Comments of DisAbility Rights Idaho on Idaho’s Application for a State Innovation Waiver Under §1332

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DisAbility Rights Idaho (DRI) is the designated Protection and Advocacy agency for Idahoans with disabilities. We are concerned about the proposed §1332 waiver’s impact on people with disabilities who will be covered by Idaho’s Medicaid expansion.

Senate Bill 1204 directs the Idaho Department of Insurance to apply for a §1332 waiver to obtain Advanced Premium Tax Credit to purchase coverage on the Your Health Idaho insurance exchange instead of being automatically enrolled in Medicaid. Previous studies and estimates have concluded that Idaho’s expansion population will include many people with disabilities and chronic health conditions, including many people with serious mental illness. Your Health Idaho (YHI) exchange policies often fail to cover essential services for people with disabilities and chronic health conditions.

Mental Health coverage in YHI plans generally includes coverage of some psychiatric visits, short term hospitalization, prescription drugs, and a limited number of psychotherapy visits. These services will likely meet the mental health needs of most people. However, people with serious mental illness often need services covered by Medicaid but absent from private health plans. These services include:

  1. Adult Partial Care/Skills Training
  2. Skills Building/Community Based Rehabilitation Services
  3. Adult Peer Support
  4. Crisis Services
  5. Family Psychoeducation
  6. Behavioral Health Case Management
  7. Mental Health: Intensive Outpatient Services.

People with other chronic health conditions or disabilities may also need Medicaid services which are not included in YHI plans. These include long term services and supports like personal care services and Home and Community Based (HCBS) waiver services. There may also be differences in the pharmacy formularies of different providers which could impose a significant burden.

People in the expansion group would have the option of choosing Medicaid if they understand the differences in coverage. However, this waiver will create a significant risk of confusion. When the waiver is implemented, many people will be solicited by YHI plans to choose a policy on the YHI exchange. There is great risk of making a poor choice in these confusing circumstances.

If this waiver is implemented, it is essential that everyone receive an accurate description of the services and drugs covered in YHI versus Medicaid as well as the provider networks, and the premiums, deductibles and co-pays. The complexity of this information, and the individual differences in what individuals need, will make it very difficult to fully inform consumers of the consequences of their choice. If this waiver is granted, Idaho must commit to investing the resources necessary to educate and advise consumers, so that they can make an informed choice. Insurance carriers and agents must be required to provide complete and unbiased information that compares coverage, provider networks, premiums, deductibles, and co-pays to eligible people as it will affect each individual.

Submitted by;

James R. Baugh, Executive Director


A Report on the Cycle of Abuse, Neglect, and Injury at the Southwest Idaho
Treatment Center

DRI is the Protection and Advocacy (P&A) system for the State of Idaho. The P&A system was originally created to safeguard the well-being of individ­uals living in institutions. This remains a major focus of P&A activity today. As such, DRI monitors, investigates, and attempts to remedy adverse condi­tions in large and small, public and private, facili­ties that care for people with disabilities. DRI believes that people with disabilities are entitled to be free from abuse, neglect, exploitation, discrimination, and isolation, and are to be treated with respect and dignity.

To complete this mission, DRI conducted a secondary, systemic investigation into allegations of abuse and neglect that occurred at the Southwest Idaho Treatment Center (SWITC) from January 1, 2017 through January 31, 2018. SWITC is Idaho’s only publically funded, state-run Intermediate Care Facility for the Intellectually Disabled (ICF/IID). DRI’s investigation was limited to reviewing the appropriateness, accuracy, and thoroughness of the investigations conducted by SWITC and Idaho Department of Health and Welfare (IDHW) investigators. In conducting this secondary investigation, DRI reviewed over five thousand (5,000) pages of records provided by SWITC and IDHW officials, including but not limited to completed internal investigations, facility policies, employee training records, and records pertaining to facility staffing. In addition, DRI also reviewed the investigations into resident abuse and neglect completed by Adult Protection and multiple licensing surveys conducted by the IDHW Bureau of Facility Standards during 2017 and 2018. In total, DRI reviewed over twenty-thousand (20,000) pages of records pertaining to SWITC. DRI also enlisted the services of a professional consultant with over twenty-five (25) years’ experience in developmental disability facility management and administration to assist in this review.

