Board of Directors
Executive Summary & Resolution

WHEREAS, the Idaho Health Care Association ("IHCA") represents more than eighty (80) Medicaid-certified nursing facilities, assisted living facilities, intermediate care facilities, and home health agencies across the State of Idaho, comprising more than 6,200 licensed beds, employing more than 9,400 healthcare workers, and serving approximately 4,500 Idaho residents daily; and

WHEREAS, Idaho's Medicaid nursing facility reimbursement rate of approximately $259 per patient day ranks forty-sixth (46th) among the fifty states and is the lowest in the Intermountain West region, below Montana ($314), Oregon ($322), and Washington ($356); and

WHEREAS, Idaho's current rate methodology relies upon the RUG-III patient classification system, which the Centers for Medicare and Medicaid Services replaced with the Patient-Driven Payment Model (PDPM) in October 2019, and a property component base rate of $9.24 per patient day established in 1985; and

WHEREAS, the Budget Adjustment Factor systematically reduces calculated rates below the level supported by actual costs, and Idaho's provider assessment rate of approximately 3.5% is substantially below the 6% federal safe harbor, resulting in an estimated $45 million or more in available federal matching funds being left unclaimed annually; and

WHEREAS, more than ten (10) Idaho nursing facilities have closed since 2020, displacing vulnerable residents and eliminating healthcare jobs in communities across the state; and

WHEREAS, certified nursing assistant wages in Idaho nursing facilities ($14-17/hour) are below starting wages offered by retail employers, creating a severe workforce recruitment and retention crisis; and

WHEREAS, IHCA staff has prepared a comprehensive legislative proposal — the Idaho Nursing Facility Sustainability & Quality Act — incorporating six reforms modeled on proven programs in North Dakota, Colorado, Indiana, Montana, Oregon, and Washington, including a modern component-based rate methodology, provider assessment enhancement to 5.5%, a quality incentive program, a rate floor at 90% of cost, a workforce development fund, and rate-setting process reform; and

WHEREAS, the proposed legislation has been reviewed by IHCA's Policy Director, Luke Malek, Esq., for legal sufficiency and compliance with federal Medicaid law;

NOW, THEREFORE, BE IT RESOLVED that the Board of Directors of the Idaho Health Care Association hereby:

1. Endorses the Idaho Nursing Facility Sustainability & Quality Act as IHCA's primary legislative priority for the 2027 Idaho legislative session;
2. Authorizes IHCA's Executive Director, Policy Director, and Director of Government Affairs to pursue legislative passage, including but not limited to sponsor recruitment, committee testimony, coalition building, media engagement, and grassroots coordination;
3. Directs all IHCA member facilities to support the legislative campaign through grassroots advocacy, including facilitating letter-writing by families, employees, and community stakeholders;
4. Authorizes IHCA staff to expend Association resources necessary to execute the legislative campaign, with regular financial reporting to the Treasurer;
5. Designates the Executive Director and Board President as the official spokespersons for the Association on all matters related to this legislation; and
6. Directs the Executive Director to report monthly to the Board on campaign progress, legislative developments, and expenditures.

ADOPTED by unanimous vote of the Board of Directors of the Idaho Health Care Association on this _____ day of _____________, 2026.

Board Members Present:
Riley Sessions • Landon Taylor • Mike Robbins • Breanna Jamison • Brian Bagley
Gary Weaver • Jamie Anthony • Graham Christensen • Jordan Monson • Justin Stenquist
Tiffany Pettit • Angie Hillishiem • Isaiah Hawkins