Overview of Idaho
Idaho is a large western state with impressive mountain ranges, large areas of high desert, and massive expanses of forested terrain. Idaho contains the second largest wilderness area in the lower 48 states, the Frank Church – River of No Return Wilderness, which covers almost 2.4 million acres. Idaho is an important agricultural state, producing nearly one-third of the potatoes grown in the United States. Wheat, sugar beets, and alfalfa hay are also major crops. Other industries contributing to Idaho’s economy include information technology, mining, lumber, tourism, and manufacturing.
Geography and distance impact both the demographic characteristics and social determinants of health within Idaho. Idaho is ranked 38th of the 50 states for total population and 14th for geographic size. According to the 2017-2021 American Community Survey (ACS) 5-Year Estimates, Idaho’s population for 2021 was 1,811,617 and because of its large size and relatively small population, Idaho remains one of the most rural states in the nation. Idaho ranks 44th of the 50 states in population density with approximately 22.3 people per square mile. The national average population density is 93.8 people per square mile, a four-fold greater density than Idaho. Thirty-five of Idaho’s 44 counties are rural with 19 of these counties considered remote or having fewer than six people per square mile. Delivering adequate health services to the entire state remains a challenge in this very rural environment.
According to the ACS, 11.4% of Idahoans were living below the poverty level. It is estimated that about 13.6% of children under the age of 18 are living below the poverty level. The median household income in Idaho was $63,377, compared to the U.S. median household income of $69,021. Idaho’s per capita income was $31,509. The state’s labor force – the only indicator that did not experience a sharp decline during the pandemic – also showed gains from 2020 with a 2.5% unemployment rate in May 2022 according to the Idaho Department of Labor.
In 2021, there were 21,203 infants under the age of one and 447,823 children aged one through 17 residing in Idaho. Of those, about 19.2% or 86,109 of Idaho’s children have a special health care need. There were 369,349 women of reproductive age (15 to 44 years old) residing in Idaho, which is just over 19% of the total state population. Idaho’s birth rate was 11.8 per 1,000 population.
The most recent national data (2017-2021 ACS 5-Year Estimates) indicate that the percentage of Idahoans over the age of 25 who have graduated from high school, or received their GED or alternative credential, is higher than the national average (91.2% and 88.9%, respectively). A total of 80% of students who started 9th grade in the fall of 2017 graduated high school in 2021. The 2021 state-level, four-year high school graduation rate for American Indian or Alaskan Native students increased from 65% to 69%. Asian students have the highest graduation rate (85.7%), followed by their White classmates (82.5%). In 2019, 46% of high school graduates enrolled in postsecondary education immediately after high school graduation. That number dropped to 39% in 2020 and continued to remain low at 38% in 2021. Approximately 29% of Idahoans hold a bachelor’s degree or higher compared with the national average of 35%.
The racial groups that comprised Idaho’s 2021 population (2017-2021 ACS 5-Year Estimates) were: (a) White, 92.1%; (b) Black, 1.3%; (c) American Indian/Alaska Native, 2.6%; and (d) Asian or Pacific Islander, 2.9%. It is estimated that 5.7% of Idahoans identify as being of two or more races. Persons of Hispanic or Latino origin comprised 13% of Idaho’s total population, making it Idaho’s largest minority population with 234,561 Hispanics/Latinos residing in the state. Most Hispanic Idahoans are U.S. born (70%) and U.S. citizens (81%), with 43% born in Idaho. The majority of Idaho's Hispanic population (77%) resides in southern Idaho. Over the last decade, the Hispanic population grew in Idaho by 30%.
Idaho has a small but growing immigrant population. According to the American Immigration Council in 2019, only 5.2% of the state’s residents were immigrants, but they represent a greater share of the workforce at 7.1%. Idaho’s top industries with the highest share of immigrant workers are in the animal production and aquaculture and crop production. In 2019, 51% of immigrants living in Idaho were women and children ages 0-15 and made up 3.1% of the foreign-born population and 23.5% of the U.S.-born population. The largest country of origin for immigrants in Idaho was Mexico, accounting for 45.7% of the immigrant population. The other top countries of origin were Canada (7.3%), China (2.9%), the Philippines (2.1%), and Germany (1.9%).
