>> COMING UP, IT SERVES THE MOST VULNERABLE AND POOR, BUT IT'S ALSO A MASSIVE PART OF A STAGE BUDGET THAT'S IN DISTRESS.

WE'LL TALK ABOUT THE EMOTIONAL AND PRACTICAL CONSIDERATIONS OF CUTTING MEDICAID, NEXT ON "DIALOGUE."

STAY TUNED.

>> HELLO, AND WELCOME TO "DIALOGUE."

I'M MARCIA FRANKLIN.

>>> WHEN IDAHO HEALTH AND WELFARE DIRECTOR RICHARD ARMSTRONG MADE HIS BUDGET PRESENTATION TO THE JOINT FINANCE APPROPRIATIONS COMMITTEE, IT WAS ALL MEDICAID, MEDICAID, MEDICAID.

THAT'S BECAUSE THE STATE AND FEDERAL PROGRAM SERVING THE POOR AND DISABLED TAKES UP FULLY 80% OF THE AGENCY'S BUDGET REQUEST, $1.8 BILLION.

SIPS FISCAL YEAR 2007, IDAHO'S MEDICAID ENROLLMENT HAS GROWN BY 20%.

MORE THAN 200,000 PEOPLE NOW RECEIVE ASSISTANCE FROM THE PROGRAM.

GOVERNOR OTTER HAS ASKED THE AGENCY TO SLASH $25 MILLION FROM MEDICAID, AND WITH OUR FEDERAL MATCH, THAT AMOUNTS TO $84 MILLION.

AND THAT NUMBER COULD GROW.

CONCERN OVER A POTENTIAL CUTS CAUSED UPWARDS AFTER THOUSAND PEOPLE TO AATTEND SPECIAL BUDGET COMMITTEE HEARING ABOUT MEDICAID.

TODAY WE'LL TALK WITH TWO OF THE PEOPLE WHO LISTENED TO THAT TESTIMONY AND HAVE TO FIGURE OUT A WAY TO CUT MEDICAID, BUT STILL HELP OUR MOST NEEDY CITIZENS.

RICHARD ARMSTRONG IS THE DIRECTOR OF THE DEPARTMENT OF HEALTH AND WELFARE, A POSITION HE'S HELD SINCE JUNE OF 2006.

WELCOME.

>> THANK YOU.

>> AND LESLIE CLEMENT IS THE IDAHO MEDICAID ADMINISTRATOR.

SHE TOO TOOK THAT JOB IN 2006, BUT SHE'S BEEN WITH THE DEPARTMENT SINCE 2001.

THAT'S FOR BEING HERE.

NOW DIRECTOR ARMSTRONG, MS.

CLEMENT, AND THEIR STAFF HAVE COME UP WITH SEVERAL APPROACHES TO SAVING MONEY, BUT THE ONE THAT'S GOTTEN THE MOST ATTEMPT IS THE SO-CALLED BLUNT APPROACH, WHICH ELIMINATES TWO WHOLE PROGRAMS, DEVELOPMENTAL DISABILITY SERVICE AND PSYCHOSOCIAL REHAB.

WE WANT TO HEAR FROM YOU.

WHAT DO YOU THINK ABOUT THE POTENTIAL CUTS?

CALL US AT 1-800-973-9800.

BUT BEFORE WE BEGIN OUR CONVERSATION, LET'S TAKE A LOOK AT A PIECE ABOUT A CLIENT OF ONE OF THOSE SERVICES.

>> APRIL HAS DECIDED TO HAVE TUNA CASSEROLE FOR LUNCH.

SHE'S 33 AND IS LEGALLY BLIND, PARTIALLY DEAF AND HAS COGNITIVE IMPAIRMENTS.

ALTHOUGH SHE LIVES ON HER OWN, APRIL NEEDS HELP TWICE A WEEK WITH COOKING, SHOPPING, AND A RIDE TO HER VOLUNTEER JOB.

THESE LIFE SKILL SERVICES PAID FOR BY MED MEDICAID MAY BE CUT, AND APRIL IS WORRIED.

>> I WILL GET DEVASTATED AND MY LIFE WILL CHANGE AROUND, AND I HAVE NOWHERE ELSE TO GO.

>> SHE DOESN'T WANT TO GO BACK TO A GROUP HOME.

>> THEY TAKE MY MONEY AWAY FROM ME, AND I ONLY GOT A LITTLE BIT OF A SMALL AMOUNT OF MONEY TO SPEND.

THEY STICK ME ON MEDICAID SOMEWHERE, AND CAUSE ME ALL KIND OF PROBLEMS.

>> DEVELOPMENTAL DISABILITY ALONG WITH PSYCHOSOCIAL REHAB FOR THE MEANTLY ILL ARE TARGETED IN FARTHER BECAUSE THEY'RE NOT CONSIDERED MEDICALLY CRITICAL.

BUT APRIL'S AIDE SAYS IN THE LONG RUN, CUTS COULD LEAD TO MEDICAL CONDITIONS IN HER CLIENTS.

>> I THINK POSSIBLY YOU WOULD SEE MORE PEOPLE BEING HOSPITALIZED.

