01/14/2026
****MEDICAID CHANGES UPDATE****
In response to recent questions regarding a new Idaho Medicaid cap on OT/ST/PT services, please find our interdisciplinary Medicaid coalition informational letter below. And please help our efforts to provide continuous coverage of services when needed by calling your local representative, senator, and governor’s office.
Governors office phone: (208) 334-2100
🛎️ALERT: if you are willing to contribute a video to lobbying efforts at the Boise Capitol next week, please notify our Front Desk that you would like to share your story. We would love to share our local family and patient stories with the people who are making these decisions to understand how important continuation and access to care is for our children! 🛎️
Dear Families and Therapists Across Idaho,
We are writing to share important information regarding recent changes to Medicaid therapy services in Idaho and to help you understand both what this means for your child and how you can advocate for your family and services across Idaho.
There was an information release MA26-05 that came out on January 8, 2026 in addition to a 4% cut that was enacted in 2025. We recognize and share your frustration with the timing and complexity of these changes. According to the Idaho Department of Health and Welfare (IDHW), these actions are being taken to stabilize the Medicaid budget and ensure the continued provision of benefits across the program. While IDHW has stated they are committed to transparency, we understand the impact this change may have on families who rely on consistent therapy services.
What is changing:
Medicaid has implemented a cap of 20 visits per year for each therapy discipline:
Occupational Therapy (OT): 20 visits
Physical Therapy (PT): 20 visits
Speech-Language Pathology (SLP): 20 visits
These visits are not combined; each therapy discipline has its own 20-visit limit.
Importantly, this cap does not prohibit a participant from receiving additional therapy services. Similar to many private insurers, Medicaid now requires a prior authorization to access services beyond the initial 20 visits. This will become a huge administrative burden as well as services may lapse as your primary care workers will also feel this burden. Participants who require long-term therapy may receive a prior authorization for up to one year of services, provided documentation demonstrates medical necessity.
Who this applies to:
This policy applies to all Medicaid participants, including those with Katie Beckett or Medicaid as secondary insurance.
The only exemptions are home health services, the Infant Toddler Program, and school-based services.
Prior authorization process:
A temporary prior authorization form is currently in use while an updated version is being developed.
The prior authorization form includes contact information for the Medicaid Clinical Unit (MCU).
The criteria for approval have not changed; documentation must demonstrate medical necessity, as was previously required.
IDHW has scheduled a meeting on the 16th to share additional information and answer questions. More details are expected to be released soon.
How families can advocate:
While providers and families are adjusting to these changes, it is critical for decision-makers to understand the real-life impact on children and families. We strongly encourage families to contact the Idaho Governor’s Office (208) 334-2100 to share concerns, describe how these changes affect access to medically necessary therapy services, and advocate for reconsideration of the policy. Right now, they are stating they have only received 12 phone calls, and this is not a big issue, so please help us!
Family voices matter, and sharing your experience can help inform state-level decisions.
Thank you for your continued partnership and advocacy on behalf of your children. We remain committed to supporting you as we navigate these changes together.
Sincerely,
Your Occupational Therapy, Physical Therapy and Speech Language Therapy Providers
Governors office phone: (208) 334-2100