Idaho has three refugee centers: two located in Ada County in central Idaho and one located in Twin Falls in south central Idaho. Idaho received an estimated 331 refugees in 2021, a 70% decrease since peak refugee arrivals in 2016. However, in 2022 over 1,200 refugees were resettled in Idaho surpassing arrivals in 2016. Most of the refugees seeking resettlement in Idaho are women and children, with the majority being from Congo, Iraq, and Afghanistan. In 2022, Ukraine was the second largest country of origin for refugees. Priorities established for FY 2024 will include assessing gaps in services for the resettlement communities with continued efforts to engage these communities in the five-year needs assessment surveys and establish new partnerships. The Maternal and Child Health (MCH) Program was able to incorporate the perspective of some individuals from the Idaho resettlement population, who are traditionally underrepresented, into the 2020 Needs Assessment.
Idaho is home to six federally recognized tribes: Coeur d’Alene Tribe, Kootenai Tribe of Idaho, Nez Perce Tribe, Shoshone-Bannock Tribes of the Fort Hall Reservation, the Northwestern Band of the Shoshone Nation, and the Shoshone-Paiute Tribes of the Duck Valley Reservation. In addition to federally funded Indian Health Services, each tribe has individually-operated health centers located on its tribal lands. Efforts to engage with tribal communities to collaborate and identify gaps in services within these communities will be a focus for FY 2024 with plans to encourage participation in the next five-year needs assessment and build on new collaborative partnerships.
Idaho's citizenry and leadership tend to emphasize the importance of individual and local control over matters involving economy, health, education, and welfare. The independent nature and philosophy of Idahoans manifests itself through development of local programs and services through grassroots efforts rather than a centralized approach. This philosophy is present within the political leadership, which influences allocations to programs within state government, including Idaho's public health programs. As reflected in the MCH priorities, access to health care and other services have been identified as barriers to improving health outcomes for Idaho residents.
Idaho Division of Public Health
The Idaho Department of Health and Welfare (DHW) is the state’s health and human services agency. With the overarching mission of strengthening the health, safety, and independence of Idahoans, DHW is dedicated to protecting the social, economic, mental, and physical health and safety of Idahoans while promoting healthy behaviors and positive lifestyles. DHW provides critical and valued services to more than a third of all Idahoans and strives to be a vital partner to other agencies and communities in our state, both in leadership and supportive roles. The DHW Director, Dave Jeppesen, oversees all department operations and is advised by an eleven-member State Board of Health and Welfare appointed by the Governor. DHW is made up of eight divisions. Across these divisions, essential programs and services are delivered to Idahoans, including Medicaid, SNAP, child protective services, foster care, early intervention, child support, and behavioral health services. DHW is the largest state agency with approximately 2,992 full-time employees and 42 locations (36 of which are publicly accessible). In addition to field and administrative offices, DHW operates visitation and counseling offices, state institutions, the state laboratory, and the Emergency Communications Center.
Within the DHW, the Division of Public Health (DPH) is the state’s public health agency. The DPH is nationally accredited by the Public Health Accreditation Board (PHAB) and staffed with 320 employees. Idaho’s DPH provides a statewide infrastructure that serves and protects the health and safety of Idahoans through a range of public health services, population health initiatives, and acts as the first responder during times of public health need. The DPH is comprised of eight bureaus, as well as the Division of Public Health Administration. The range of programs and services includes immunizations, nutrition services, suicide and drug overdose prevention, chronic and communicable disease surveillance and intervention, maternal and child health services, food safety regulation, emergency medical personnel licensing, vital records administration, health statistics compilation, rural healthcare provider recruitment and retention, maintenance of an advance care directive registry, laboratory services, and emergency preparedness and response.
Within DPH, the Bureau of Clinical and Preventive Services (BOCAPS) fulfills the primary roles of administering grant programs, developing policies, assuring health care access, and overseeing statewide public health programs across the life course. BOCAPS programs are focused on providing gap-filling clinical services, nutrition and medical benefits, health education and prevention, population-based screening, and testing and treatment of STDs. BOCAPS is organized into three sections of programs, including the Women, Infants, and Children supplemental food program (WIC) Section, the HIV, STD, and Hepatitis Section (HSHS), and the Maternal and Child Health (MCH) Section. The MCH Section serves as the state’s Title V Program and is managed by the Title V MCH Director. The Title V MCH Program leverages the existing public health infrastructure with local public health districts, health systems, and community partners to meet the unique needs of Idaho’s MCH populations. Please see “Title V Program Design and Purpose” for more information about Idaho’s Title V MCH Program.
