State Independent Living Council tells committee housing, Medicaid and workforce shortfalls drive institutionalization risk

Mel Levitan, executive director of the Idaho State Independent Living Council, told the Idaho Senate Health and Welfare Committee on Jan. 16, 2025 that the council's statewide needs assessment and ongoing work identify housing affordability, access to health care, a shortage of direct support professionals, and limited case management as top challenges for Idahoans with disabilities.

"We do a whole lot for with 4 people, and we're pretty excited about the things that we get to do," Levitan said, summarizing the council's work. Levitan said the council is a volunteer body of roughly 17 to 24 members with four ex officio state-agency seats and a four-person staff, including a financial specialist and a program specialist, Jamie Davis, who was present at the hearing.

Levitan described the SILC's collaboration with the three regional centers for independent living — Disability Action Center Northwest (serving northern Idaho), Living Independence Network Corporation (LINC, serving southern and southwestern Idaho) and LIFE (serving eastern Idaho) — and said the council does not provide direct services but coordinates and advocates statewide.

The council collected input from 871 Idahoans during its most recent statewide needs assessment; Levitan said respondents represented 304 of Idaho's 44 counties (some respondents did not mark a county) and the outreach included 29 listening sessions and visits to about 27 communities. Top issues cited were housing affordability and accessibility, access to health care (including specialist shortages in areas such as Latah County), loss of volunteer transportation programs, and a shortage of direct support professionals.

Levitan said the council is tracking changes to Medicaid home-and-community-based services and referenced a Department of Justice report dated Jan. 16, 2025 that raised concerns about remote certified family homes, lack of case management, and other access issues. "I'm happy to provide that Department of Justice complaint to anybody who'd like it," Levitan said; he told senators he would send electronic copies to the committee and provided several printed copies at the hearing.

Levitan said the state is planning to add two hours of case management per month for some participants but expressed concern that "if you can imagine being a person in a nursing home, not having any family... to only have 2 hours to help find housing in today's housing market, that's 2 hours worth of help" and that the increase may be insufficient to support transitions out of institutions.

He provided comparative cost figures cited in the DOJ report and other sources: average home-and-community-based services costs for participants he cited as "less than $20,000 a year," compared with annual nursing-home costs he cited at roughly $85,800 per person.

Levitan said the SILC is pursuing several goals in its current state plan (effective Oct. 1, year not specified in the presentation), including emergency-preparedness inclusion for people with disabilities, improving access to housing and transportation, strengthening leadership development and youth engagement, and exploring a potential Idaho ABLE savings program. He said the three regional centers tailor services to their regions and provide peer support, accessibility projects (for example, waterfront access in Coeur d'Alene), ramp and grab-bar installation programs, and training for businesses and medical providers.

Sen. Wintrow asked Levitan to explain what "integration, inclusion and equity" mean in practice. Levitan used accessibility examples — accessible routes to hearing-system tuning to accommodate cochlear implants, and removing podiums to permit sight lines for wheelchair users — and said the terms are about ensuring people with disabilities have the same opportunity to participate.

Levitan also flagged workforce problems, calling the shortage of direct support professionals "a catastrophic issue," and said potential policy changes such as Medicaid block grants or per-capita caps could dramatically reduce home-and-community-based services and increase institutionalization, with both human and fiscal consequences.

The committee asked Levitan to provide the DOJ report electronically; Levitan agreed and the chair said committee staff would distribute it to members. The hearing contained no formal committee action on the council's materials.

Levitan concluded, "We really do a lot for with 4 people, and we're pretty excited about the things that we get to do."