Idaho Medicaid Announces New Prior Authorization Policy as State Budget Proposes to Eliminate Medicaid Coverage of Essential Services

January 27, 2026

On January 8, without any notice, Idaho Medicaid announced it was instituting prior authorization on speech therapy, occupational therapy, and physical therapy services after 20 sessions of each discipline. The policy is retroactive to January 1.

Idaho providers, including members of ASHA and the Idaho Speech, Language, Hearing Association (ISHA), have received limited details on the steps they need to take to satisfy the prior authorization requirement. While the Idaho Medicaid agency held a therapy stakeholder meeting on January 16 and just released the prior authorization form via provider listserv email on January 21, the process remains fraught with many outstanding issues.

Many therapy providers are frustrated by a policy that began January 1 when they couldn't even submit prior authorization requests until January 21. ISHA President Amy Hardy sent a letter imploring Idaho Medicaid to reconsider its decision to install prior authorization and future proposed cuts.

To make things much, much worse, the Idaho state budget for 2027 proposes to eliminate all Idaho Medicaid coverage of speech therapy, occupational therapy, and physical therapy services, certain home and community-based services, and adult audiology services. Reducing coverage of these services for children could violate the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit mandate, which is a federal law that requires children under age 21 who are enrolled in Medicaid to receive comprehensive and preventive health care services.

Cutting audiology services for the adult Medicaid expansion population would have dramatic impacts, as would the elimination of home and community-based service setting coverage. (Note: In Medicaid expansion states, people can qualify for Medicaid coverage based on their income alone. In non-expansion states, people have to meet a number of other factors, including household size and disability, in order to qualify.)

A Compounding Problem

Idaho Governor Brad Little cites a $500 million budget deficit as the reason for these proposed cuts. These policy changes can be linked to the One Big Beautiful Bill Act (OBBBA), which President Trump signed into law in July 2025. OBBBA made significant cuts to Medicaid programs across the country. Without the same amount of federal funding, many states are now changing or eliminating Medicaid services in order to balance their budgets.

Idaho is one of many states that will be affected by cuts to Medicaid included in OBBBA, including the lowering of a significant source of income for Idaho's Medicaid program: provider taxes and state-directed payments. As of May 2025, Idaho Medicaid provided health insurance for 355,000 children and adults as a Medicaid-expansion state, so these policies will affect over 17% of the state's population.

Regress, not Progress

Sara Bergsma, ASHA member and vice president of legislative affairs at ISHA, is a speech-language pathologist (SLP) who owns a private practice and contracts with schools to deliver services. Bergsma said about 65% of the 300 kids she serves per week at her private practice are on Medicaid.

"I'm scared for a lot of our patients," Bergsma said in an interview with KTVB. "If there's a couple weeks' lapse of therapy if they're not sure if the paperwork is done, they regress."

ASHA and ISHA have been collaborating on SLP coverage issues with Idaho Medicaid for years, including advocating for the elimination of paraprofessionals billing Idaho Medicaid in schools, supporting the restoration of Idaho Medicaid coverage of Clinical Fellow services, and opposing an earlier OBBBA-related consequence that cut SLP reimbursement rates by 4%.

ASHA is also working to facilitate meetings with federal legislators to highlight OBBBA's impact on the critical services ASHA members provide, including in Idaho.

Rallying for Change

These proposed cuts have already caused a massive public outcry. Hundreds of people rallied at the Idaho State Capitol to oppose these policy changes and cuts last week, including ASHA and ISHA members, as part of "Rehab at the Rotunda." Though these members were not able to participate in closed door hearings on the budget, ASHA Committee of Ambassadors member and ISHA member Lauren Tandy spoke directly with Idaho Medicaid staff and legislators participating in the hearings.

Opposing these changes will require a major effort. The Idaho legislature and governor need to hear from Idaho providers to help us push back on both the prior authorization policy and the proposed budget. Idaho providers can contact their members of the Idaho State Legislature and Governor Brad Little using ASHA's Take Action campaign. Idaho patients, families, and the general public can also take action using ASHA's public Take Action campaign.

ASHA will continue to partner with providers, parents, and ISHA to advocate at the state level to oppose the reimbursement rate cuts, installation of prior authorization, and elimination of the vital services our members provide.

Questions?

Contact [email protected].