The Idaho 2-1-1 CareLine is a statewide, bilingual, toll-free information and resource referral service linking Idaho citizens to health and human services. In SFY 2022, the CareLine facilitated 83,269 information contacts and CareLine staff provided 104,292 individual referrals. The CareLine received 21 calls related to prenatal/family planning and 2,928 calls related to Medicaid for children less than 19 years old. The CareLine referral database has an estimated 10,616 active services relating to 3,352 programs to increase the health, stability, and safety of Idahoans. The CareLine serves as Idaho’s mechanism to meet the required OBRA legislation.
Local public health infrastructure is established around the state’s population centers and arranged in seven autonomous public health districts (PHDs) containing contiguous counties across the state. These seven areas are further defined by geographic barriers and transportation routes. Each district responds to local needs to provide services that may vary from district to district, ranging from community health nursing and home visiting to environmental health, clinical services, dental hygiene, and nutrition. Many services are provided through subgrants with the Division of Public Health.
Health Care Systems
There are 28 birthing hospitals statewide, as well as 13 free-standing birthing centers. In 2021, 94.4% of births occurred in a hospital, 2.0% occurred in freestanding birthing centers, and 3.6% occurred in a home setting. In-hospital births decreased slightly by 0.7% in 2021 and the percentage of births occurring in free-standing birthing centers or home settings increased by 12.5% and 17.6%, respectively.
There are 15 community health centers (CHCs) that provide patient-centered primary healthcare services for medical, dental, pharmacy, and behavioral health services on a sliding scale serving 67 communities with 192 clinic sites. These community clinics help bring affordable access for care in rural communities with the majority on Medicaid or Medicare with pockets of uninsured individuals. CHCs provide essential health services and are often the only source of primary and preventive care in rural Idaho.
The largest health care system is St. Luke’s Health System with 200 clinics across Idaho. St. Luke’s has 1,000 beds, 30 medical centers/specialty clinics, and the state’s only Children’s Hospital and Level II Pediatric Trauma Care Facility. In 2018, St. Luke’s opened its first virtual hospital with a 35,000 square foot center that offers a telehealth program that helps to fill the gap for patients experiencing challenges to accessing medical care, especially those living in remote, rural areas. In 2019, St. Luke’s opened Idaho’s first pediatric trauma program at its Children’s Hospital and began its pursuit of the Level II Pediatric Trauma verification. Due to COVID-19 this effort was paused, but in June 2022 they received their Level II Pediatric Trauma verification by the American College of Surgeons. St. Luke’s Regional Medical Center in Boise is a Level I Stroke Center and a Level I STEMI (heart attack) Center.
The second largest health care system is Saint Alphonsus, which is a member of the national Trinity Health System. Saint Alphonsus has hospitals in Boise and Nampa in the southwestern portion of the state as well as two hospitals in Oregon near the Idaho border. Saint Alphonsus Regional Medical Center in Boise is a 381-bed medical, surgical, and acute care hospital with primary care and specialty medical centers. Saint Alphonsus Regional Medical Center in Boise is a Level II trauma center, Level I Stroke Center, and a Level I STEMI (heart attack) center. The system has over 2,000 medical staff across 38 clinic locations.
Trauma, stroke, and STEMI designations are managed by the Idaho Time Sensitive Emergency System within the Idaho Bureau of Emergency Medical Services and Public Health Preparedness. As of 2022, Idaho has 28 designated trauma centers, but only five are Level II, including St. Luke’s pediatric designation, and the remainder are Levels III and IV. Idaho does not have a Level I Trauma Center, so Idahoans needing Level I medical care are transported via air ambulance to Utah, Oregon, or Washington state. Idaho has two Level I Stroke Centers, both of which are located in Ada County, the most populous county. A patient needing Level I stroke care would need to be transported to these hospitals. There are an additional 11 hospitals designated as Level II or Level III Stroke Centers and all districts, except Health District 5, have some level of care for strokes. There are 16 STEMI centers in Idaho and in all health districts, except Health District 2.
According to the 2021 Idaho Kids Covered Report, 35% of Idaho’s children are covered by Medicaid/CHIP, another 8% are covered through the health insurance exchange, and 5% are uninsured. In 2021, 27% of Medicaid Trustee & Benefits expenditures were spent on children from birth to 18 years of age and 33.3% of Idaho births were covered by Medicaid. The average monthly Medicaid enrollment increased by 11 percent during SFY 2022 and as of June 2022, about 448,500 people were receiving Medicaid. The growth rate was impacted by the national public health emergency, and it is projected that eligibility will drop in SFY 2024 once the emergency ends and Medicaid redetermination is complete.