Please click on the links below to download documents associated with this investigation.

Download the Report.

SWITC Press Release.

Fact Sheet: What Abuse or Neglect Occurred?

Fact Sheet: Improper Investigation.

The Cycle of Abuse.

Free Training Supported Decision-Making in Action

Do I HAVE to get guardianship? MUST I have a guardian?

We’ll help you answer these questions in a FREE half-day training*

Supported Decision-Making in Action Statewide on November 30, 2018

Do I HAVE to get guardianship? Parents face this question day after day as their children with intellectual, developmental and mental health disabilities get older. Some people think they have no choice, that guardianship is their only option.

MUST I have a guardian? Individuals with disabilities often have this question with nobody there to give them a straight answer. Most individuals feel they have no choice and others decide they need a guardian, limiting their ability to make decisions about their life and removing many of their civil rights.

It doesn’t always have to be this way.

Jonathan Martinis, advocate and nationally known expert, will teach us about Supported Decision-Making (SDM), a way for people with disabilities to make their own decisions and direct their own lives, with the help of friends, family and professionals. We’ll show parents how they can help their children, and individuals how they can get the support and services they need to lead their best possible lives.

Join us for a 4-hour workshop to learn if Supported Decision-Making is for you. The Boise venue is live with Mr. Martinis, other locations will be video conference.

*Space is limited so we recommend you register


Registration Information Needed…

  • Your Name
  • Your Phone Number
  • Your Email
  • Address
  • Training location and time you want to attend – choose one 4-hour time slot (see below).
  • Any accommodations you need

And please tell us if you are…

  • A person with a developmental disability
  • A parent/guardian
  • Other – please describe who you are

Please contact the person listed below for the training you wish to attend and provide this information:

Training Times and Locations

ID Health & Welfare

8am-12pm or

1120 Ironwood Drive 2pm-6pm

Large Conference Room

Pete Petersen 208-798-4117

Lewiston ID Health & Welfare

8am-12pm or

2604 16th Avenue 2pm-6pm

NW Conference Room

Pete Petersen 208-798-4117

Caldwell ID Health & Welfare

9am-1pm or

3402 Franklin Road 3pm-7pm

Conference Room 353

Sarah Allen 208-334-0970

Boise ID Health & Welfare

9am-1pm or

1720 Westgate Drive, Suite D 3pm-7pm

Conference Rooms A and B

Sarah Allen 208-334-0970

Twin Falls ID Health & Welfare

9am-1pm or

601 Pole Line Road 3pm-7pm

Conference Room B

Heidi Napier 208-234-7945


ID Health & Welfare 9am-1pm or

421 Memorial Drive 3pm-7pm

HDC Conference Room 210

Heidi Napier 208-234-7945

Idaho Falls

ID Health & Welfare 150 Shoup Avenue 2nd Floor Large Conference Rm 9am-1pm or 3pm-7pm

Heidi Napier 208-234-7945

View This Announcement in PDF Form

The Idaho Health Care Plan Using State Innovation Waivers to Increase Access to Health Care

The Idaho Health Care Plan (IHCP) is a unique and innovative approach to extending opportunities for affordable health insurance coverage to some Idahoans in the health insurance gap, and to provide Medicaid coverage for Idahoans with certain diagnoses. IHCP requires two State Innovation Waivers, a Medicaid waiver under §1115 of the Social Security Act, and a waiver under §1332 of the Affordable Care Act.

The §1115 Waiver would allow Idaho to extend Medicaid coverage to people who have certain conditions which result in very high medical costs. Removing these people from the Idaho health insurance exchange and transferring their coverage to Medicaid will reduce costs and risk for the insurance carriers selling plans on the exchange. This in turn will result in lower premiums for insurance exchange customers, and also in lower federal premium assistance costs.