>> SHE ALSO DOESN'T THINK VOLUNTEERS CAN FILL THE GAP AS THE GOVERNOR HAS SUGGESTED.

>> A VOLUNTEER THEY MIGHT BE HAVING FURNTION BUT NOT WORKING ON THEIR SKILL AREAS.

>> APRIL AND DLAIN'S CONCERNS WERE ECHOED BY ALMOST ALL THE 82 PEOPLE WHO TESTIFIED BEFORE THE JOINT FINANCE APPROPRIATIONS COMMITTEE ABOUT PROPOSED MEDICAID CUTS.

>> THE VOLUNTEERS WON'T WORK.

I AS HER MOTHER HAD TO HAVE A BACKGROUND CHECK TO BE HER CERTIFIED FAMILY HOME PROVIDER.

SHE IS AT AN 80% INCREASED RISK OF BEING SEXUALLY MOLESTED IN HER LIFETIME.

I DON'T WANT SOME RANDOM VOLUNTEER TAKING CARE OF MY CHILD.

>> I'VE BEEN IN TWO GROUP HOMES, AND BELIEVE ME, IT'S NOT VERY FUN.

AND I KNOW FOR A FACT THAT IF YOU CUT THESE -- IF YOU MAKE THESE CUTS, I HAVE TO GO BACK TO A GROUP HOME.

I MADE A PROMISE TO MYSELF, YOU GUYS, THAT YOU WOULD NOT GO BACK.

NOT WITHOUT A FIGHT.

I WANT YOU TO KNOW, YOU ARE -- YOU GUYS ARE MY ONLY HOPE.

>> MORE THAN 13,000 PEOPLE SIGNED A PETITION SUPPORTING TAX INCREASES TO COVER THE $25 MILLION THE GOVERNOR WANTS CUT FROM MEDICAID.

BUT OTHERS SAID THE DEPARTMENT SHOULD DO A BETTER JOB POLICING FRAUD.

>> I BELIEVE OUR BIGGEST PROBLEM IS THE ABUSE OF MEDICAID AND OTHER GOVERNMENT ASSISTED PROGRAMS, MANY PEOPLE THAT NEED THESE SERVICES DESPERATELY ARE NOT ABLE TO GET THEM.

MANY PEOPLE WHO DON'T NEED THESE SERVICES ABUSE THEM.

>> APRIL ISN'T INVOLVED IN POLITICS.

SHE JUST WANTS TO KEEP DEVELOPING HER OWN RECIPE OF LIFE ALONG WITH HER HELPERS.

>> IF I DIDN'T HAVE ANYBODY COME OUT AND SHOW ME THIS STUFF, I DON'T KNOW WHAT I WILL DO FOR THE REST OF MY LIFE.

IT'S IMPORTANT TO ME TO BE MORE INDEPENDENT THAN ANYBODY I KNOW.

>> IT'S AN EMOTIONAL SUBJECT.

WERE YOU IN FRONT OF THE GROUP, DIRECTOR ARMSTRONG, YOU TOLD THEM THERE'S NOTHING IN HEALTH AND WELFARE THAT LACKS EMOTION.

THAT'S JUST THE WAY WE ARE.

YOU LOOK AT A PIECE LIKE THIS, APRIL AND THE OTHER PEOPLE THAT TESTIFIED, AND THEY NEED THE SERVICES, THEY'RE SCARED, AND YET THE MONEY HAS TO BE CUT.

AND SO YOU'RE IN THIS BALANCING ACT.

>> VERY MUCH SO.

VERY MUCH SO.

>> LET'S TALK A LITTLE BIT ABOUT THE BLUNT APPROACH THAT I DISCUSSED AT THE LEAD OF THAT PIECE.

WE HAVE A GRAPHIC THAT SHOWS THAT.

THE BLUNT APPROACH, WHICH WOULD JUST COME TO THE $84 MILLION THAT THE GOVERNOR HAS ASKED FOR, BY ELIMINATING THESE TWO PROGRAMS, DEVELOPMENTAL DISABILITY SERVICE AND PSYCHOSOCIAL REHAB, COVERING ONLY URGENT DENTAL SERVICE AND ESTABLISHING COPAYS.

PEOPLE, AS YOU SAWRKS APRIL AND THE PEOPLE WHO TESTIFIED, WORRIED BY ELIMINATING THOSE PROGRAMS, WHICH HAVE PEOPLE COMING INTO THE HOME AND TEACH THEM LIFE SKILLS, THAT THEY COULD END UP BACK IN A GROUP HOME SOMEHOW, OR IN AN INSTITUTION.

HOW DO YOU RESPOND TO THAT FEAR?

>> WE'VE LEARNED A LOT OVER THE LAST NUMBER OF YEARS ABOUT WHAT IS THE BEST ENVIRONMENT FOR DISABLED INDIVIDUALS.

AND GOING BACK TO A PRIOR ERA, WHERE THESE INDIVIDUALS WERE STUCK IN INSTITUTIONS, SIMPLY IS NOT WHERE WE'RE HEADED.

>> WHAT ABOUT GROUP HOMES?

