KELLOGG — Sweeping Medicaid cuts have rural medical professionals bracing for impact, and one nursing home in the Silver Valley is pushing back. 

Mountain Valley of Cascadia, a 68-bed skilled nursing facility that has operated in Kellogg for decades, says recent Medicaid reductions threaten its ability to maintain a high standard of care.

The Idaho Department of Health and Welfare announced last month a 4% across-the-board reimbursement rate cut for Medicaid providers, affecting hospitals, behavioral health services, home and community-based care, and nursing homes. The cuts took effect earlier this month. 

According to IDHW, the reductions aim to curb rapidly rising program costs. State officials have warned that more cuts may follow and that some providers could stop accepting Medicaid patients. 

The cuts are expected to save an estimated $36.8 million in fiscal year 2026, said Health and Welfare spokesperson A.J. McWhorter. 

“The appropriated budget for Medicaid going into the state fiscal year 2026 accounted for 8% growth trend. DHW is now forecasting a 19% growth trend, which is not sustainable,” McWhorter said. 

Mountain Valley CEO Emilee Kulin said the cuts are putting financial pressure on nursing homes and skilled nursing facilities, potentially leading to reduced services, limited availability, or even closures statewide.

“These additional, across-the-board cuts make those losses from reimbursements untenable for long-term and skilled-care facilities,” Kulin said. “We already operate on razor-thin margins. If we can’t provide adequate care or staff safety, we’ll have to make serious reductions.” 

Medicaid allows low-income and eligible residents to access care while providers bill the program for reimbursement. Each state sets its own reimbursement rates, but Kulin said those rates often fall below the actual cost of providing care. 

Mountain Valley is the larger of two Cascadia facilities in Shoshone County, with capacity for 68 residents and a staff of 70, including dozens of nurses and certified nursing assistants — many of whom have worked at the center for more than 20 years. 

The facility has earned regional and national recognition in recent years, including two bronze, two silver, and two gold Quality Excellence Awards from the American Health Care Association and National Center for Assisted Living. It remains the only skilled nursing facility to receive the prestigious Malcolm Baldrige Award. 

This fall, Kulin and Chief Nursing Operator Jodi Hagaman will attend the national convention, where they and Cascadia owners will speak with industry leaders about the long-term effects of the cuts. 

“We are a five-star facility; we will not let Medicaid cuts impact all we stand for and will do everything necessary to ensure the best outcome for our staff and residents,” said Mountain Valley Human Resource Director Katie Wuolle. “In Kellogg, Idaho, we have one of the best skilled nursing facilities in the entire country. We have gone through a lot the past few years, and we remain strong.” 

Mountain Valley Director of Therapy Services Tara Lodi said if nursing homes are not utilized in the healthcare continuum, especially in rural communities, patients will often end up back in hospitals.

“These costs can be avoided by being a bridge from hospital to home, with a short-term stay for rehab at our skilled nursing center," she said. "There’s nowhere else for them to go, especially if they want to stay in their communities, and our community members deserve to stay in the place they call home.” 

Kulin said about 40 of the facility’s residents are Medicaid recipients. 

If funding continues to dwindle, facilities may be forced to make difficult decisions beyond patient care. With 70 employees, Mountain Valley is one of the larger employers in Shoshone County, but it could be forced to cut positions.

More changes may be coming. At the most recent meeting of the Idaho Legislature’s Medicaid Review Panel, IDHW Director Juliet Charron said additional adjustments could be made based on specific needs. 

“What we expect to see and dig into, in addition to some folks just saying we disagree with this, is ‘are there specific access or impact concerns within specific communities that we need to look at,’” she said. “For example, maybe it’s a specific home and community-based service in a very rural community.” 

McWhorter said the state expects robust feedback and will review all public comments, but it may not be enough if costs continue to outpace revenues. 

“DHW values our provider network and access to care for participants. Federal regulations require Idaho Medicaid to submit an access analysis and monitoring plan for review and approval by CMS following a period of public comment on this change,” McWhorter said. “DHW will review public comment and the access analysis before finalizing the revision request with CMS. Absent any changes in revenue projections, service cuts will be needed to stay within our budget if Idaho Medicaid does not implement rate adjustments.”