As of 2022, all Idaho counties were federally designated as having mental health professional shortages. DHW’s Division of Behavioral Health (DBH) helps children, youth adults, and families address and manage personal challenges resulting from mental illness and/or substance use disorder. DBH includes Children’s Mental Health Services, Youth Empowerment Services, Adult Mental Health Services, and Substance Use Disorder Services. They also administer the state’s three psychiatric hospitals, including State Hospital West in Nampa, State Hospital North in Orofino, and State Hospital South in Blackfoot.
SFY 2022 was the first full year of operation for State Hospital West, a 16-bed adolescent psychiatric facility for youth ages 12 through 17. State Hospital West opened in May 2021, replacing the adolescent unit at State Hospital South in Blackfoot and allows the majority of patients to receive help closer to home in the Treasure Valley. In SFY 2022, State Hospital West had 58 admissions, with an average length of stay between 50 and 60 days.
DBH also addresses the need for children’s mental health services through the Youth Empowerment Services (YES) project. YES was conceived in 2018 after a class-action suit settlement (Jeff D. v Otter) in 2016. The settlement agreement targeted the provision of community-based services rather than housing mentally ill children within the correctional system without treatment. The YES system of care relies on a model of service delivery in which all child-serving systems coordinate care collaboratively to support youth and parents as the main drivers of care and treatment with the goal of producing positive outcomes that otherwise would not be achieved. In SFY 2022, DBH implemented therapeutic behavioral services as a newly available treatment in the community. Additionally, DHW is in the process of establishing therapeutic foster care as a supplement to other more intensive out-of-home placements.
Idaho had the fifth highest suicide rate in the nation in 2020 according to the Centers for Disease Control and Prevention. In SFY 2022, DBH led the state’s implementation of the National Suicide and Crisis Lifeline, 9-8-8. DBH, in partnership with the DPH and the Idaho Crisis and Suicide Hotline, focused on connecting Idahoans in a behavioral health crisis with trained crisis workers and resources.
Crisis intervention services are provided statewide to adults, children, youth and their families by DBH’s mobile crisis teams. Mobile crisis teams provide immediate response and deliver community-based crisis intervention services to individuals in need wherever they are, including at home, work, or anywhere else in the community. Crisis interventions are available 24 hours a day, seven days a week, and include assessment, de-escalation/resolution, peer support, coordination with medical and behavioral health services, and crisis follow-up planning.
There are seven community-based regional behavioral health centers which provide services to Idaho’s adult population. Each regional behavioral health center is staffed with a variety of licensed treatment professionals, including psychiatrists, nurse practitioners, social workers, clinicians, peer support specialists, recovery coaches, and other mental health workers. They also house community crisis centers which have been shown to reduce unnecessary hospitalizations and incarceration and have become an integral part of the continuum of care in these underserved communities with special needs. During SFY 2022, 94% of the adults receiving services received crisis services. A total of 6% percent of adults received ongoing mental health treatment.
Funding from the Idaho Legislature allocated during the 2022 legislative session allowed the Idaho Behavioral Health Council to continue the implementation of its strategic action plan to improve behavioral healthcare for Idahoans. The 13-member Idaho Behavioral Health Council includes members from all three branches of government and focuses on creating a coordinated approach to care that will improve Idahoans’ lives and offer a better return on the investment of public resources. The council has completed the process of issuing subgrants for at least three youth psychiatric residential treatment facilities. The first facility is expected to open in FY 2023.
As of 2022, 98.7% of Idaho counties were federally designated as a shortage area for primary care. According to the 2021 Association of American Medical Colleges Physician Workforce Report, Idaho had 74.3 active primary care physicians per 100,000 population and ranked 45th in the U.S. Idaho ranked 50th with 196.1 active physicians per 100,000 population. Nationally, the state median is 272.0 per 100,000.
According to America’s Health Rankings 2022 Health of Women and Children Report, Idaho ranked 49th (45.1 per 100,000) in the nation for the number of pediatricians per 100,000 children ages 0-21. While there are general practitioners, family practice doctors, and advanced practice providers, it is unknown how many serve children. Lack of access to pediatric sub-specialists is a critical barrier to receiving quality care and treatment, especially for children with special health care needs (CSHCN).
Idaho ranked 27th (47.4 per 100,000) in the nation for the number of active obstetricians, gynecologists, and midwives per 100,000 females ages 15 and older. Comparatively across Region X, Washington ranked 15th and Oregon ranked 4th. In 2021, 93% of pregnant women initiated prenatal care in the first trimester. In FY 2022, the Bureau of Rural Health and Primary Care worked with the Health Resources and Services Administration to sub-designate Maternal Care Target Areas (MCTA) under Primary Care Health Professional Shortage Areas. In FY 2024, the MCH Program will review Idaho’s MCTA scores to help inform their work.