SHE WORRIES ABOUT SOMEBODY DOESN'T COME VISIT HER IN HER HOME, SHE'LL LOSE HER INDEPENDENCE AND DECOMPENSATE, WE CALL IT, AND END UP BACK IN A GROUP HOME.

>> WE'RE ONLY TALKING ABOUT A SMALL NUMBER OF THE SERVICES THAT THESE INDIVIDUALS ARE ELIGIBLE FOR.

WE STILL WILL PROVIDE A NUMBER OF SERVICES TO THEM, AND ONE OF THE COMPONENTS IS TO MAKE SURE THAT THEY HAVE A SERVICE COORDINATOR OR A POINT PERSON THAT IS CLINICALLY ORIENTED WHO IS AVAILABLE FOR THEM TO CONTACT AND ASK FOR ASSISTANCE FOR SERVICES WITHIN THE COMMUNITY.

IT'S NOT OUR DESIRE TO LEAVE THEM COMPLETELY WITHOUT ANY ASSISTANCE.

>> SO THERE ARE ABOUT 2,000 INDIVIDUALS, ADULTS, AND WE'RE TALKING ABOUT ADULTS, WE'RE NOT TALKING ABOUT CHILDREN, AND THAT'S THE OTHER KIND OF PIECE TO THE APPROACH THAT WE'VE BEEN TRYING TO PRIORITIZE CHILDREN'S SERVICES OVER ADULTS.

IS THERE ABOUT -- THERE ARE ABOUT 2,000 ADULTS THAT ARE USING THIS PARTICULAR TYPE OF SERVICE, THE DEVELOPMENTAL DISABILITY AGENCY SERVICE TODAY.

1500 OF THOSE ADULTS HAVE ACCESS TO 16 OTHER SERVICES THROUGH WHAT'S CALLED THE DEVELOPMENTAL DISABILITY WAIVER.

SO WE'RE REALLY TALKING ABOUT 500 INDIVIDUALS WHO ARE THE HIGHEST FUNCTIONING ADULTS USING THOSE SERVICES THAT WOULD JUST NOT HAVE ACCESS TO DEVELOPMENTAL THERAPY, BUT WOULD HAVE ACCESS TO THE FULL ARRAY OF THE OTHER MEDICAID BENEFITS.

>> SO YOU DON'T THINK THE FEAR OF BEING INSTITUTIONALIZED OR GOING BACK TO A GROUP HOME AS JACK HANSEN SAID, IS A REAL ONE?

>> I THINK WHAT ALL THESE CUTS ARE VERY SERIOUS, AND THEY HAVE MAJOR IMPACTS.

SO I DON'T WANT TO MINIMIZE THAT AT ALL.

BUT THE INTENT HERE IS TO PROTECT THOSE WITH THE GREATEST NEEDS THAT -- SO THE INDIVIDUALS WHO USED TO BE INSTITUTIONS, OR ARE ELIGIBLE FOR INSTITUTIONAL CARE, ARE PROTECTED THROUGH THE DEVELOPMENTAL DISABILITY WAIVER.

SO THEY HAVE THOSE SERVICES, THEY HAVE THEIR HOME SETTINGS CERTIFIED FAMILY HOMES, THEIR APARTMENT SETTINGS, THOSE THINGS REMAIN INTACT.

>> BUT FOR THE 500 PEOPLE NO ARE HIGHER FUNCTIONING LIKE APRIL, THOSE WOULDN'T EXIST.

>> AND I DON'T KNOW WHETHER APRIL IS ON THE DEVELOPMENTAL DISABILITY WAIVER OR NOT.

SO IT'S HARD TO SPEAK TO HER INDIVIDUAL CASE.

>> SURE.

SEVERAL PEOPLE HAVE WRITTEN IN ON EMAIL ABOUT, WHY NOT SPREAD OUT THE CUTS INSTEAD OF CUTTING OUT WHOLE PROGRAMS?

AND DO YOU HAVE WHAT'S CALLED A TAILORED APPROACH.

I DIDN'T PUT OUT SCREEN BECAUSE IT INVOLVES MANY, MANY -- LOOKING AT MANY PROGRAMS.

BUT MIGHT THAT BE AN OPTION AS WELL INSTEAD OF CUTTING OUT WHOLE PROGRAMS, TO NIP AND TUCK AROUND THE EDGES, DECREASE PROVIDER HOURS, MAYBE BENEFITS, THINGS LIKE THAT A LITTLE BIT TO GET THROUGH THIS TIME?

>> YEAH, I THINK LEGISLATORS IN PARTICULAR WITH THE GOVERNOR'S OFFICE HAVE A REALLY CHALLENGING TIME RIGHT NOW.

BECAUSE THEY HAVE TO DECIDE HOW TO DO THIS THE BEST WAY POSSIBLE.

MY GUESS IS THAT IT WILL BE NEITHER THE BLUNT APPROACH NOR THE -- IT LAB TAILORED APPROACH, BUT IT WILL PROBABLY INCLUDE A WHOLE ARRAY OF DIFFERENT KINDS OF APPROACHES.

>> COULD THIS NUMBER GET HIGHER?

