Budget tools can resemble the instruments used in surgery or construction. Chain saws, scalpels, and machetes all achieve different results, but the level of precision required determines which one is appropriate.
Today, many Idahoans are questioning which tool the Idaho Department of Health and Welfare is using as the state faces the risk of an unbalanced budget.
Chain Saws, Scalpels, and Now… a Machete?
A chain saw helps complete fast tasks that do not require extreme accuracy. A scalpel, however, demands in-depth knowledge, expertise, and delicate precision.
But the current approach from Idaho’s leaders feels less like either tool—and more like a machete, swung broadly without considering what may be cut down in the process.
Gov. Brad Little recently instructed state agencies to impose a 3% budget holdback, despite legislators approving record-breaking tax cuts just months ago.
This sudden shift from celebrating tax relief to scrambling to stabilize the budget raises serious concerns, especially with an election year approaching.
How Budget Cuts Impact Medicaid Services
As the head of a nonprofit that supports individuals on Medicaid, the author emphasizes the need for fiscal responsibility paired with accountability.
Medicaid providers, including organizations like Opportunities Unlimited, Inc., help residents stay in their communities instead of costly institutions—saving the state money while enabling independence.
One major initiative involves partnering with the Idaho Department of Correction to help individuals with disabilities transition back into the workforce after incarceration. This support reduces recidivism, lowers long-term state costs, and fulfills release requirements.
Yet despite their value, these providers now face a 4% reimbursement reduction. While 4% may seem small, it creates major strain when organizations must pay competitive wages, cover payroll taxes, provide benefits, and retain staff.
In rural communities that already struggle to keep enough physicians, more budget pressure could drive even more professionals away.
Where Is the Supporting Data?
The Department of Health and Welfare manages one of the state’s largest budgets, yet obtaining timely, accurate data from the agency is difficult.
Lawmakers are approving budget changes without strong data-driven justification, pushing cuts simply to close the financial gap.
The author warns that lawsuits are likely—avoidable ones—caused by decisions that lack research and long-term planning.
Why Idaho Needs a Scalpel, Not a Machete
With a $5 billion budget, careful analysis—not broad cuts—is essential. Every department should document how funds are used and why programs matter.
For example, supporting people in their homes through Medicaid is far cheaper than nursing home care. Idaho’s aging population continues to grow, and long-term care facilities often have long waiting lists or stop accepting Medicaid altogether. Reducing home-based services only shifts costs elsewhere.
Between 2019 and 2024, direct-care providers helped the state revert $340 million in general fund dollars—clear evidence of cost-effective services.
Cuts That Ignore the Bigger Picture
Some areas were protected from reductions, including state-run institutions, self-directed services, and school-based Medicaid. Yet publicly available data shows state-run institutions have rising personnel costs despite fewer full-time staff. Many of these programs lack consistent oversight or audits to identify waste.
Health and Welfare also announced sweeping cuts to a community program serving individuals with severe mental illness—a program proven to reduce hospitalizations, institutional care, and incarceration.
Without support, people may end up in county jails, where taxpayers must cover medical expenses. Counties will face tough choices: cut essential services or raise property taxes, undermining Idaho’s celebrated tax cuts.
Idaho can reduce spending without jeopardizing programs that ultimately save taxpayers money. Using a scalpel-like approach, grounded in transparent data and long-term planning, is far more effective than slashing budgets with a machete.
History consistently shows that dismantling cost-efficient services creates heavier financial burdens down the road. Idaho’s leaders must choose precision over speed if they want a balanced budget that truly protects taxpayers.