The Idaho legislature reserves 40 seats in the University of Washington School of Medicine in partnership with the University of Idaho (WWAMI Program), which allows medical students to train in their own state for four years to increase their familiarity with rural Idaho and the rural health care needs across regions. The goal of this partnership is to increase the likelihood that graduating medical students will seek opportunities in Idaho that could fill the physician shortages.
In 2018, the first college of osteopathic medicine began operating in Idaho for the purpose of training and developing physicians. The Idaho College of Osteopathic Medicine (ICOM) has received full accreditation from the Commission on Osteopathic College Accreditation. The College graduated its inaugural class on May 13, 2022.
In 2022, 95.7% of Idaho was designated a dental health professional shortage area. The Idaho Oral Health Program (IOHP) serves as the primary source of oral health surveillance and community-based oral disease prevention programs. The Oral Health Program was established by the state in 1951 and continues to create strong stakeholder partnerships that lead to improved oral health for all who live in Idaho. The program offers infrastructure and essential resources to support, create, implement, and evaluate oral health initiatives and policies. In SFY 2022, IOHP awarded four subgrants that resulted in 700 tele-dentistry visits and 500 silver diamine fluoride applications in Dental Health Professional Shortage Areas.
Disparities, Challenges, and Strengths
The following populations have been identified by the MCH Program as Idaho’s disparate MCH populations through ongoing needs assessment efforts. Identification of these groups was based on a systematic review of secondary data (vital records and health survey data) stratified across multiple demographic and geographic variables, and these groups were found to be the most vulnerable and at the highest risk for poor health outcomes, including birth outcomes.
- Hispanic and Latino residents
- Rural residents
- American Indians and Alaska Natives
- Low-income residents
- Refugees
In Idaho, Hispanic and Latino women had higher rates of preterm births and teen pregnancies than non-Hispanic or Latino women. When compared with their urban counterparts, Idaho women living in remote and rural areas accessed first trimester prenatal care at a lower rate, had higher rates of unintended pregnancy and teen births, lower breastfeeding initiation and duration, higher rates of unsafe sleep practices, higher prevalence of overweight and obesity, higher rates of smoking during pregnancy, and higher rates of low birth weight and preterm births (rural only). American Indian and Alaska Native women have the highest rate of smoking during pregnancy, lowest prevalence of obtaining prenatal care, and the highest rate of being overweight or obese prior to pregnancy. Low-income women were less likely to access first trimester prenatal care, had higher rates of unintended pregnancy, lower breastfeeding initiation and duration, higher rates of unsafe sleep practices, and higher rates of smoking during pregnancy when compared with women in higher income categories.
Due to small numbers, there is limited Idaho-specific vital record or health survey data for refugees and American Indians/Alaskan Natives. The average poverty rate for American Indians/Alaskan Natives in Idaho is 22.9% (compared with 10.2% of white residents), slightly lower than the national average of about 21.4% of Native Americans living in poverty. Higher poverty rates are associated with greater challenges accessing health care services. According to the Centers for Disease Control and Prevention, American Indian/Alaska Natives had the highest rate of suicide in 2021 at 28.1, compared to their non-Hispanic White counterparts at 17.4. According to the U.S. Department of the Interior Indian Affairs, American Indian women experience higher levels of violence than other U.S. women, with 84.3% experiencing violence in their lifetime. American Indian/Alaska Natives experience lower life expectancy due in part to higher chronic disease burden, inadequate education, poverty, discrimination, and cultural differences.
For refugees, time spent in war zones and refugee camps result in a higher likelihood to suffer from unmet health care needs. These may include untreated chronic illnesses such as diabetes and hypertension, mental health issues and post-traumatic stress disorder, sexual trauma, as well as hearing, dental, and vision issues. Refugees in Idaho face difficulties navigating the complex health care system and are likely to forgo health care due to inability to pay and/or afford health insurance. Refugees are less likely to work for businesses that provide health insurance and more likely to face unemployment and low wages compared to U.S. natives. Idaho’s Refugee Health Screening Program helps ensure that refugees who resettle in Idaho receive a timely health screening and necessary follow-up care. In federal fiscal year 2021, 193 refugee arrivals were screened.