I MENTIONED THE 25 MILLION WITH THE MATCHES, $84 MILLION, COULD THIS NUMBER GROW?

>> YES.

INVARIABLY IT WILL.

>> WHAT ARE YOU HEARING?

>> WELL, WE HEARD TODAY THAT IT COULD BE -- GROW TO 35 MILLION, OR MORE.

>> IN STATE GENERAL FUNDS?

>> IN STATE GENERAL FUNDS, YES.

AND THE FINAL NUMBER IS SUPPOSED TO BE KNOWN WITHIN THE NEXT TWO WEEKS.

>> ADRIAN WROTE N. SAYING I'D LIKE AN EXPLANATION OF HOW CUTTING STATE FUNDING AND LOSING OUT ON FEDERAL MATCHING DOLLARS IS AN EFFECTIVE BUDGETARY PRACTICE.

>> WELL, IT'S A SHAME TO LOSE THE FEDERAL DOLLARS, BUT IN ORDER TO DRAW DOWN THOSE DOLLARS, YOU FIRST HAVE TO PUT UP STATE DOLLARS.

SO IF WE DON'T HAVE THE STATE DOLLARS, THEN IT JUST SIMPLY DOESN'T MATTER.

WE CAN'T REACH -- WE CAN'T REACH THOSE MATCHING DOLLARS AT ALL.

AND THOSE HAVE TO BE TAX DOLLARS.

IT CAN'T BE CHARITABLE CONTRIBUTIONS.

THESE HAVE TO BE REVENUES THAT THE STATE CONTROLS AS DEDICATED MONEY FOR THIS PURPOSE.

>> SEVERAL PEOPLE WROTE IN WANTING TO KNOW IF THIS -- IF WE CUT THESE PROGRAMS AND THE FEDERAL MATCHING DOLLARS, WOULD -- THIS PERSON WRITES, AS WE ALL KNOW, ONCE SOMETHING IS GIVEN BACK IT'S HARD TO REINSTATE THE FEDERAL DOLLARS WHEN THE ECONOMY TURNS IN A POSITIVE DIRECTION.

>> I THINK THAT'S A POSITIVE THING ABOUT THE MEDICAID PROGRAM.

REALLY, WE CAN EXPAND IT, WE CAN RESTORE THOSE BENEFIT HOURS WHEN THE STATE REVENUES INCREASE, AND THE FEDERAL MATCH WILL BE THERE.

>> ANOTHER PERSON WRITES, "IT WOULD BE POSSIBLE FOR A PARENT OR A GUARDIAN TO PATE STATE OF IDAHO, THE AMOUNT OF STATE FUNDS LOST FOR THE INDIVIDUAL?"

IF IT WENT FROM $10,000 IN STATE FUNDS TO $5,000 COULD THE PARENT OR GUARDIAN MAKE UP THE DIFFERENCE SO THE STATE COULD GET THE MATCH FOR THE INDIVIDUAL?

>> AS I MENTIONED, NO, THEY COULD NOT.

HOWEVER, IF THEY WANTED TO PAY FOR SOME OF THE SERVICES DIRECTLY TO THE PROVIDER, NOTHING WOULD STOP THEM FROM DOING THAT.

BUT NO, WE COULDN'T TAKE THOSE CONTRIBUTIONS, BECAUSE IT DOESN'T MEET THE FEDERAL REQUIREMENTS.

>> OK.

WE'VE HAD SOME PHONE CALLS SCREENED.

LET'S HEAR FROM ROB, GO AHEAD, PLEASE.

>> Caller: YEAH, I'LL TRY TO BE AS BRIEF AS POSSIBLE.

I TRULY BELIEVE THAT WE HAVE AN OBLIGATION ARE TERROR HELP THOSE THAT TRULY DO NEED THE HELP, AND I HAVE NO PROBLEM WITH THAT.

AND IF THOSE WERE THE ONLY PEOPLE THAT WERE TAKEN FROM THE SYSTEM, I WOULD BE EVEN WILLING FOR MY TAXES TO BE RAISED TO HELP THEM.

THE PROBLEM IS THAT A GREAT PERCENTAGE OF THOSE PEOPLE THAT TAKE THOSE MEDICAID DOLLARS COULD ACTUALLY WORK, COULD AT LEAST PAY A PORTION OF THE BILL, BUT THEY DON'T.

I HAVE A FAMILY MEMBER THAT WORKS AT A HOSPITAL, AND WELL OVER 50% OF THE PEOPLE THAT COME WALK THROUGH THOSE DOORS DO NOT PAY THE BILL.

WHETHER THEY'RE -- IT'S BECAUSE THEY'RE ILLEGAL ALIENS, OR WHATEVER.

THEY DON'T PAY THE BILL.

THEY CAN PAY THE BILL.

I DON'T KNOW WHAT THE SOLUTION IS.

>> LET'S GET AN ANSWER TO YOUR QUESTION, BECAUSE WE HAVE EMAILS ALONG THIS LINE AS WELL.

THANK YOU VERY MUCH.

GREAT CONCERN ABOUT FRAUD.

IT'S REFLECTED IN SOME OF THE EMAILS THAT I RECEIVED AS WELL.