The §1332 Waiver would use some of those savings to extend premium assistance to households with incomes below the Federal Poverty Level making insurance affordable for about 30,000 Idahoans currently in the “gap”.

This helps Idahoans with disabilities in two ways:

  1. People with one or more of the listed diagnoses (which include e.g., spinal cord injuries, cerebral palsy, several forms of cancer, Multiple Sclerosis, Osteogenesis Imperfecta) will have access to the full range of Medicaid covered services. Some of these people are currently without coverage, and some currently have a policy on the exchange. Medicaid covers long term services and supports (LTSS) which are not covered by private insurance policies. Even people who are currently covered by insurance will benefit from coverage of these services, and more comprehensive coverage from Medicaid.
  2. Many people with disabilities, living below the FPL, who don’t have one of the listed conditions (e.g. people with mental illness) will at least have access to affordable health insurance on the exchange.

The IHCP is not a complete solution to the Idaho’s Health coverage problems. At least 20,000 Idahoans will still be left in the insurance gap. The IHCP does not provide premium assistance to people who do not have taxable income. Medicaid Expansion under the Affordable Care Act would provide much better coverage for Idahoans with disabilities, especially people with serious mental illness. It would also provide significant savings to the state of Idaho, not realized by the IHCP ( )

However, an estimated 5,000 Idahoans with serious health conditions would gain access to Medicaid coverage under the IHCP. Another 30,000 Idahoans living below the poverty level will have access to affordable coverage on the Idaho insurance exchange (Your Health Idaho). Many of these people also have disabilities and serious health conditions. These factors make the IHCP a significant step forward and a great improvement on the status quo. The IHCP is an opportunity to move Idaho in the right direction by making affordable health care available to Idahoans with low incomes, including many Idahoans with disabilities.

James R. Baugh, DisAbility Rights Idaho, 4477 Emerald St. Ste. B-100, Boise, ID 83706 phone (208)336-5353



Comments on Idaho State Innovation Medicaid Waiver (§1115) Application for People with Complex Medical Needs.

DisAbility Rights Idaho is Idaho’s Protection and Advocacy System for people with disabilities.  We provide advocacy, legal assistance and public policy analysis on behalf of Idahoans with disabilities.

We recognize that this waiver, in conjunction with a proposed §1332 Affordable Care Act, State Innovation Waiver, seeks to provide health care coverage for about 35,000 Idahoans who are currently without coverage, and to provide Medicaid eligibility for Idahoans with certain diagnoses. We support the waiver application as a significant first step in shrinking the coverage gap and providing an appropriate range of long term services and supports for some Idahoans with disabilities.

The last comprehensive attempt to quantify the number of Idahoans without access to affordable health coverage fond approximately 78,000 people in the insurance gap[note]Milliman, Inc. “2015 Financial Impact of the Medicaid Expansion on the Idaho Medicaid Budget Including State and County Cost Offsets.” Jan. 2016.[/note]. Several years of improved economic conditions and increased employment have probably substantially reduced that number. Current estimates using SNAP data and other sources suggest that the population is currently around 54,000. It is likely that the people who remain in the gap are even more disproportionately people with disabilities, and chronic health conditions, since these people are the least likely to benefit from increased job availability.

By far the best option for Idaho and Idahoans with disabilities is to take advantage of the enhanced federal match associated with the Affordable Care Act’s expansion provision to provide coverage for everyone in the gap. The Legislature has not been willing to do that so far. This proposal is a positive step in that direction.

We recognize that the selection of conditions for the §1115 waiver are based primarily on the impact that these conditions have on private insurance costs, and the impact that those costs have on premiums. Our concern however, is the impact on people with disabilities. We are very supportive of the changes released on November 22, 2017 to the list of eligible conditions to include, spinal cord injuries, and others.

