DSP vacancy — five quarter trend

Median across reporting providers. The March 2026 rate cuts took effect at the start of Q2.

Quadrant one — Provider stability

Share of reporting providers in each category indicating at least one stability change in the last 90 days.

Quadrant four — Crisis spillover

Service-gap-attributed events across the reporting period. These events represent costs that have shifted from HCBS to higher-cost or non-Medicaid settings, including hospitals, law enforcement, and unpaid family caregivers.

Stress indicator by IDHW region

Composite of all four quadrants. Regions with fewer than five reporting providers fold up to neighbors.

Intervention thresholds

Per the Potentia framework, deterioration is normalized one step at a time without defined trigger points. Each indicator below has a published threshold at which the coalition considers system stress to have crossed from elevated into emergency.

Framework

The survey instrument is structured around the four-quadrant system-stress framework set out in the April 2026 Potentia Public Policy Institute white paper, Strategic Responses to Idaho Medicaid Rate Reductions (Cook, Villegas-Grubbs, Deshaies). Recommendation nine of that paper calls for coordinated tracking of provider closures, service reductions, workforce stress, waitlist growth, denied referrals, and crisis-system utilization. This site implements that recommendation.

A fifth section captures financial position and direct attribution of changes to the March 2026 rate cuts. A sixth section captures narrative.

Relationship to H.B. 863 cost-survey audits

House Bill 863 directs the Department of Health and Welfare to cost-survey several HCBS service categories annually, with at least 15 percent of responses audited and used to develop future payment rates. The first publicly available audit report is due December 31, 2027.

The coalition's voluntary data collection is intentionally aligned with — but independent of — that audit infrastructure. Three reasons that distinction matters.

First, this data is collected quarterly rather than annually, producing the early-warning signals the state's annual cycle will miss. Second, the indicators here cover workforce, access, and crisis spillover, not only cost composition — capturing operational reality the cost survey alone will not. Third, an independent record exists alongside the state's record, which matters when the state's record is the same instrument used to set the rates being challenged.

Providers participating in coalition data collection are also building the documentation discipline — cost allocation, wage and staffing records, program-specific data — that H.B. 863 will require starting in 2027.

Who reports

Any Idaho Medicaid HCBS provider can voluntarily submit data each quarter. Providers self-identify and self-report. We do not verify against IDHW records, payroll, or billing systems. Each submission is reviewed by a coalition analyst before being included in aggregates.

Current participation

Q2 2026: 47 providers across 32 of 44 counties.

Aggregation and suppression

Public statistics require a minimum of five reporting providers in the dimension being shown. Counties with fewer reporters roll up to their IDHW region. Provider organization names are never displayed.

What we do not claim

This is not a random sample. Providers in financial distress may be more motivated to report; providers in active crisis may lack time to report. We mitigate by reporting trends across periods, by reporting alongside narrative examples, and by stating sample composition openly.

We do not claim statistical representativeness. We do claim that the trends across periods are real, the providers reporting them are real, and the operational consequences described are real.

Definitions

Why this exists

In March 2026, the Idaho Legislature approved cuts that together produce an effective reduction of roughly 10 percent to home and community-based services. When rates change, the operational effects on the ground are not visible in any public dataset. Closures, staff shortages, declined referrals, and downstream costs exist, but the only people who know the scale are the providers themselves, scattered across the state.

This coalition exists to make those effects visible — every quarter, transparently, with consistent methodology — so that conversations about Medicaid policy can be grounded in operational reality rather than anecdote.

Strategic framework

The instrument is built directly on the four-quadrant system-stress framework set out in the April 2026 Potentia Public Policy Institute white paper, Strategic Responses to Idaho Medicaid Rate Reductions. Authored by Thomas Cook, John Villegas-Grubbs, and Roger Deshaies, the paper synthesizes provider-association experience, state DD agency leadership, and the rate-architecture work behind Idaho's current fee-for-service rate system.

Recommendation nine of that paper calls for coordinated tracking of the indicators captured here. This site is the operational implementation of that recommendation. Recommendation eleven calls for explicit intervention thresholds — those appear on the dashboard.

Dual purpose: today and 2027

The coalition's quarterly data collection serves two purposes. In the near term, it produces an evidence base for legislative and administrative correction of the March 2026 reductions, with operational consequences tied directly to policy decisions. In the longer term, it prepares participating providers for the mandatory annual cost-survey environment created by H.B. 863, where IDHW will collect cost data, audit 15 percent of responses, and use the results to set future rates beginning in late 2027.

Providers who build the documentation discipline now will be in a stronger position when participation becomes mandatory and the stakes — including potential corrective action, intake closure, or provider-agreement termination for non-compliance — become higher.

Governance

The coalition is provider-led. Survey questions are reviewed by a working group of participating providers each quarter. Methodology is published openly. There is no corporate sponsor and no contracting relationship with any state agency or political organization. The coalition operates in coordination with the protectidahohomecare.com effort and the Idaho Association of Community Providers.

Contact

To participate, request data, or invite a coalition member to present, reach out to the coordinating team.