IT WAS REFLECTED IN THE TESTIMONY THAT PEOPLE ARE ABUSING THE SYSTEM.

WHAT DO YOU SEE OUT THERE?

>> WELL, FIRST, WE SOURCE VERIFY CITIZENSHIP.

SO WE KNOW AND DELIVER BENEFITS TO CITIZENS OF THE UNITED STATES.

>> SOME ARE REFUGEE WHO'S ARE NOT YET CITIZENS.

>> BUT THEY HAVE -- THEY'RE HERE LEGALLY, 3 -- >> THAT'S THE DIFFERENCE.

>> BUT ILLEGAL IS SIMPLY NOT PART OF THIS EQUATION.

NOW, FRAUD IS A VERY UNFORTUNATE PART OF ANY BENEFIT PLAN, AND WE HAVE FRAUD INVESTIGATORS, AND WE PURSUE EVERY AVENUE TO STOP FRAUD.

FRAUD, BY THE CLIENT, AS WELL AS THE PROVIDER, AND BOTH DO EXIST -- >> WHAT DO YOU FIND IN TERMS OF NUMBERS?

>> WE HAVE HAD SUCCESSFUL LAWSUITS AGAINST THEM, WE COLLECT THE MONEY BACK.

WE HAVE -- >> DO YOU KNOW WHAT IT IS AS A PERCENTAGE?

>> IT'S RELATIVELY SMALL PERCENTAGE.

THE CALLER WAS REFERRING TO 50%, THAT -- >> I THINK THERE'S MIXING OF ISSUES HERE, BECAUSE THE COUNTY CATASTROPHIC FUND END UP PICKING UP THE TAB FOR THE PEOPLE, A LOT OF THE HEALTH INSURANCE COSTS WE WERE TALKING ABOUT, AND THERE IS AN ISSUE OF UNDOCUMENTED WORKERS, BUT THEY'RE NOT GETTING MEDICAID.

>> NO.

>> I THINK THAT THERE IS A CONFUSION ABOUT THAT.

THE STATE, THOUGH, STILL IS PICKING UP THE TAB FOR THAT, AND SO ARE PROPERTY TAXPAYERS IN A LOT OF INSTANCES.

CHERYL IN ST.

ANTHONY, I'M SORRY, SHERRY OR CHERYL.

GO AHEAD, PLEASE.

SHERRY?

>> Caller: YES, HELLO.

THIS IS SHERRY.

>> GO AHEAD.

WHAT'S YOUR QUESTION?

>> Caller: THIS IS SHERRY.

>> GO AHEAD.

>> Caller: YES, HI.

I WILL MAKE THIS AS BRIEF AS POSSIBLE.

>> GO ON.

>> Caller: SORRY, I'M GETTING FEEDBACK FROM MY TV.

SORRY ABOUT THAT.

MY QUESTION IS, I AM A PSYCHOSOCIAL REHABILITATION SPECIALIST IN IDAHO FALLS, AND MY CONCERNS ARE FOR MY CLIENTS THAT NEED THESE MENTAL HEALTH SERVICES.

WHAT'S GOING TO HAPPEN TO THEM SNITS GOING TO BE VERY DEVASTATE CAN IN THEY LOSE THEIR SERVICES.

IT WOULD BE SO DETRIMENTAL TO THEM.

>> FOR PSR, YOU MEAN, THE PSYCHOSOCIAL REHAB PORTION?

>> Caller: YES, IT WOULD BE.

I WORK WITH SEVERELY MENTALLY ILL CLIENTS WHO HAVE SCHIZOPHRENIA, THESE PEOPLE ARE GOING TO BE OUT ON THE STREETS.

>> SO YOU FEEL PSR REALLY HELPS THEM A LOT EXPWHR.

>> Caller: YES, I DO.

IT'S VERY IMPORTANT.

VERY CRUCIAL.

THERE ARE SOME PEOPLE THAT REALLY NEED THIS.

THESE SERVICES.

>> LET'S GET AN ANSWER.

THANK YOU.

>> Caller: THANK YOU.

>> WE HEARD THIS AS WELL IN THE TESTIMONY, PEOPLE -- ONE WOMAN SAID SHE WAS HOMELESS UNTIL SHE GOT HELP.

>> SO TODAY MEDICAID PROVIDES PSR TO ABOUT 8,000 ADULTS, A LITTLE OVER 8,000 ACROSS -- >> PSYCHOSOCIAL REHAB.

>> PSYCHOSOCIAL REHABILITATION.

IT'S A COMMUNITY-BASED MENTAL HEALTH SKILL-BUILDING SERVICE.

AND INDIVIDUALS WHO HAVE ACCESS TO PSYCHOSOCIAL REHABILITATION ALSO HAVE ACCESS TO MENTAL HEALTH CLINIC SERVICES, INDIVIDUAL PSYCHO THERAPY, GROUP PSYCHO THERAPY, AND FAMILY COUNSELING, MEDICATION MANAGEMENT, AND MEDICATION.