The Application for the Complex Medical Condition waiver (CMC) will provide Medicaid coverage for some people with disabilities, that is, people with the listed conditions. This is obviously a significant benefit for those people currently in the “gap”, but it is also a significant benefit for people with disabilities who have an insurance policy on the state exchange. Private health insurance policies do not provide significant coverage for either long term care or for Home and Community Based Services (HCBS). Under the CMC waiver, both are covered. This will improve the risk pool for the exchange plans while providing coverage better suited to the needs of people with complex health conditions. Appropriate HCBS can delay or eliminate the need for long term care facility placements, and can prevent deterioration in health conditions, thereby reducing preventable hospitalizations, surgeries and other high cost treatments.

The CMC waiver does not include any coverage for people with serious mental illness (SMI).  We strongly recommend that the department include people with SMI.

Although their inclusion will increase the cost of the Medicaid program, those costs to the state are offset by savings in the Division of Behavioral Health, the State Catastrophic Care fund, the county indigent programs, and  the regional crisis centers. Indirectly, there will eventually be savings to local law enforcement, emergency departments, jails, first responders and the courts. Medicaid coverage for people with SMI is an overall fiscal benefit to Idaho.

It may be argued that the 1332 waiver will provide an opportunity for coverage for Idahoans with SMI who are “in the gap”. First, it is not clear how people without taxable income will qualify for the 1332 waiver. This is likely to be a problem for people with SMI. Second, private insurance plans will cover psychiatrist visits, prescription drugs, and some level of hospitalization. But private policies do not cover the range of services that have been demonstrated to be needed to support people with SMI in the community. Some of the most critical services such as psychiatric rehabilitation, intensive outpatient, peer supports, case management, partial care, and medication management, are covered by Medicaid, but not by insurance. Without some of these supportive services many people with SMI will not be able to comply with their psychiatrist’s appointments, or their medication regime. DBH provides some supports like ACT teams, but only for people who are already in crisis, not as ongoing supports.

It may be the case that the inclusion of people with SMI, makes it more difficult to establish the budget neutrality component of the application, if the Medicaid costs are not offset by reduced premium credits. We do not have the actuarial information needed to assess this issue. However, if it is possible to develop a waiver application which includes people with SMI, we should not let the opportunity pass by.

Idaho has a broken and fragmented mental health system which provides few services for people with SMI until they are in a serious crisis, posing a risk to themselves or others. We have little to offer these Idahoans unless they qualify for Idaho Medicaid. This approach to mental health has filled our jails and clogged our courts with people whose only offense is having inadequately treated mental illness. By failing to implement the expansion offered by the ACA, we have refused funding which could help Idaho make significant improvements to our system. If there is any way that we can use this waiver to improve mental health services for Idahoans with SMI, it would be a shame to let another opportunity pass by.


Submitted by James R. Baugh, Executive Director, DRI

2018 Idaho Election Calendar

February 16, 2018 Last day to pre-register to vote for the March 13 election.

March 2, 2018 Last day for an application for a mail-in absentee ballot to be received by the County Clerk for the March 13 election.

March 9, 2018 Last day for in-person absentee voting and for early voting for the March 13 election.

March 13, 2018. Election 8:00am to 8:00pm (*) At clerks option, polling places may be opened at 7:00am. Absentee ballots must be submitted to the County Clerk’s
Elections office by 8:00pm.

April 20, 2018 Last day to pre-register to vote for the May 15 Primary Election.

April 30, 2018 Last day to begin Early Voting for the May 15 Primary Election at the Early Voting Polling Place for the Primary Election for those counties who elect to conduct Early Voting.

May 04, 2018 Last day for an application for a mail-in absentee ballot to be received by the County Clerk not later than 5:00pm for the Primary Election May 15.

May 11, 2018 Last day for in-person absentee voting and for early voting for the May 15 Primary Election.

May 11, 2018 Last day for Early Voting until 5:00pm for the Primary Election (May 15) at the Early Voting polling place.

May 15, 2018 Primary Election – 8 am-8 pm (*) At clerks option, polling places may be opened at 7:00am. Absentee ballots must be submitted to the County Clerk’s
Elections office by 8:00pm.

August 13, 2018 Last day to begin Early Voting at the Early Voting polling place for the August 28 election for those counties who elect to conduct Early Voting.

