Idaho changes rules on therapy. What will it mean for kids with disabilities?
In 2020, Evan Kates was struck with a devastating brain aneurysm. It came out of nowhere, and left him with a severe seizure disorder and profound developmental disabilities. Evan, then 5, was left reliant on a feeding tube, and doctors told his family he would probably never talk again.
But years of physical, occupational and speech therapy have made a huge difference, his mother, Brooke Kates, told the Idaho Statesman. Evan has been able to re-learn how to eat solid foods and how to speak in sentences.
“We know a full recovery is not something that’s going to happen, but the goal is always progress where it’s possible,” Kates said during one of Evan’s appointments on Wednesday. Therapists fitted him for a wheelchair that day that would allow him to switch between sitting and standing positions to develop more muscle tone in his legs.
Such progress relies on the Boise family’s ability to access and afford multiple therapy appointments each week. Evan even spent part of his 11th birthday, on Tuesday, at a therapy appointment, Kates said.
These days, Kates worries her son’s access to such care could be in jeopardy. In early January, she, other parents and care providers were caught off-guard by an announcement that the Department of Health and Welfare had started to place caps on the number of therapy appointments it would allow Medicaid to cover. Patients and providers will still be able to request appointments beyond those caps, but they must receive prior authorization from the department.
Many families, including Evan’s, have private insurance but rely on Medicaid to fill the gap for the additional care that those with disabilities require. Private insurance often covers a finite number of occupational or physical therapy sessions that would help someone recover from, say, a surgery or a broken bone. But Kates’ family has found few insurers that will cover that care for someone like Evan. Individual therapy appointments can cost hundreds of dollars out-of-pocket, Kates said.
Her family relies on a Medicaid program called Katie Beckett, which covers children with long-term disabilities or complex needs. Those children are often eligible for Medicaid services even if their family’s income is higher than Medicaid federal poverty guidelines.
Families in Idaho who qualify for Medicaid will be limited to 20 sessions each of occupational, speech and physical therapy per year unless their providers get prior authorization from Health and Welfare to offer more sessions, according to the department’s Jan. 8 announcement. Providers and advocates told the Statesman that this will add more paperwork and red tape to the process and risks further clogging up a system that is already dealing with cuts.
“It’s just one more hoop that both the parents and the providers have to jump through to maintain the care that these kids are going to need,” said Julie McConnel, a longtime member of the Treasure Valley Down Syndrome Association and mom of 10-year-old twin boys with Down Syndrome. “A lot of providers are already pretty stretched.”
Decision surprised providers, spurred confusion and frustration
The Department of Health and Welfare notified providers about the change in a Jan. 8 memo, which said the change took effect Jan. 1, about a week before the notification was sent out.
“It’s kind of like a bomb was dropped on us, just out of nowhere,” said Josh Wilde, a pediatric occupational therapist in Idaho Falls. Parents received no direct notification about the change, several told the Statesman.
The change was part of a regular review of Idaho Medicaid policies, said AJ McWhorter, a spokesperson for Health and Welfare. He did not provide answers to follow-up questions about the reason for the department’s decision, including whether it hoped that the change would save the state money. He said the department had no estimate on how much the cuts could save the state.
Before the Jan. 1 change, providers were responsible for ordering therapy sessions for patients, but Idaho Medicaid didn’t need to authorize those as a medical necessity, McWhorter said. With the policy change, Idaho joins other states with similar therapy caps, he said.
But the details of how the change will play out remain unclear, contributing to anxiety, parents and providers told the Statesman. They said they weren’t sure how often they’d have to reassess eligibility, how likely they were to be approved or if the changes could lead to gaps or delays in care.
Providers and disability advocates worry that the added burden could force providers to limit the number of Medicaid patients they’ll accept. The families that spoke to the Statesman all said their children needed far more than 20 therapy sessions per year to progress.
“It’s going to strain an already-strained system,” Wilde said. “Imagine having a child with severe special needs and not being able to get the help you need.”
In the long run, advocates said, the move could drive needed therapists out of the state, especially because the changes follow a 4% cut in 2025 to the rates Idaho pays providers who offer care to Medicaid patients. These changes tighten the screws for providers who already face slim margins, they told the Statesman.
“There’s kids that in the last year went from not being able to walk to walking, or kids that haven’t been able to talk but can talk, or there’s kids that haven’t been able to get dressed on their own, they can get dressed now,” Wilde said. “Without therapy, that’s going to be halted.”
Families, providers emphasize importance of consistent therapy
At Kaleidoscope Pediatric Therapy in Boise, where Evan receives care, therapists conduct over 400 visits a week, about 70% of which are covered by Medicaid, said co-owner Katie Rowe.
That money pays dividends for the state, she said. The right therapy can diminish the care kids will need later in life and can help some join the workforce who may otherwise not have had the motor skills to do so. Other providers said it also decreases the burden on schools.
Losing access to care, parents and providers said, could cause kids to regress and would require more intensive care or costly interventions later on.
When Gracie Elmore’s daughter was in the neonatal intensive care unit, doctors told her that her daughter, who has a rare genetic condition, would never walk. With therapy, she’s made significant progress.
“We’re so close to doing steps independently, and she would never be able to do any of this without therapies, consistent therapies,” Elmore said.
Before therapy, Ciera Belnap’s daughter cried and hid under the bed when family members used a vacuum cleaner. Coaxing her out could take an hour. At 4 years old, she insisted on taking only ice-cold baths – anything warmer felt like it was hurting her skin.
“It just broke my heart as a mom, because she became a shell of who she is,” Belnap, of Ammon, said.
With therapy, her daughter’s sensory processing disorder improved in months. She later started going to speech therapy after struggling with language, reading and expression. But the consistency is key: If her daughter, now 11, could only attend 20 sessions a year, Belnap said, it would slow her progress, and she’d fall further behind her peers.
Families brace for more Medicaid cuts
For now, providers are cautioning families not to panic. They should still be able to access therapy sessions for their children, although the process is changing.
But with the uncertainty, and the potential for more cuts down the line, that could change.
After years of tax cuts, and amid rising state health care and other costs, Idaho lawmakers in the 2026 legislative session are looking to cut state spending. Medicaid – and the budget for Idaho Health and Welfare in general – have been on the chopping block in early-session meetings.
Gov. Brad Little’s proposed budget, which he presented during his annual State of the State address Jan. 12, called for cutting Medicaid coverage for therapy sessions entirely.
Kayla Heap worries about what cuts to therapies would mean for children like her daughter. Earlier this month, she excitedly watched the girl say a line during a school event in front of an audience – a huge milestone. Heap’s daughter, 10, has apraxia of speech, a neurological speech disorder, and spent years attending speech therapy about three times a week.
“To see her up on that stage amongst every fourth grader at her school, all of their parents and grandparents and siblings, and for her to say a line that everyone understood, I don’t think you can even put that moment into words,” Heap told the Statesman. “I’m reminded every day how lucky we are that she got the services she needed because she has a voice, and I think that’s something that so many people take for granted.”