>> SO WHAT YOU'RE SAYING IS, THE PSYCHOSOCIAL REHAB IS ONLY ONE OF THE SERVICES THEY RECEIVE, THEY RECEIVE OTHERS, BUT MANY EMPHYSEMA PEOPLE KNEEL PSR SERVICE IS CRITICAL BECAUSE IT TEACHES LIFE SKILLS AND IT ALSO HELPS THE MENTALLY ILL PERSON NOTICE WHEN SYMPTOMS ARE ABOUT TO HAPPEN.

SO YOU KNOW, HOW DO YOU RESPOND TO THAT?

>> THAT'S RIGHT.

WE'VE HEARD A LOT OF THAT.

I THINK THERE'S A LOT OF ANXIETY OUT THERE RIGHT NOW ABOUT WHAT WILL HAPPEN IN ABSENCE, IF THIS BENEFIT GOES AWAY.

NOW, OVER THE LAST FEW YEARS, BECAUSE THIS IS THE THIRD YEAR THAT WE'VE BEEN FACING BUDGET REDUCTIONS, THAT BENEFIT HAS BEEN DECREASED OVER THE LAST FEW YEARS FROM 20 TO 10, TO FIVE, AND NOW WE'RE HEARING RATHER THAN ELIMINATING IT ALL TOGETHER, WE'RE HAPPENS -- PERHAPS EVEN JUST PRESERVING IT AT FOUR HOURS WOULD BE A GOOD THING TO DO.

THE OTHER THING THAT WE'RE DOING IS, WE FEEL IT'S IMPORTANT AT THIS TIME TO REALIZE THAT, YOU KNOW, THINGS WILL TURN AROUND, AND THE ECONOMY WILL GET BETTER, AND WE NEED TO PREPARE FOR THAT, AND WE SHOULD START WORKING ON A MEMO HEALTH SYSTEM.

>> I WANT TO ADDRESS THE ISSUE OF VOLUNTEERS.

BECAUSE THE GOVERNOR ADDRESSED IT AND YOU ADDRESSED IT IN THE BUDGET COMMITTEE, PEOPLE SPOKE TO IT AS WELL.

WE HAVE SOME SOUND ON TAPE ABOUT PEOPLE WHO ARE CONCERNED ABOUT THIS ISSUE OF VOLUNTEERS STEPPING IN FOR THESE PROVIDERS LIKE THE WOMAN THAT JUST CALLED.

I WONDER IF WE COULD ROLL THAT TAPE.

>> MOST VOLUNTEERS FROM THE COMMUNITY HAVE NO TRAINING OR EDUCATION IN THERAPEUTIC INTERVENTION OR POSITIVE BEHAVIORAL TECHNIQUES.

AND VOLUNTEERS WOULD NOT HAVE PROFESSIONAL SUPERVISION.

>> I'M NOT PROUD TO SAY LAST WEEK MY SON TRIED TO BITE HIS DEVELOPMENTAL THERAPIST.

THIS IS EXTREMELY UNUSUAL FOR HIM, BUT HE GOT OVERWHELMED IN THE SITUATION, AND AGAIN, HE TRIED TO BITE HER.

I CRINGE TO THINK WHAT MIGHT HAVE HAPPENED IF HE HAD BEEN OUT WITH A VOLUNTEER.

>> TO THINK THAT THEY CAN RECEIVE SUFFICIENT SUPPORT FROM THEIR FAMILIES, COMMUNITIES, AND NONPROFIT ORGANIZATIONS SUCH AS CATHOLIC CHARITIES OF IDAHO IS UNREALISTIC IN THIS DAY AND AGE.

FOR EXAMPLE, CATHOLIC CHARITIES OF IDAHO IS NOW MAXED OUT.

>> PRETTY BIG STATEMENT FROM THE MONSIGNOR, CATHOLIC CHARITY ASSIST MAXED OUT.

THAT'S A BIG POTENTIAL SOURCE OF HELP THERE.

DO YOU REALLY FEEL THAT VOLUNTEERS CAN FILL THIS GAP?

I HAVE SEVERAL EMAILS FROM PEOPLE SAYING THEY'RE VERY WORRIED ABOUT THIS ISSUE, ABOUT SOME OF THE LIABILITY ISSUES, AND THE TRAINING AND SKILLS ISSUE.

>> WE WOULD NEVER BE SUGGESTING THAT VOLUNTEERS TRY TO PROVIDE ANY KIND OF CLINICAL SERVICES WHATSOEVER.

THAT WOULD NEVER MAKE SENSE.

BUT WE KNOW THAT THERE ARE A HOST OF SERVICES THAT ARE JUST MAKING SURE THAT A PERSON GETS UP IN THE MORNING AND THEY GET GOING.

JUST SOMEBODY TO CHECK IN ON THEM, TO OBSERVE THEM, AND WITH TRAINING, AGAIN, NO VOLUNTEERS SHOULD BE ASKED TO EASTBOUND GAUGE -- ENGAGE IN THE ACTIVITY -- >> WITH A CHILD THAT PERHAPS COULD BITE THEM.

>> OF COURSE.

>> BUT DO YOU HAVE A STAFF TO TRAIN THESE PEOPLE?

NICOLE ASKED THAT YOU IN THE COMMITTEE, AND YOU SAID, NO, FRANKLY, WE DON'T.

