BOISE, Idaho — Clinic owners, families, and therapists gathered on Thursday at the Idaho State Capitol to discuss a new restriction that limits physical, speech, and occupational therapy to just 20 visits per year for Medicaid patients.
The change, which took effect Jan. 1, has left families across Idaho frustrated. Many clinics offering therapy services were equally dismayed after they received a letter from the Idaho Department of Health and Welfare earlier this month informing them of the new caps.
"You are hurting me, and you're hurting my son, and so many other parents out there that rely on these services," said Alexis Baker, a parent who attended the gathering.
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Sara Bergsma, legislative representative for the Idaho Speech and Hearing Association, confirmed the policy is already in effect.
"It is happening, yeah, it's already happened as of January 1st," Bergsma explained.
Under previous rules, additional visits beyond the initial allowance could be approved more easily. The new system requires significantly more paperwork and creates uncertainty for families and providers.
"We just don't know when they will approve or deny those services,” Bergsma said. “How many they'll approve, how many more, [and] if they'll approve them for everybody or if there's gonna be certain stipulations on who will get more visits or not."
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The change impacts families like the Thompsons, whose daughter Clementine has made immense progress following a spinal cord injury. Scott Thompson said therapy has transformed his daughter's life over the past five years.
“She's able to walk with mobility devices now,” Thompson said. "In 5 years, she's gone from no mobility to that, and it wouldn't be possible without PT and OT— just wouldn't.”
While the Thompson family has private insurance, they rely on Medicaid for additional coverage to manage the high costs of therapy.
"There's no way, even if you were a parent that had a lot of savings and a great job, you wouldn't be able to cover the expenses," Thompson said.
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Alexis Baker, a single mother whose 4-year-old son has autism, said weekly therapy sessions have been crucial for her child's development.
"My son needs these,” Baker said. “And these services are so beneficial to my son that now he is on track to start school on time.”
Therapists who typically see patients once a week are concerned about losing 32 sessions per year, which they said could be detrimental to patient progress.
"It's just going to cause them to lose those skills and have to come back and regain those skills and to rely more solely on parents and caregivers," said Melissa Mazzaglia, a speech language pathologist at Beyond Words Speech and Language Services.
The policy change could have broader economic impacts on Idaho's healthcare system. Katie Rowe, owner of Kaleidoscope Pediatric Therapy, said over 70% of their patients rely on Medicaid. She warns that the restrictions could force therapists to leave the state if clinics struggle financially.
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"So we lose providers, and we would also then lose all of that revenue for someone just living in the state of Idaho and working, owning homes, and going out to dinner and all of the stuff that it is to live here," Rowe said.
The Idaho Department of Health and Welfare will hold a virtual listening session on February 3, where Idaho residents can share their experiences and concerns about potential Medicaid changes.