Idaho’s Bureau of Rural Health and Primary Care (BRHPC) is dedicated to strengthening healthcare access in rural and underserved communities across Idaho. BRHPC oversees medical education loan repayment programs, offers education, resources, and technical assistance to support quality and performance improvement for critical access hospitals, rural health clinics, and free medical clinics, and provides scholarships for training and peer-to-peer learning. Their programs have been fundamentally vital in identifying and addressing health profession shortages and promoting partnerships to improve healthcare in rural areas.
Qualifying physicians serving federally designated health professional shortage areas (HPSAs) can apply for the Rural Physician Incentive Program (RPIP), a medical education loan repayment program receiving up to $100,000 over four years. In SFY 2022, 11 new physician applicants were awarded RPIP grants. In total, 48 Idaho physicians are currently receiving medical education loan repayment through this program. There is also a state loan repayment program which began in September 2014. This loan repayment is funded with federal funds and participating sites must implement a sliding-fee scale for low-income and uninsured patients. Loan repayment awards range from $5,000-25,000 per year, depending on the discipline. Sixteen healthcare providers participated in this program in SFY 2022. These recipients included six advanced practice providers, seven medical doctors, a pharmacist, a psychologist, and a certified nurse anesthetist.
During the 2023 legislative session, the Rural Nursing Loan Repayment Program was passed. This bill was signed into law and will take effect on July 1, 2023. This bill is intended to incentivize nurses to seek employment in rural health professional shortage areas in Idaho by repaying nursing education loans for eligible nurses working in rural and underserved areas. Awards will be granted up to 50 applicants each year and eligible nurses may receive up to $25,000 for a maximum of three years. This bill will remain in effect until the sunset date of June 30, 2029.
The Rural Healthcare Access Program provides up to $35,000 per year to communities in HPSAs and Medically Underserved Areas in Idaho to improve access to primary medical and dental health care. Funded activities improve access through community development, telehealth, and other relevant assistance categories such as recruitment and retention. In SFY 2022, six grants were issued to Idaho communities in Ada, Bannock, Clearwater, Elmore, Idaho, and Power Counties. Projects ranged from recruitment and retention for medical education loan repayment for a doctor of osteopathy, physician assistant, advanced nurse practitioner, and a dentist, to support for two free medical clinic operations.
The Office of Healthcare Policy Initiatives (OHPI) is housed within BRHPC and supports Idaho’s transition to value-based healthcare. Value-based healthcare is a delivery model whereby healthcare providers and systems are given incentives to provide high quality patient-centered care that improves health outcomes and reduces cost. Transitioning Idaho from a fee-for-service model toward a value-based system of care is a long-term endeavor for healthcare providers and organizations. OHPI supports this transition through multiple initiatives, including providing administrative and logistical support to the Healthcare Transformation Council of Idaho (HTCI), which formed in 2019. HTCI provides leadership, coordination, and strategies based on input from multiple stakeholders with a wide range of healthcare delivery system expertise and experience. OPHI also manages the Idaho Healthcare Directive Registry. The registry allows consumers to create, store, and share their advance directives. Healthcare providers and consumers have access to the secure, web-based system 24/7. The registry has been available since October 2021, and in SFY 2022 the contained more than 52,000 advance directives and 13,000 physician orders for scope of treatment. A total of 67 healthcare organizations have created accounts for access.
Idaho’s Title IV-E waiver for foster care provides federal funds to implement practices to assure child safety, help children in foster care move to safe, permanent homes more quickly, and to improve the wellbeing of any child entering the foster care system. Priority is placed on reunification with a parent or placement with a family member. The need to recruit and retain licensed families for placement of foster children in Idaho is critical, with a focus on recruiting Hispanic, Black, and Native American families and families who can provide care for CSHCN, as well as families who can provide care to sibling groups and adolescents. In SFY 2022, a total of 2,756 children were served through the foster care program. In the same year, 1,293 children left foster care with 62% being reunified with their parents/caregivers and a total of 382 children were adopted from foster care.
Idaho Legislation
With the U.S. Supreme Court’s decision on Dobbs v. Jackson Women’s Health Organization, a law passed during the 2020 legislative session became effective 30 days after the Court made its final issuance of judgment. The law criminalizes abortion, making it a felony to perform, or attempt to perform, an abortion with exceptions for preventing the death of the mother, rape, and incest. There are two notes in the law regarding the exceptions. First, a physician may not perform an abortion even if they believe the pregnant woman may, or will, take action to harm herself. Second, prior to the performance of an abortion related to rape or incest the woman must report the act to law enforcement and provide a copy of the report to the physician performing the abortion. Any person who performs or attempts to perform and abortion can be imprisoned for no less than two years and no more than five and those with a professional license will have their license suspended for a minimum of six months upon a first offense and permanently revoked for subsequent offenses. During the 2023 legislative session, the law was amended with House Bill 374 which added that abortion shall not mean the removal of a dead unborn child; the removal of an ectopic or molar pregnancy; or the treatment of a woman who is no longer pregnant. The bill also removed the affirmative defense to prosecution and added that copies of reports concerning incest or rape be provided within 72 hours upon request.