>> NO, WE DON'T.

NOR ARE WE GOING TO BUILD A CORE OF MANAGERS TO MANAGE THE VOLUNTEERS.

THAT HAS TO COME FROM THE COMMUNITY.

AND IF WE CAN ASSIST IN SOME WAY IN THE COMMUNITY DEVELOPING THOSE SKILLS AND EVOLVING THE CORE OF VOLUNTEERS, THEN THAT WOULD BE AN APPROPRIATE ROLE FOR US TO ENGAGE WITH.

BUT IT'S A COMPLICATED GRASS-ROOTS ISSUE, BUT WE KNOW IN THE PAST THAT THERE HAD BEEN A GREATER USE OF VOLUNTEERS BY HEALTH AND WELFARE FOR THE CLIENTS THAT WE SERVE, AND THAT KIND OF WENT AWAY AS WE BECAME MORE AFLIGHT ATTENDANT AND WERE ABLE TO PAY FOR A PROFESSIONAL GROUP ARE.

>> I'M SURE THIS DISCUSSION WILL CONTINUE ON THIS ISSUE.

AND WE'RE GOON GOOGLE CONTINUE TO TAKE SOME CALLS.

ROSEMARY, THANKS FOR CALLING IN.

>> Caller: HELLO.

I WOULD LIKE TO KNOW IF ANYBODY HAS CONSIDERED THE RAMIFICATIONS FINANCIALLY OF THIS TAKING PLACE.

THE COSTS FOR THE FIRE DEPARTMENT COMING FOR FIRES, FOR UNEMPLOYMENT, FOR ALL OF THE ISSUES THAT ARE GOING TO HAPPEN.

>> YOU MEAN UNEMPLOYMENT OF THE WORKERS THAT HAVE BEEN -- >> Caller: YES.

>> LET'S GET AN ANSWER TO YOUR QUESTION.

>> Caller: HOMELESS, YOU NAME IT.

>> OK.

THANK YOU.

>> Caller: HAS ANYBODY CONSIDERED THE COSTS?

>> THANK YOU.

WE ALSO HAVE AN EMAIL THAT SAYS, "TO TAKE AWAY THE SERVICES PROVIDED BY AGENCIES WOULD BE AN ABSOLUTE DISASTER NOT ONLY TO THE INDIVIDUALS BEING SERVED, BUT THE-TO-THE FAMILIES WOULD HAVE TO STAY AT HOME TO CARE FOR THE PARTICIPANT AND THE EMPLOYEES OF THE AGENCY WHO WOULD BE UNEMPLOYED AND COLLECT UNEMPLOYMENT FROM AN ECONOMY THAT'S ALREADY STRAINED."

WEV HEARD SOME TESTIMONY ABOUT THIS AS WELL, PEOPLE SAYING THEY WOULD GO BANKRUPT.

>> YOU CAN'T EXTRACT 84 TO 100 MILLION DOLLARS OUT OF THE IDAHO ECONOMY WITHOUT IT HAVING A NEGATIVE CONSEQUENCE.

WE UNDERSTAND THAT.

IF WE HAD THE FINANCIAL RESOURCES, WE WOULD NEVER BE HERE.

WE'D NEVER BE PROPOSING THIS.

BUT WE DON'T.

AND SO THAT IS THE UNFORTUNATE SITUATION WE'RE IN, AND WE'RE TRYING TO FIND THE MOST EFFECTIVE WAY OF GETTING TO THAT BUDGET NUMBER WITH THE LEAST AMOUNT OF DAMAGE.

BUT UNFORTUNATELY THERE ISN'T ANYTHING THAT WE ARE INVOLVED WITH THAT DOESN'T HAVE A LOT OF EMOTION ATTACHED TO IT, AND CERTAINLY FOR THOSE RECEIVING THE SERVICES, THEY ARE VERY IMPORTANT.

NOW, TO SOMEONE ELSE, THEY MAY LOOK AT AND IT SAY, THAT'S NOT SO IMPORTANT.

MY ISSUE IS MOST IMPORTANT.

THAT'S THE PROBLEM.

EVERYTHING CANNOT BE EQUAL OR WE CAN NEVER MAKE A DECISION.

>> WE HAVE SO LITTLE TIME LEFT.

I WANT THE FOLKS ON THE PHONE LINE TO KNOW TO STAY ON THE PHONE LINE.

WE WILL KEEP TAPING FOR OUR WEB EXTRA, AND WE'LL GET YOUR QUESTIONS ANSWERED.

I WANT TO ASK THIS QUESTION TOWRKS LESLIE, BRENDA SAID, "IS SOMEONE GOING TO TRACK THE PEOPLE WHO LOSE SERVICES TO SEE IF THERE IS A CAUSE AND EFFECT RELATIONSHIP IN TERMS OF HOMELESSNESS, OR INTERACTION WITH THE LEGAL SYSTEM?"

I THINK YOU'VE DONE A STUDY IN THE PAST, HAVE YOU NOT?

>> WE HAVE.

