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. Geography and distance impact both the demographic characteristics and social determinants of health within Idaho.
Idaho is ranked 38th of the 50 United States for total population and the 11th largest state by area. According to the national Census, Idaho’s population for 2020 was 1,839,106, a 17.3% increase from 2010, making Idaho second in the nation for the largest population growth. Because of Idaho’s large size and relatively small population, Idaho remains one of the most rural states in the nation. The Idaho Department of Commerce defines rural as any county that does not have a population center with 20,000 persons or greater. With approximately 22.3 people per square mile, Idaho ranks 46th of the 50 states in population density. Thirty-five of Idaho’s 44 counties are rural with 16 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.
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.
According to the 2020 American Community Survey 5-Year Estimates, 11.9% of Idahoans were living below the poverty level. It is estimated that about 14.4% of children under the age of 18 are living below the poverty level. 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 3% unemployment rate in May 2021. The median household income in Idaho was $58,915, compared to the U.S. median household income of $64,994. Idaho’s per capita income was $29,494.
In 2020, there were 21,547 infants under the age of one and 429,496 children aged one through 17 residing in Idaho. Of those, about 18.6% or 82,285 of Idaho’s children have a special health care need. There were 353,367 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 (2016 to 2020, 5-year average) 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 (91.3% and 88.5%, respectively). Of all students who started 9th grade in the fall of 2016, 82% graduated high school in 2020. However, a 17% gap exists between economically disadvantaged and non-economically disadvantaged students. Between 2019 and 2020, the percentage of American Indian or Alaskan Native students graduating high school decreased from 68% to 65%, and these students continue to have the lowest high school graduation rate (68%) compared to all other races and ethnicities. Asian students have the highest graduation rate (89%), followed by their White classmates (84%). In 2019, 46% of high school graduates enrolled in postsecondary education immediately after high school graduation, but in 2020 that number dropped to 39%. Over a quarter (28.7%) of Idahoans over the age of 25 hold a bachelor’s degree or higher, compared with the national average of 32.9%.
The racial groups that comprised Idaho’s population in 2020 were: (a) White, 94.5%; (b) Black, 1.3%; (c) American Indian/Alaska Native, 2.0%; and (d) Asian or Pacific Islander, 2.1%. It is estimated that 3.1% of Idahoans identify as being of two or more races. Persons of Hispanic or Latino origin comprised 13% of Idaho’s total population.
Persons of Hispanic or Latino descent are the largest minority population and make up roughly 13% of the total population with 237,272 Hispanics/Latinos residing in Idaho. 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. While only 6% of the state’s residents are immigrants, they represent a greater share of the workforce. Idaho’s farming and fishing industry – one of the state’s top economic drivers – benefits from immigrants who make up over 29% of the industry’s labor force. In 2018, Idaho was home to approximately 50,071 women and 5,942 children who were immigrants, with more than half (52%) being from Mexico. The other top countries of origin were Canada (5%), the Philippines (5%), China (3%), and Germany (2%).
Idaho has three refugee centers: two located in Ada County in Southwest Idaho and one located in Twin Falls County in South Central Idaho. Idaho received an estimated 214 refugees in 2020, an 81% decrease since peak refugee arrivals in 2016. However, over 1,200 refugees are projected to arrive in Idaho between October 2021 and September 2022. Most of the refugees seeking resettlement in Idaho are women and children, with the majority being from Democratic Republic of Congo, Iraq, and Butan. Most new arrivals are from Afghanistan. Priorities established for FY 2023 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 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 2023. This includes plans to encourage participation in the next five-year needs assessment and build on new collaborative partnerships.
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 2021, the CareLine facilitated 92,456 information contacts and CareLine staff provided 109,017 individual referrals. The CareLine received 25 calls related to prenatal/family planning and 4,470 calls related to Medicaid for children less than 19 years old. The CareLine referral database has an estimated 10,838 active services relating to 3,411 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 health nursing to environmental health, clinical services, dental hygiene, and nutrition. Many services are provided through subgrants with the Division of Public Health.
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 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 a seven-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 mental health services. DHW is the largest state agency with approximately 2,917 full-time employees, 51 locations (19 of which are publicly accessible), three psychiatric hospitals, and one care facility for intellectual disabilities.
Within 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 has 253 full-time 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 seven bureaus, as well as the Center for Drug Overdose and Suicide Prevention and the Office of Policy, Performance, and Strategy. The range of programs and services include immunizations, nutrition services, chronic and communicable disease surveillance, public health intervention, food safety regulation, emergency medical personnel and agency licensing, vital records administration, health surveillance and epidemiology, rural healthcare provider recruitment, laboratory services, and bioterrorism preparedness.