August 17, 2018 Last day for an application for a mail-in absentee ballot to be received by the County Clerk not later than 5:00pm for the August 28 election.

August 24, 2018 Last day for in-person absentee voting until 5:00pm for the August 28 election at the absent elector’s polling place.

August 24, 2018 Last day for Early Voting until 5:00pm for the August 28 election at the Early Voting polling place.

August 28, 2018 Election – 8am-8pm pm (*) At clerks option, polling places may be opened at 7:00am. Absentee ballots must be submitted to the County Clerk’s Elections office by 8:00pm.

October 12, 2018 Last day to pre-register to vote for the General Election November 6.

October 22, 2018 Last day to begin Early Voting at the Early Voting polling place for the General Election (November 6) for those counties who elect to conduct Early Voting.

October 26, 2018 Last day for an application for a mail-in absentee ballot to be received by the County Clerk not later than 5:00pm for the general Election (November 6).

November 2, 2018 Last day for in-person absentee voting until 5:00pm for the General Election (November 6) at the absent elector’s polling place.

November 2, 2018 Last day for Early Voting until 5:00pm for the General Election (November 6) at the Early Voting polling place.

November 6, 2018 General Election – 8am-8pm At clerks option, polling places may be opened at 7:00am. Absentee ballots must be submitted to the County Clerk’s Elections office by 8:00pm.

Combining the SILC, the DD Council & TBI Programs into a Single Council is a Bad Idea

DisAbility Rights Idaho, Comments on proposal for the Partnerships for Innovation, Inclusion and Independence (PIII)

The PIII proposal is one of those concepts that seems like a good idea to people in Washington D.C. examining the various laws and grants, but is obviously a very bad idea to people with disabilities in the states where the councils actually do their work. I do not believe that there is any way to combine the three councils without diminishing their effectiveness. I do not believe that a single council can have effective representation from all of the affected constituencies.

Combining the Councils will destroy their focus and dilute disability representation.

All three councils are concerned with some type of disability, all three councils are required to have some representation of people with disabilities or family members. All three councils have some role in recommending state policies concerning issues involving people with disabilities. Nothing else is the same. Even in these three areas, each council’s mission and makeup are very different. In theory, the councils’ activities could overlap. In practice they never duplicate but sometimes collaborate. In Idaho the DD Council has interacted with the State Independent Living Council (SILC) for thirty five years, complimenting each other’s activities without duplicating or overlapping.

  1. The State Independent Living Council (SILC) and Centers for Independent Living (CIL) are cross disability organizations, but they are exclusively focused on independent living in the community. The SILC’s activities are focused on adults and transition age youth, soon to enter adulthood. They are NOT directly concerned with conditions in facilities, early childhood services, family support, K-12 education (except for transition), abuse or neglect in facilities, diagnosis or treatment. By concentrating on independent living, the SILC can work on a wide variety of disabilities, although it is a challenge to maintain a board which fairly represents this variety.
  2. The DD Council is focused on people whose disability is severe and occurs at birth or during the developmental period, but mostly addresses people with Intellectual Disability, Autism Spectrum Disorders, and Cerebral Palsy. By keeping a narrower focus in terms of disability, DD Councils can address issues across the lifespan including prevention, infant and toddler, preschool, Education, medical treatment, abuse and neglect in homes and facilities, specialized skill development, job training and placement, benefits policies, rights protections, and community integration. By having a narrower disability focus, DD Councils can assure that they have representation for the variety of disabilities, different ages and issues, and can include parents of children with DD.
  3. Congress established the Traumatic Brain Injury (TBI) Programs for the specific reason that the unique problems of people with TBI were not being addressed by the various disability related programs and the medical and rehabilitation establishment. People with TBI found themselves without appropriate treatment, rehabilitation services, education or medical treatment. As the incidence of TBI increased due to combat injuries, and sports injuries, this lack of specialized services was exacerbated. Recombining the TBI program into pre-existing programs would defeat the purpose of the legislation.

