When Jordan and Kade Serumgard were diagnosed with autism and intellectual disabilities as children, their mother, Post Falls resident Susan Llewellyn, knew they would need lifelong care.

“We had planned all these years to keep the boys with us and to take care of them as a family,” she said. 

Llewellyn retired from her job at Bonner General Health in Sandpoint to care for her sons, who are now 25 and 23. 

“Caring for both boys is a full-time job,” she said. 

That care has been made possible through home and community-based services, which provide opportunities for Medicaid members to receive services in their own homes or communities rather than in institutions or other isolated settings. 

Llewellyn is a paid certified family home provider for her sons. Her home meets the state of Idaho's approval criteria and is certified by the Idaho Department of Health and Welfare to care for up to four adult residents who can’t live on their own. 

“This program has been so vital to us,” Llewellyn said. 

Now Llewellyn is one of many Idahoans who are concerned about cuts to home and community-based services proposed in Idaho Gov. Brad Little’s budget plan. 

The governor’s plan calls for $22 million in Medicaid cuts next fiscal year. These cuts could be accomplished by removing home and community-based services, ending Medicaid dental coverage for adults, or through other rate reductions and service terminations. 

Home and community-based services cost about $176.5 million in state general funds, according to DHW. More than 16,400 Idahoans use these services, including case management, homemaker services, home health aides, adult day services, respite care and more, at least once a year.  

While certified family homes and personal care services are exempt from reimbursement rate cuts, other home and community-based services are not.  

Sasha O’Connell, the DHW deputy director leading the Division of Medicaid, told legislators last week that developmental services are one of several “primary drivers of spend” across the Medicaid program.  

Medicaid expansion isn’t driving the costs, she said. Instead, factors such as the “significant investments” the Legislature has made in home and community-based services in recent years are driving increases in residential care rates.  

“As those rates increase, we do see an increase in access to care,” she said. “That means more people can get the care that they need.” 

Heather Raglin owns Coordinated Services of Idaho, which provides case management and residential habilitation services to disabled clients in Post Falls, Hayden and Coeur d’Alene. 

“All of these community-based services enhance these clients’ lives,” she said. 

Clients live in their own homes and receive hourly support, with staff assisting with fundamental self-care tasks such as preparing food and bathing, managing medication and finances, connecting clients with volunteer opportunities and more. 

“These clients would not be functioning without these supports,” Raglin said. 

Home and community-based services allow Raglin’s clients and other disabled Idahoans to remain in their communities. 

“I am blessed daily by working with my clients,” she said. “They bring a lot to the table. They might need help with cooking or cleaning their homes, but that doesn’t mean they shouldn’t be part of society.” 

Without these services, Raglin said some of her clients would have to enter assisted living facilities, which are costlier and more complicated to access than the in-home help they currently receive. 

“It would cost the state so much more money,” she said. 

Last week, Sen. Janie Ward-Engleking, D-Boise, expressed concerns to the Joint Finance Appropriation Committee that cutting line items like adult dental services will cost Idaho more in the long run. 

“I hope we look at this carefully and don’t shift the costs to something else that’s going to really impact our state and the people of this state in a negative way,” she said. “I’m kind of frightened, looking at this list.” 

Sen. Carl Bjerke, R-Coeur d’Alene, told the committee he had received up to 1,000 emails from Idahoans who are fearful about Medicaid cuts. 

The state needs to “triage,” he said, and fund services for the most vulnerable Idahoans. 

“We serve a population that we care very much about and we also have a population that doesn’t want us to spend so much money in certain areas,” he said. “It’s a tough balance.”