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.
Health Care Systems
There are 30 birthing hospitals statewide, as well as 44 free-standing birthing clinics and midwifery practices. In 2020, 93.6% of births occurred in a hospital, 3.1% occurred in freestanding birthing centers, and 3.2% occurred in a home setting. In-hospital births decreased slightly by 0.7% in 2020 and the percentage of births occurring in free standing birthing centers a home setting increased slightly, 0.3% and 0.4% respectively.
There are 16 community health centers (CHCs) that provide patient-centered primary healthcare services for medical, dental, and behavioral health services on a sliding scale serving 50 communities with 72 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 and 1,000 beds, 30 medical centers, specialty clinics, and the state’s only Children’s Hospital and Level 2 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 2 Pediatric Trauma Verification. Due to COVID-19 this effort was paused, but in June 2022 they received their Level 2 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 and is looking to becoming designated as a trauma center by the American College of Surgeons (ACS).
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 2021, Idaho has 23 designated trauma centers, but only four are Level II, 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 health insurance exchange and 5% are uninsured. In SFY 2021, 27% of Medicaid Trustee & Benefits expenditures were spent on children from birth to 18 years of age. In 2020 35.2% of Idaho births were covered by Medicaid. Medicaid enrollment averaged approximately 380,000 participants per month in SFY 2021, a 12 percent increase from SFY 2020. During COVID-19, CHIP is required by federal law and state Medicaid not to terminate eligibility in circumstances where they otherwise would. This requirement exists until after the end of the federal and state public health emergency and there is likely inflation in the enrollment numbers and related percentages of growth between these two fiscal years.
As of 2021, all Idaho counties were federally designated as having mental health professional shortages. There are seven behavioral health community crisis centers in Idaho, serving every region in the state. The crisis centers 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. In SFY 2021 the crisis centers served a total of 4,434 clients. In early 2021, a new stand-alone adolescent psychiatric hospital opened that will provide treatment for up to 16 adolescents ages 12-17 years old. Previously, adolescents that needed this level of care were treated in a hospital in Blackfoot, Idaho, more than 250 miles away from the new location. Most of the adolescents in the Blackfoot location had family and support in the Treasure Valley. This new location will make it easier for families to support their children.
Across Idaho are nine Recovery Community Centers and five satellite recovery community offices. These centers aim to remove barriers to recovery by providing Peer-Based Recovery Support Services.
As of 2021, 97.7% of Idaho counties were federally designated as a shortage area for primary care. 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 shortage of physicians.
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 been granted pre-accreditation status while it continues working towards establishing full accreditation status from the Commission on Osteopathic College Accreditation (COCA). The College graduated its inaugural class on May 13, 2022.
In 2021, 100% of Idaho was a federally designated mental health professional shortage area, 97.7% of Idaho was a federally designated shortage area in primary care, and 94% of Idaho was designated a dental health professional shortage area. Idaho had 69 primary care physicians per 100,000 population in 2020. In 2021, the Idaho Hospital Association membership directory reported 53 hospitals (including facilities in Oregon, Washington, and Wyoming). Twenty-seven of these hospitals are critical access hospitals which own 55 clinics. These clinics include primary care and specialty services and may be co-located with the hospital as well as remote clinics.
The demand for genetic services in Idaho has increased with an estimated 1,000 individuals seeking access annually. This has resulted in an eight-month waitlist for an appointment. Title V funding partially supports a Genetics and Metabolic Clinic at St. Luke’s Children’s Hospital, which has the state’s only geneticist. Expanding access to genetic counseling has been a challenge due to licensed genetic counselors not recognized as billable providers of care, lack of accessibility for the uninsured or underinsured (as most are on Medicaid), and the lack of provider education on the limited genetic services. To help remedy the need for genetic counseling services, Boise State University added an online genetic counseling graduate program in Fall 2019.
To address the need for improving and implementing a new care delivery model for children’s mental health services, the Youth Empowerment Services (YES) project 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.
Disparities, Challenges, and Strengths
Through on-going needs assessment efforts, the following populations have been identified by the MCH Program as Idaho’s disparate MCH populations. 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. 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 rural areas accessed first trimester prenatal care at a lower rate, had higher rates of unintended pregnancy, 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 25.7% (compared with 11.1% of white residents), slightly higher than the national average of about 24% of Native Americans living in poverty. Higher poverty rates are associated with greater challenges accessing health care services. Recently, there has been media attention on the high suicide rate among Native Americans, especially women. In 2019, suicide was the second leading cause of death for American Indian/Alaska Natives between the ages of 10 and 341. The death rate for suicide among American Indian/Alaska Natives is 22.3% when compared to their non-Hispanic, White counterparts at 18.1%. American Indian women also experience higher levels of violence than other US women, with nearly 84% 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 (University of Idaho, 2016). 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 (U.S. Bureau of Labor Statistics, 2014).
