COEUR d’ALENE — When new medical providers meet 16-year-old Evie Wismer for the first time, they’re usually overwhelmed by her medical records.
Evie is medically fragile and has health problems that require frequent visits to the emergency room. Her chart contains hundreds of pages of history.
Through the Healthy Connections program, an Idaho Medicaid program that helps members connect with a primary care provider or clinic who will coordinate their healthcare needs, Evie’s family can reach her doctors at Coeur d’Alene Pediatrics, even after hours.
“For families like ours with kids who are medically fragile and have special needs, Healthy Connections often feels like and can be a lifesaver,” said Olwyn Wismer, Evie’s mom.
Healthy Connections is slated to be cut in January due to a new law that proposes sweeping policy changes to control Medicaid’s costs.
It costs around $24 million annually to fund Healthy Connections.
Families and medical care providers throughout Kootenai County said they’re concerned the changes implemented by House Bill 345, which Idaho Gov. Brad Little signed into law in April, will cause children to lose access to important health care services.
Representatives from the Idaho Department of Health and Welfare stated that the department will review public comment before finalizing a revision request through the Centers for Medicare and Medicaid Services.
The appropriated budget for Medicaid going into the state fiscal year 2026 accounted for an 8% growth trend, but the DHW is now forecasting a 19% growth trend. Service cuts to Medicaid will be needed to stay within the IDHW budget if Idaho Medicaid does not implement rate adjustments.
Coeur d’Alene Pediatrics cares for about 6,000 children in Kootenai County whose families are enrolled in Medicaid. The practice takes on 100 to 150 new children who receive Medicaid each month.
Dr. Cheri Savage said she’s worried the practice won’t be able to take on those child patients after Healthy Connections is cut. Triage, patient advocacy and care coordination will be lost along with the program.
“You’re talking about delayed treatment, delay of diagnostic care,” Savage said.
Dr. Karen Cabell, chief physician executive at Kootenai Health, warned that the changes to Medicaid could overwhelm local resources and “compromise the quality, continuity and timeliness of care these children receive.”
“If even one private pediatric practice stopped accepting Medicaid patients, the impact on the community would be immediate and significant,” Cabell said. “We expect that Kootenai Health would see a sharp increase in pediatric visits to our emergency department and urgent care locations.”
IDHW staff shared that federal regulations require Idaho Medicaid to submit an access analysis and monitoring plan for review and approval by CMS after a period of public comment.
Redman’s vision for Idaho Medicaid
Rep. Jordan Redman, R-Coeur d’Alene, introduced in February a bill that would have required Idaho to enact 11 Medicaid policy changes by next July or repeal Medicaid expansion, a policy that makes more low-income Idahoans eligible for Medicaid.
When that bill stalled, Redman introduced House Bill 345, which he said was meant to contain Medicaid costs without the threat of repealing the voter-approved law. HB 345 passed on party-line votes in both chambers of the Idaho Legislature.
Redman said his goal is to try to expand the number of providers who accept Medicaid through incentives.
“What’s important? What’s your baseline? How do we incentivize that if you’ve been doing an excellent job?” Redman said.
Responses coming to Redman about the bill so far have largely been positive.
Redman said his hope was to implement proposed changes to Medicaid within 18 months, but the timeline has been pushed to two or three years.
“It is a very large process, I understand it’s a lot of work to do,” he said.
Local pediatricians talk change
Medicaid is a “stepping stone” for families, said Dr. Jeff Shirts of Lakeside Pediatrics and Adolescent Medicine.
Dr. Jeff Shirts, a provider with the practice, said changes to Medicaid and cutting programs like Healthy Connections will impact doctors’ ability to care for pediatric patients in Kootenai County.
“Healthy Connections has worked,” he said. “Pediatricians are among the lowest-paid specialists. Taking away that cushion that is allowing them to be a profitable enterprise — you can’t stay open and really everybody is harmed by that.”
At Coeur d’Alene Pediatrics, Dr. Cheri Savage said the practice has had bumps in the road before with Medicaid, but the coming changes have been a concern.
“Since the inception of Coeur d’Alene Pediatrics years ago, we have never closed to Medicaid,” Savage said. “There was a summer we didn’t get paid for an entire summer and we didn’t say no.”
If Healthy Connection is shuttered Jan. 1, Savage said she’s worried the practice won’t be able to continue seeing pediatric Medicaid patients.
In trying to adapt business models on the fly, Savage said she and others in the pediatric community are trying to raise the alarm on the impacts to families on finding the right resources.
“If there aren’t any changes in the financial piece, it will absolutely put the medical needs of kids in jeopardy. We’re going to have to be nimble and clever and maybe think outside the box in this situation,” Savage said. “If you have nowhere to go, does it really matter?”