There is no way that these councils can be efficiently combined into a single entity. To insure adequate representation of all of the different disability types, ages, and geographic and cultural groups would require a huge and unwieldy council. Maintaining a focus on all of the issues addressed by each of the councils would dilute the targeted efforts and make them less efficient and less effective.

PIII would dismantle a successful program of State and Local innovation, often leveraging private resources to create local solutions.

These Councils have been productive laboratories for state innovation. Congress designed these programs to be focused on specific priorities, but to leave the implementation to the states to find innovative and local solutions. Within each council’s mission they are required to have consumer controlled processes for developing plans and projects. These projects in Idaho have often focused on developing and connecting people with disabilities to local, private or charitable resources to help people integrate more fully into community life, rather than promoting dependence on federal programs. For over 30 years these unique programs have been successful laboratories of innovation, responsive to their constituent communities. In those three plus decades, they have developed cooperative arrangements, collaborating when appropriate, but never duplicating services. In Idaho at least, this process is effective and efficient.

Each Council is an essential part of a State Network.

SILCs have a unique relationship with the state’s Centers for Independent Living (CIL). CILS receive guidance, public policy assistance, coordination and planning assistance from the SILC. CILs are the main focus of the SILC and this very beneficial collaboration could not be sustained at the same level with a broader, less focused, combined council. The SILC also provides a statewide point of contact for broader collaboration with Protection and Advocacy services, and the other two councils.

DD Councils are intimately associated with The University Centers for Excellence in DD (UCEDD), and with the Protection and Advocacy System (P&A). DisAbility Rights Idaho is the P&A system for Idaho. The UCEDD, through research training and dissemination helps to define evidence based “best practices” for people with DD. DD Councils provide planning coordination and public policy guidance to help the state adopt and implement those practices. P&As, in addition to protecting the rights of people with developmental disabilities, monitor the success of those practices and policies and provide important feedback and legal analysis to the Council and the UCEDD (See also NDRN”s comments on this issue, with which we concur). These three entities are required to collaborate on five or more priority issues every year.

TBIACs are integrated with the state TBI program and the Protection and Advocacy for people with TBI (PATBI). This combination of programs provides for collaborative planning and priority selection to help drive state level solutions to the lack of specialized services and treatment for people with TBI.

A combined council could not hope to achieve the level of joint planning and collaboration on the three areas of focus. This would make the process of planning and priority setting cumbersome at best and impractical in general. The focus which Congress placed on particular populations, like TBI, and on particular goals, like independent living, would surely be lost.

Reduced Funding will Reduce Effectiveness.

Since the merger of the councils will not increase efficiency, reduced resources will simply reduce effectiveness. The drastic reduction in overall funding will create destructive competition for shrinking and inadequate resources by diverse and deserving groups of people with disabilities. Making a single council choose between addressing abuse of people with DD in institutions, and finding transportation resources to enable people with disabilities to gain employment, or making web based services accessible for blind people, or improving access to mental health services for people with persistent mental illness, is not productive. These programs are in need of more funding, not less. (See also the comments of NDRN).


The PIII proposal has superficial appeal to people in Washington D.C. reviewing statutes and bureaucracies, but it discounts the collective experience of people with disabilities in the states where these programs have succeeded, and over thirty years, have found effective ways to achieve the Congressional purpose of each program, individually and collaboratively. PIII would destroy the focus of each program and dilute their mission across many dissimilar disabilities and goals. It would make adequate representation of different disabilities, geographic areas, and cultural concerns in a single council impossible. It would disrupt the three networks which improve the effectiveness of the councils. Reduced funding will reduce effectiveness.

If You Are Having Problems with Veyo – CID Wants to Hear About It.

The Consortium for Idahoans with Disabilities (CID) is collecting information regarding issues that people with disabilities (and/or parents of children with disabilities) may be experiencing with non-emergency medical transportation being provided by the new managed care organization Veyo.

CID is sharing these concerns with the Department of Health and Welfare, legislators, and VEYO in an effort to determine what problems may exist and how to provide immediate solutions.

Idaho Parents Unlimited (IPUL) is hosting a form on their website for you to share your story, as well as to be contacted for more information. Please click here to go to the form.