Idaho’s Bureau of Rural Health and Primary Care is dedicated to strengthening healthcare access in rural and underserved communities across Idaho. The bureau programs have been fundamentally vital in identifying and addressing health profession shortages and promoting partnerships to improve healthcare in rural areas. In 2021, 97.7% of Idaho was designated as a primary care Health Provider Shortage Area (HPSA). According to the Association of American Medical Colleges Physician Workforce Profile, Idaho ranked 45th in the U.S. for the number of active primary care physicians for the state’s population in 2020, with only 74.3 active primary care physicians per 100,000 people. Idaho ranked 50th for active physicians for the same year, with 196.1 active physicians per 100,000 people. Nationally the state median, with 25 states ranking higher and 25 states ranking lower, is 272 active physicians per 100,000 people. Qualifying physicians serving federally designated HPSA’s 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 2021, 16 new physician applicants were awarded RPIP grants and 46 Idaho physicians received medical education loan repayment.
In 2020, Idaho ranked 28th (44.5 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 17th and Oregon ranked 4th. There are approximately 162 actively practicing obstetricians-gynecologists (OB/GYNs) and 75 licensed midwives statewide. There are 821 family medicine/general practitioners and several advanced practice providers. However, it is unknown how many provide prenatal care or labor/delivery services. In 2020, 82.6% of pregnant women initiated prenatal care in the first trimester.
There are 164 practicing pediatricians with a ratio of one pediatrician for approximately every 3,757 persons under the age of 24. Sixty-six (66%) percent of counties in the state do not have a pediatrician. 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’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. The focus is on recruiting Hispanic, African-American, and Native American families, families who can provide care for CSHCN, and families who can provide care to sibling groups and adolescents. In SFY 2021, a total of 2,867 children were served through the foster care program. In the same year, 1,293 children left foster care with 57% being reunified with their parents/caregivers and a total of 382 children were adopted from foster care.
In September 2019, the Office of Healthcare Policy Initiatives (OHPI) moved into the Bureau of Rural Health and Primary Care (BRH-PC) within the Division of Public Health after the completion of the Statewide Healthcare Innovation Plan (SHIP) initiative to continue healthcare transformation efforts. SHIP was a 4-year model test period to transform primary care practices across the state. OHPI and the Healthcare Transformation Council of Idaho (HTCI) identified several initiatives to achieve the following the goals: (1) increase value-based healthcare payments from 29% to 50% by 2023, and (2) improve the healthcare quality, access, and health of Idahoans. HTCI established the Telehealth Task Force (TTF) in January 2020 to identify the opportunities to expand telehealth services and to recommend mitigation strategies to increase utilization. In September 2021, the TTF completed their charge by creating a final report with solution-based recommendations and proposed actions to advance telehealth in Idaho. In July 2020, HTCI created a Rural Nursing Loan Repayment (RNLR) Task force to define the drivers of the Idaho rural nursing workforce shortages and recommend solutions to recruit, train, and retain nurses. In June 2021, the RNLR Task Force completed their charge and developed an Idaho-specified RNLR program framework and sought legislative support for it during the 2022 legislative session. Unfortunately, the bill failed in the Senate with 14 ayes, 17 nays, with 4 absent votes. In 2020, OHPI also developed the Idaho Healthcare Directive Registry and transitioned it from the Secretary of State. The new 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 new registry was available beginning in October 2021.
The Idaho Child Fatality Review Team (CFRT) was formed by the Governor’s Task Force for Children at Risk, under Executive Order 2012-2013, to review deaths to children under the age of 18 using a comprehensive and multidisciplinary process. In 2016, the MCH Director became a member of this team to inform the MCH program of findings for program activity prioritization and general awareness of review determinations. The team utilizes information gathered by coroners, law enforcement, medical personnel and state government agencies in their reviews. Currently, the Chief of the Bureau of Clinical and Preventive Services serves on the CFRT and provides information and recommendations from the MCH Program to the team.
Idaho Legislation
With the U.S. Supreme Court’s final majority opinion in the Dobbs V. Jackson Women’s Health Organization case effectively overturning Roe v. Wade, and giving authority over abortions back to the states, a law passed during the 2020 legislative session will become effective 30 days after the Court makes its final issuance of judgment. The law will criminalize 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.