House Bill 242 was also introduced and passed during the 2023 legislative session. The bill amends and adds to existing law the definition of “abortion trafficking” as the act of an adult helping a minor seek an abortion in another state or obtaining medication that will induce an abortion. It also provides prosecution authority for the Idaho attorney general and allows them to prosecute a person in violation of this section if the prosecuting attorney authorized to prosecute violations of this section refuses to do so. A person can be punished by imprisonment for not less than two years and no more than five years.
During the 2023 legislative session, House Bill 81 was introduced to remove the sunset date of July 1, 2023, in the existing Maternal Mortality Review Committee (MMRC) statute. The removal of the sunset clause would have allowed the MMRC to maintain its authorities and protections to continue to conduct comprehensive multidisciplinary reviews of maternal deaths in Idaho. The proposed legislation was tabled in the House Health and Welfare Committee and did not receive a vote. With no action taken on the bill, the MMRC statute will sunset on July 1, 2023.
During the 2023 legislative session, House Bill 71 was introduced and passed to ban gender affirming care including puberty blockers, transgender hormone therapy, and gender confirmation surgeries for those under 18 years of age. The bill outlines a few exemptions but specifically states that, “surgical operation or medical intervention is never necessary to the health of the child on whom it is performed if it is for the purpose of attempting to alter the appearance of or affirm the child's perception of the child's sex if that perception is inconsistent with the child's biological sex.” A medical professional found in violation of the law will be charged with a felony and can be imprisoned for up to 10 years.
During the 2023 legislative session, House Bill 61 was introduced and passed to permit interstate telehealth and behavioral health access to providers and will take effect on July 1, 2023. This bill declares that a mental or behavioral health provider may practice mental or behavior health care as long as they are licensed or registered in another state, district, or territory of the United States. Telehealth services for an Idaho resident or person residing in Idaho may still be supplied if the provider does not have their license in Idaho. House Bill 162 was also introduced and passed to update the Idaho Telehealth Access Care Act in Idaho Code by changing the term “telehealth” to “virtual health” and clarifies virtual care practice requirements.
The Idaho Legislature determines the budget for the Idaho Department of Health and Welfare through the passing of appropriation bills for each division. The SFY 2024 appropriation bill for DPH removed spending authority for sex education grants, including Idaho’s federal Personal Responsibility and Education Program (PREP) and Sexual Risk Avoidance Education (SRAE) grants. Intent language was also added for Temporary Assistance for Needy Families funds under this appropriation, stating that, “none shall be used to support coursework, electives, programs, or any other activities that involve the participation of students, faculty, staff, or volunteers and that deal with the subjects of sexual behavior, sexual health, sexual attitudes, or sexual philosophy.”
Idaho voters passed Medicaid expansion in November 2018. After a contentious 2019 legislative session during which multiple expansion bills were introduced, the Idaho Governor signed Medicaid expansion into law with a starting date of January 1, 2020. The expansion bill contained 10 sideboards, including work requirements, family planning restrictions, and substance abuse assessment. Other proposed provisions include: allowing Idahoans earning 100%-138% of the federal poverty level to have the option to purchase subsidized health insurance through the Your Health Idaho exchange; directing Medicaid expansion patients be placed in a medical home managed care program to help coordinate their medical care; giving the state the option to repeal Medicaid expansion if the federal government reduces its 90% funding rate; a requirement that the House and Senate Health and Welfare Committees review all impacts of Medicaid expansion by 2023 and recommend whether expansion should remain in effect; and nullification of Medicaid expansion if the U.S. Supreme Court rules that the Affordable Care Act is unconstitutional.
