⚖
Master Execution Playbook

Idaho Nursing Facility
Sustainability & Quality Act

Complete step-by-step execution guide — from board endorsement through bill signing and implementation

H.B. ____  ·  69th Idaho Legislature  ·  2027 Session
Prepared for: Idaho Health Care Association Version 1.0 — August 2026 CONFIDENTIAL — Strategic Document
Section 1

Executive Summary

The Idaho Nursing Facility Sustainability & Quality Act is a comprehensive Medicaid reimbursement reform bill designed to modernize Idaho's nursing facility payment system, unlock over $32 million in federal matching funds, and establish a quality-driven rate framework — all at a net state cost of approximately $5.3 million ($2.80 per Idaho resident per year).

Idaho currently ranks 46th nationally in Medicaid nursing facility reimbursement at $259/day. The Act proposes raising the existing provider assessment from 3.5% to 5.5% — still below the federal 6% safe harbor — to generate the state match needed to draw down federal funds that Idaho currently leaves on the table. Six core reforms are enacted over a 3-year phase-in: a modern rate formula, federal fund optimization, quality bonuses, a rate floor, a workforce development fund, and enhanced transparency reporting.

46th
National Ranking
$5.3M
Net State Cost (Yr 1)
$32M+
Federal Funds Unlocked
$2.80
Cost Per Resident/Year
5.5%
Assessment (Below 6% Cap)
3-Year
Phase-In Period

Execution Overview

This playbook covers nine phases spanning August 2026 through July 2027:

  1. Foundation (Aug–Sep 2026): Secure IHCA board endorsement, identify bill sponsors, initiate DHW engagement.
  2. Build Support (Oct–Nov 2026): Assemble coalition, consult CMS Region 10, present to interim committee, brief DFM, commission independent economic study.
  3. Pre-Session (Dec 2026): Submit draft to LSO, prepare JFAC materials, finalize media strategy, activate grassroots network.
  4. Session Opens (Jan 2027): Formal bill introduction, press release, prepare committee hearing package.
  5. Committee (Feb 2027): Health & Welfare Committee hearing, testimony, secure committee vote.
  6. Floor & Crossover (Feb–Mar 2027): Full chamber vote, crossover to second chamber, conference committee if needed.
  7. Governor (Mar 2027): Governor Little signs the bill into law.
  8. Post-Passage (Apr–Jun 2027): DHW submits State Plan Amendment to CMS, negotiated rulemaking begins.
  9. Effective Date (Jul 1, 2027): Phase 1 of the rate reforms takes effect.
Key Principle: This is an Idaho-grown, bipartisan solution. It does not increase general fund burden — it uses an existing federal mechanism that 45+ states already leverage. The narrative must consistently emphasize fiscal responsibility, federal fund recovery, and quality improvement.

Who Executes This Plan

Execution is led by the Idaho Health Care Association (IHCA) under Executive Director Robert Vande Merwe, with critical strategic support and financial backing from Cascadia Healthcare (CEO Owen Hammond). IHCA staff — Policy Director Luke Malek, Government Affairs Director Lindsay Likes, and Member Services Director Dana Leavitt — serve as the operational engine. The full IHCA Board of Directors, led by President Riley Sessions, provides governance and statewide member activation. All supporting materials are hosted at medicaid-panel-study.vercel.app.

Section 2

Legislative Pathway — Visual Flowchart

The complete path from strategic preparation through implementation, with key actions at each phase.

Phase 1
Foundation
August – September 2026
  • IHCA Board formal endorsement vote
  • Identify & recruit lead bill sponsor
  • Initiate DHW Director meeting
  • Internal financial modeling complete
  • Sponsor recruitment conversations begin
Phase 2
Build Support
October – November 2026
  • Coalition letters: AARP, IHA, IMA, AAA, Commission on Aging
  • CMS Region 10 pre-consultation meeting
  • Interim Health & Welfare Committee presentation
  • Division of Financial Management briefing
  • Commission independent economic study
  • Co-sponsor recruitment (target 3-5 bipartisan)
Phase 3
Pre-Session
December 2026
  • Submit bill draft to Legislative Services Office
  • Prepare JFAC fiscal briefing materials
  • Finalize media strategy & op-eds
  • Activate grassroots network across 80+ facilities
  • Governor's office advance briefing
  • Editorial board meetings with key media
Phase 4
Session Opens
January 2027
  • Formal bill introduction — H.B. ____
  • Press release & media availability
  • Committee hearing preparation & witness coordination
  • JFAC fiscal note response preparation
  • Legislative tracking begins
Phase 5
Committee
February 2027
  • House Health & Welfare Committee hearing
  • Testimony: Robert (18-22 min), Luke (5-7 min), industry panel
  • CNA, family, & administrator testimony
  • Committee vote — target "do pass" recommendation
Phase 6
Floor & Crossover
February – March 2027
  • Full House floor vote
  • Crossover to Senate Health & Welfare
  • Senate committee hearing & vote
  • Senate floor vote
  • Conference committee if amendments differ
Phase 7
Governor Signs
March 2027
  • Enrolled bill transmitted to Governor Little
  • Bill signing ceremony (coordinate with Governor's office)
  • Press release & public celebration
Phase 8
Post-Passage Implementation
April – June 2027
  • DHW submits State Plan Amendment to CMS
  • Negotiated rulemaking begins (IDAPA 16.03.10)
  • Provider assessment collection mechanism established
  • Quality metrics program design
  • Workforce fund implementation planning
Phase 9 — Milestone
Phase 1 Takes Effect
July 1, 2027
  • New assessment rate effective
  • Rate floor implemented
  • First enhanced federal draws begin
  • Quality reporting requirements commence
Section 3

