What’s happening in Idaho might look like a local budget issue—one governor, one legislature, and a $22 million cut. But that perspective misses the bigger picture. When Governer Brad Little approved cuts to Medicaid services, he became another part of national trend that’s been growing for years.
These cuts mainly hit home- and community-based services, or HCBS. This part of Medicaid helps disabled and older people live outside of institutions. Home and community-based services can include things like caregivers, home delivered meals, and therapies that help people stay in their homes rather than moving into nursing homes.
For decades, the U.S. has moved in this direction. Home and community-based services are seen as more humane and often cheaper than institutional care. Families and disabled people prefer it. But there’s a big problem with the system.
Federal law requires Medicaid to cover nursing home care. But home- and community-based services—the very supports that keep people out of nursing homes and connected to their communities—are optional. That difference matters a lot.
It means states can cut HCBS programs whenever money gets tight. It’s why families are always on edge. They are never sure if the help they count on will still be there next year.
As federal support decreases and costs increase, states are facing a new phase in Medicaid policy. They can’t easily cut required services like hospital or nursing home care, but home and community-based services are optional. So they often target them.
Sometimes the cuts are clear, like in Idaho. Other times, they’re subtle: stopping new people from enrolling, limiting how many hours of care someone gets, or increasing the administrative burden, which makes access harder over time. The outcome is the same—fewer people get help or they get less of it.
People who lose support at home or in the community don’t just stop needing care. Instead, they end up in emergency rooms, hospitals, or nursing homes—the very places the system has tried to avoid. Often, these options cost more and aren’t the best fit, causing a cycle where short-term savings lead to higher costs later on.
This reveals a big contradiction in Medicaid. For years, policy has pushed for community living instead of institutionalization. But the way Medicaid is funded still treats community care as optional. That means the services allowing independent living are also easiest to cut.
Meanwhile, the disability services sector is fragile. Providers across the country struggle to find and retain employees. The jobs are often difficult and don’t pay well. If reimbursement rates drop even a little, providers don’t have much choice. They cut staff, stop taking new clients, or shut down programs. That’s when the real problems start.
So states grow HCBS when money is good, then cut back when budgets tighten—even though the need never goes away. Until HCBS is seen as essential, not optional, states will keep balancing budgets at the expense of disabled, and older people.
Unfortunately, what is happening in Idaho isn’t unusual. It shows what happens when this system faces pressure. As more states deal with tight budgets, decisions like this will probably become more common.
That’s the real story. Not just one state cutting one program, but a system showing where it works, where it doesn’t, and who ends up paying.
Sources:
Maniates, Hannah. “Why Did They Do It That Way? Home and Community-Based Services.” National Association of Medicaid Directors, National Association of Medicaid Directors, 16 Apr. 2024, medicaiddirectors.org/resource/why-did-they-do-it-that-way-home-and-community-based-services/.
Pfannenstiel, Kyle. “Idaho Governor Approves $22M in Medicaid Disability Budget Cuts.” Idaho Capital Sun, States Newsroom, 27 Mar. 2026, https://idahocapitalsun.com/2026/03/27/idaho-governor-approves-22m-in-medicaid-disability-budget-cuts/.