During the 2023 legislative session, the Division of Medicaid provided several presentations on the impacts of Medicaid expansion, the budget, and the plan for the unwinding of the Medicaid federal public health emergency. Both the House and Senate Health and Welfare Committees recommended Medicaid expansion remain in effect but noted serious concerns about the sustainability of cost. Several requests were made of DHW by the committees: identify cost savings; request waivers for work requirements, allow individuals with a certain household income the option of utilizing Medicaid or the state insurance exchange; place the Medicaid expansion population on managed care; and complete the redetermination process as quickly as possible. DHW was asked to give an update on the implementation of these recommendations during the 2024 legislative session. Medicaid Expansion will once again be re-evaluated during the 2025 legislative session. In addition, House Concurrent Resolution 9 was adopted during the 2023 legislative session establishing a task force to study Medicaid managed care and make recommendations to the legislature.
Other bills that were introduced during the legislative session, but did not pass, were: 1) House Bill 201, which would have extended postpartum coverage for Medicaid participants from 60 days to 12 months, and revised provisions regarding eligibility requirements for CHIP Plan B and certain requirements for Medicaid; and 2) House Bill 123, which would have repealed Medicaid expansion.
During the 2022 legislative session, Senate Bill 1270 was passed to establish the Down Syndrome Diagnosis Information Act. This Act requires health care professionals who administer a prenatal, postnatal, or diagnostic test that detects Down syndrome or receives a result indicating a high likelihood or definite presence of Down syndrome to provide an informational support sheet to parents. DHW will be responsible for developing the support sheet, posting the information for health care professionals, and meeting annually with representatives of the Idaho Down Syndrome Council to ensure the support sheet is current. This bill is similar to House Bill 302, which was introduced and passed during the 2021 legislative session to amend the Informed Consent Law to provide information specific to babies diagnosed with Down syndrome. This bill requires DHW to provide printed materials at no expense to physicians, hospitals, or other facilities providing abortion and abortion-related services about the development of children with Down syndrome and the resources available in the public and private sector to assist parents with the delivery and care of a child born with Down syndrome. DHW must also provide a Spanish language version of the informed consent materials. The MCH Program has been tasked with maintaining this information and works with the Infant Toddler Program to address this requirement.
Impact of COVID-19
Idaho’s first reported COVID-19 case occurred on March 13, 2020, and Idaho’s Governor signed a proactive emergency declaration to prevent the spread of COVID-19 in Idaho. On March 25, 2020, a statewide stay-home order was issued, along with an extreme emergency declaration. Over the next year many actions were taken to help combat COVID-19, including suspending rules to increase telehealth access, easing licensing for medical professionals, and providing funding to hospitals, schools, small businesses and other community organizations. On October 1, 2020, DHW and the Governor’s Office outlined the steps towards COVID-19 vaccine distribution in Idaho. From March 13, 2020, through December 31, 2020, there were 141,077 cases documented. By the end of 2020, COVID-19 had caused 1,500 deaths in the state and 500,000 Idahoans had been tested for COVID-19.
Beginning in 2021, DHW was directed to provide weekly virtual press briefings on COVID-19, which covered vaccinations, case numbers, and other initiatives to combat COVID-19. As Idahoans received vaccinations and case numbers began to decline, the Idaho National Guard began to draw down and a push to return to in-person learning for schools ramped up. On August 31, 2021, the Governor activated the National Guard again, and directed hundreds of new medical personnel to help Idaho hospitals overwhelmed with unvaccinated COVID-19 patients. By mid-September, schools were facing a shortage of hundreds of substitute teachers daily. State of Idaho executive branch, agency-level employees, were allowed to take paid time off to serve as substitute teachers to help address the shortage. On September 16, 2021, statewide crisis standards of care were implemented until November 22, 2021, when they were deactivated for all but one region.
Between March 13, 2020, and December 31, 2021, Idaho recorded 321,502 cases of COVID-19 and 4,221 deaths. During that same time frame, 41,236 adult patients were hospitalized in the intensive care unit and 1,727 pediatric patients were hospitalized in an inpatient bed. Idaho ended its public health disaster emergency declaration on April 15, 2022. The Division of Public Health continues to provide updates for COVID-19 data via a dashboard showing the number of cases, people tested and vaccinated, disease hot spots, hospitalizations and more. As of May 26, 2023, 63.4% of adults ages 18 and older have completed the primary vaccine series and 26.9% have completed the primary series and received a bivalent booster dose. For children ages 5-11, 19% have completed the primary vaccination series; for children ages 12-15, the number increases to 39%; and for children ages 16-17, a total of 45% have completed the primary series. With the end of the national public health emergency, Idaho’s COVID-19 dashboard will no longer display case and testing volume data. DPH will continue to review and publish COVID-19 data from several sources including deaths, hospitalizations, and emergency department visits.
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