Master Timeline — Week by Week

Detailed action items from August 2026 through July 2027. Check boxes to track completion.

Date Action Responsible Deliverable ✓
Phase 1: Foundation — August–September 2026
Aug 19–23 Finalize bill draft language and fiscal impact analysis Luke Malek Final bill draft (v1.0)
Aug 19–23 Prepare IHCA board presentation package Robert Vande Merwe Board presentation deck
Aug 25–29 Owen approves Cascadia financial commitment to campaign Owen Hammond Budget authorization
Aug 25–29 Steve models assessment impact on all Cascadia facilities Steve (CFO) Cascadia facility impact model
Sep 1–5 IHCA Board meeting — endorsement resolution vote Riley Sessions, Robert Vande Merwe Signed endorsement resolution
Sep 1–5 Breanna presents financial overview to board Breanna Jamison Financial summary presentation
Sep 8–12 Draft and send formal DHW meeting request letter Robert Vande Merwe Signed letter to DHW Director
Sep 8–12 Begin sponsor identification — Luke contacts former legislative colleagues Luke Malek Target sponsor list (3-5 names)
Sep 15–19 Owen begins personal outreach to Governor Little's office Owen Hammond Governor's office initial contact
Sep 15–19 Lindsay begins coalition outreach — contact AARP Idaho, IHA Lindsay Likes Initial coalition contact log
Sep 22–26 DHW Director meeting — present concept and data Robert Vande Merwe, Luke Malek DHW meeting notes & follow-up items
Sep 22–30 Lead sponsor confirmed and committed Luke Malek Sponsor commitment letter/confirmation
Phase 2: Build Support — October–November 2026
Oct 1–10 Draft and send CMS Region 10 pre-consultation request Robert Vande Merwe CMS meeting request letter
Oct 1–10 Commission independent economic study (RFP to consulting firms) Robert Vande Merwe, Steve (CFO) Signed consulting engagement
Oct 6–17 Coalition outreach: IMA, Commission on Aging, AAAs, Council on DD Lindsay Likes Coalition briefing meetings completed
Oct 13–17 CMS Region 10 pre-consultation meeting (Seattle) Robert Vande Merwe, Luke Malek CMS feedback summary
Oct 20–31 Recruit co-sponsors — target 3-5 bipartisan legislators Luke Malek, Lindsay Likes Co-sponsor commitment list
Oct 20–31 Collect first round of coalition support letters Lindsay Likes Signed coalition letters (batch 1)
Nov 1–7 Interim Health & Welfare Committee presentation Robert Vande Merwe, Luke Malek Committee presentation & handouts
Nov 1–14 Division of Financial Management briefing Robert Vande Merwe DFM briefing memo & fiscal model
Nov 10–14 Jordan coordinates with Tiffany Pettit on northern Idaho grassroots Jordan Monson Northern ID activation plan
Nov 15–21 Federal safe harbor compliance documentation complete Luke Malek Compliance memo
Nov 15–28 Independent economic study — preliminary results review Robert Vande Merwe, Steve (CFO) Draft study findings
Nov 17–28 Tim coordinates with Chase on Cascadia facility grassroots engagement Tim Nelson, Chase Gunderson Facility engagement plan
Nov 24–28 Tribal consultation preparation — identify contacts for 5 Idaho tribes Lindsay Likes, Luke Malek Tribal consultation plan
Phase 3: Pre-Session — December 2026
Dec 1–5 Submit final bill draft to Legislative Services Office (LSO) Luke Malek (via sponsor) LSO drafting request filed
Dec 1–5 Independent economic study — final report received Robert Vande Merwe Final economic study report
Dec 1–12 UPL analysis coordination with Medicaid consulting firm Luke Malek UPL analysis report
Dec 8–12 JFAC fiscal briefing preparation — complete materials package Robert Vande Merwe, Steve (CFO) JFAC briefing binder
Dec 8–12 Finalize media strategy — op-ed drafted, press release template ready Robert Vande Merwe, Lindsay Likes Media kit (op-ed, press release, talking points)