WHEN WE MADE OTHER SMALLER CUTS, THIS IS THE BIGGEST CUT WE'VE EVER BEEN FACED WITH, BUT WHEN WE'VE MADE OTHER SMALLER CUTS, WE'VE ACTUALLY IDENTIFIED THE INDIVIDUALS WHO HAD BENEFITS REDUCE AND TRACKED THEM OVER TIME.

AND REALLY AT THAT POINT WE DIDN'T SEE THE NEGATIVE OUTCOMES THAT PEOPLE HAD SAID MIGHT OCCUR FROM THIS.

HOWEVER, WHAT WE'RE FACING HERE IS A LOT MORE SERIOUS THAN WHAT WE'VE BEEN -- WHAT WE'VE EXPERIENCED IN THE PAST.

>> VERY QUICKLY, SEVERAL PEOPLE WROTE IN ABOUT AN AGENCY CALLED ICBE, WHICH DETERMINES A PERSON'S ELIGIBILITY AND THEIR BUDGET.

PEOPLE HAD AN ISSUE, SEVERAL PEOPLE WHO WROTE IN SAYING THAT THIS ENTITY SETS PEOPLE'S BUDGETS TOO HIGH, AND IT'S WASTING MONEY.

AND ALSO REQUIRES TOO MANY EVALUATIONS OVER AND OVER AND OVER AGAIN.

THOSE WOULD BE PLACES TO SAVE ALONG WITH A CONTRACT WITH THIS ENTITY.

HOW MUCH IS THE CONTRACT?

>> THE CONTRACT WAS $3 BILLION TWO YEARS AGO.

>> $3 MILLION.

>> $3 MILLION.

AND WE CUT IT IN A THIRD, SO WE CUT A MILLION DOLLARS OUT OF THAT CONTRACT, AND STREAMLINED SOME OF THE PROCESSES.

WE ALSO SHIFTED SOME OF THE WORK TO MY OWN STATE STAFF.

BUT I THINK WHAT WE WANT TO DO IS A COUPLE THINGS.

I CONTINUE TO WORK ON THAT PROCESS AND STREAMLINE IT, SO WE'RE NOT -- WE DON'T HAVE REDUNDANCIES, AND TAKE ANOTHER LOOK AT HOW WE'RE SETTING BUDGETS FOR ADULTS ON THE DEVELOPMENTAL DISABILITY WAIVER.

I THINK WE CAN IMPROVE THAT.

>> AS WE WRAP UP, THIS QUESTION CAME IN FROM BOB, AND IT IS PROBABLY ONE THAT WOULD TAKE LONGER TO ANSWER, BUT HE WANTED TO KNOW, HOW DOES IT FEEL PERSONALLY FOR TO YOU HAVE TO MAKE THESE CUTS?

THIS HAS TO BE ONE OF THE TOUGHEST JOBS IN STATE GOVERNMENT.

COULD YOU BOTH ADDRESS THAT ISSUE FROM A PERSONAL STANDPOINT?

>> WELL, WE WORK ON THIS DAILY.

AND WE FIND THIS TO BE EXTREMELY DIFFICULT, BECAUSE EVERYWHERE WE TURN, WE CAN SEE THE VALUE OF WHAT WE DO.

AND NOW THAT'S HEARTENING, BECAUSE WE REALIZE THAT WE'RE HELPING PEOPLE.

AND SO WE KNOW WE'RE DOING GOOD, WE KNOW WE'RE HELPING FOLKS, BUT HERE WE ARE, HAVING TO UNDO A LOT OF THINGS THAT WE'VE DONE IN THE PAST.

AND THAT'S PAINFUL.

>> SO YOU DON'T SLEEP VERY WELL MOST OF THE TIME.

I THINK IT'S AN INCREDIBLY CHALLENGING ENVIRONMENT, IT'S VERY, VERY HARD, IT'S VERY DISTRESSING.

I DON'T THINK EITHER ONE OF US WANTED TO REALLY EXPERIENCE THIS KIND OF ENVIRONMENT.

AND I THINK YEAR AFTER YEAR WE KEEP SAYING, OK, IT'S GOT TO GET BETTER NOW.

COULD WE JUST MOVE FORWARD AND START REALLY IMPROVING THINGS AND LOOKING TO ENHANCE THINGS?

BUT, YEAH, IT TAKES ITS TOLL.

IT'S A TOUGH JOB.

>> THANK YOU BOTH FOR COMING ON TO "DIALOGUE" TO DISCUSS THIS ISSUE.

WE'VE BEEN TALKING WITH THE DIRECTOR OF THE DEPARTMENT OF HEALTH AND WELFARE, RICHARD ARMSTRONG, AND LESLIE CLEMENT, THE ADMINISTRATOR OF THE MEDICAID PROGRAM ABOUT POTENTIAL MEDICAID CUTS.

WE'RE GOING TO CONTINUE TAPING OUR WEB EXTRA, SO FOR THOSE OF YOU ON THE PHONE LINES, PLEASE STAY THERE.

I'M MARCIA FRANKLIN.

THANKS FOR TUNING IN TO "DIALOGUE."

PLEASE JOIN US NEXT WEEK, SAME TIME.

Captioning performed by LNS Captioning www.LNScaptioning.com