coverage over the summer online at Idaho reports.org.

I'm Logan Finney.

From all of us here Idaho Public Television.

Thank you for watching.

Narrator: 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.

By the Friends of Idaho Public Television and by the Corporation for Public Broadcasting.