During the 2022 legislative session, House Concurrent Resolution 29 was passed, which encourages certain officers, agencies, and employees of the State to become informed about the impacts of traumatic childhood experiences and implement interventions and practices to develop resiliency in children and adults who suffered from traumatic childhood experiences. The MCH Program anticipates there will be more widespread training on ACEs and trauma-informed services with the passing of the resolution.
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.
During the 2022 legislative session, Senate Bill 1284 passed, which amends existing law to raise the age of legal possession and use of tobacco products and electronic smoking devices to 21 years, bringing Idaho into compliance with federal law. Penalties for violations of different sections of the law range from $17.50 to $200 fines, as well as imprisonment for no more than 30 days. The court may, in addition to these penalties, require minors under age 18 to attend or perform community service in programs related to tobacco product or electronic smoking device awareness programs.
During the 2022 legislative session, House Bill 521 passed and went into effect 30 days after Governor’s signature, restricting the location of where second and third trimester abortions can be performed. Senate Bill 1309 also passed, which amends existing law to revise the prohibitions, penalties, and causes of action of the Fetal Heartbeat Preborn Child Protection Act. The Act now includes a private enforcement mechanism allowing civil lawsuits against medical professionals who perform unlawful abortions after a fetal heartbeat can be detected.
During the 2022 legislative session, the legislature appropriated an ongoing $1,000,000 state general fund allocation and $1,000,000 federal American Rescue Plan Act (ARPA) fund allocation to support the home visiting programs at the public health districts. The funds are intended to expand home visiting services to additional counties beyond the MIECHV service areas. However, the allocations do not include funds that would allow the MIECHV Program to administer and provide oversight to ensure seamless home visiting implementation and further development of the current home visiting infrastructure.
During the 2022 legislative session several bills were introduced and did not pass, that would have had an impact on MCH populations. House Bill 733 would have added to existing law to prohibit evaluations, questionnaires, surveys, and data collection on a student’s behavioral well-being without the approval of the school board and a parent or guardian. It also would have required any curricular materials or activities related to social and emotional learning and mental behavioral well-being to be displayed on the school’s website. House Bill 486 would have repealed a section of Idaho Code (39-3801) specific to the treatment of infectious, contagious, or communicable diseases in minors 14-17 years of age without parental consent. House Bill 447, the Idaho Paid Family Leave Act, would have provided paid family leave, up to two-thirds of an employee’s earnings, for all public and private employees in the State of Idaho. Lastly, Senate Bill 1260 would have allowed prescriptions for a 6-month supply of contraceptives.
During the 2021 legislative session, House Bill 220 was introduced and passed to prohibit the expenditure of taxpayer dollars to abortion providers and affiliates. It prohibits public contracting or participating in any commercial transaction with an abortion provider and prohibits the use of any public asset or employee to procure, counsel in favor, refer to, or perform an abortion.
In January 2020, Governor Brad Little passed the Families First Act. This Executive Order directed the Division of Human Resources to create policies and rules to allow parents eight weeks of paid paternal leave as a benefit eligible to state employees after birth or adoption of a child. Governor Little recognizes the importance of bonding between parents and children when a child is born or adopted and how bonding with the child is essential in establishing a deep connection between them.
Idaho enacted House Bill 109 during the 2019 Legislative Session which authorized the implementation of a Maternal Mortality Review Committee (MMRC) that began on July 1, 2019. This review committee conducts a comprehensive, multidisciplinary review of maternal deaths in Idaho for the purposes of identifying causative and associated factors and to make policy recommendations to improve health care services for women. The overarching goal is to reduce the incidence of maternal mortality in Idaho and achieve improved maternal and child health outcomes. The MCH Program is responsible for development, operation, and coordination of the committee. The bill was passed without any appropriated funding; therefore, Title V funds support the committee and program activities.
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. As of March 2022, 121,219 Idahoans have enrolled as new participants.
In April 2020, the Division of Medicaid worked with the Centers for Medicare and Medicaid Services to approve the Idaho Behavioral Health Transformation Waiver. This waiver allows Idaho Medicaid to use federal funding to pay for mental health and substance use disorder services received in Institutions for Mental Disease (IMD). Prior to this, Medicaid participants between the ages of 21 through 64 had not been able to access these services, which had to be covered using state general funds. The overall goal of this waiver is to increase access to care and improve care coordination in the Idaho behavioral health system of care.
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.
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. 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. As of June 8, 2022, 61.7% of adults 18 and older are fully vaccinated and 48.1% are fully vaccinated with one additional booster dose. For children ages 5-11, 17% have completed the primary vaccination series; for children ages 12-15, the number increases to 38%; and for children ages 16-17, a total of 43% have completed the recommended series.
Idaho Maps
To Top
Narrative Search