Dec 8–19 Editorial board meetings with Idaho Statesman, other outlets Lindsay Likes, Robert Vande Merwe Editorial meetings completed
Dec 15–19 Dana distributes grassroots activation kit to all 80+ member facilities Dana Leavitt Kit distributed, receipt confirmed
Dec 15–19 Governor's office advance briefing Owen Hammond, Robert Vande Merwe, Riley Sessions Governor briefing notes
Dec 22–31 All coalition support letters collected Lindsay Likes Complete coalition letter package
Dec 22–31 Grassroots letter-writing campaign launch (holiday recess push) Dana Leavitt, Tim Nelson First wave of constituent letters
Phase 4: Session Opens — January 2027
Jan 6–9 Idaho Legislature convenes — session opens All —
Jan 13–17 Formal bill introduction — H.B. ____ filed Lead Sponsor, Luke Malek Bill number assigned
Jan 13–17 Press release issued; media availability for Robert & Riley Lindsay Likes, Robert Vande Merwe Press release distributed
Jan 13–17 Robert publishes op-ed in Idaho Statesman Robert Vande Merwe Published op-ed
Jan 20–24 Committee hearing preparation — finalize witness list and testimony Luke Malek, Lindsay Likes Witness list, testimony scripts
Jan 20–24 JFAC fiscal note response preparation Robert Vande Merwe, Steve (CFO) Fiscal note response memo
Jan 20–31 Legislative vote counting begins — track supporters/opponents Lindsay Likes Vote count tracker (updated weekly)
Jan 20–31 Identify and prepare CNA, family, and administrator testimony witnesses Tim Nelson, Dana Leavitt, Breanna Jamison Confirmed witnesses with prepared testimony
Phase 5: Committee — February 2027
Feb 2–6 House Health & Welfare Committee hearing Robert (lead testimony), Luke (policy), witnesses Testimony delivered
Feb 2–6 Luke drafts real-time responses to committee questions Luke Malek Committee Q&A responses
Feb 9–13 Committee vote — secure "do pass" recommendation Lindsay Likes (whip count), All Committee vote result
Feb 9–13 Post-committee media push — results & next steps Lindsay Likes, Robert Vande Merwe Post-hearing press statement
Phase 6: Floor & Crossover — February–March 2027
Feb 16–20 Full House floor debate and vote Lead Sponsor, Luke Malek, Lindsay Likes House vote result
Feb 23–27 Bill crosses to Senate — assigned to Senate H&W Committee Lindsay Likes Senate committee assignment
Mar 2–6 Senate Health & Welfare Committee hearing Robert (testimony), Luke (policy), witnesses Senate testimony delivered
Mar 9–13 Senate committee vote & floor vote All Senate vote result
Mar 9–20 Conference committee (if needed for amendment reconciliation) Luke Malek Conference report
Phase 7: Governor — March 2027
Mar 16–20 Enrolled bill transmitted to Governor Little Lindsay Likes Enrolled bill
Mar 20–27 Governor signs bill into law Owen Hammond, Robert Vande Merwe, Riley Sessions Signed law / bill signing ceremony
Mar 20–27 Press release: bill signing announcement Lindsay Likes Signing press release
Phase 8: Post-Passage — April–June 2027
Apr 1–15 DHW begins State Plan Amendment (SPA) preparation Robert Vande Merwe, Luke Malek (advisory) SPA draft initiated
Apr 1–30 IDAPA 16.03.10 negotiated rulemaking initiated Luke Malek (IHCA representative) Rulemaking notice published
Apr 15–30 Provider assessment collection mechanism design Steve (CFO), Robert Vande Merwe Assessment collection framework
May 1–31 Quality metrics program design finalized Robert Vande Merwe, IHCA Board Quality program design document
May 1–31 Workforce fund implementation planning Dana Leavitt Workforce fund implementation plan
Jun 1–15 DHW submits SPA to CMS DHW (IHCA advisory support) SPA submitted to CMS
Jun 15–30 Provider readiness communications — rate change guidance to facilities Dana Leavitt Provider readiness bulletin
Phase 9: Effective Date — July 1, 2027
Jul 1 Phase 1 of rate reforms takes effect All New rates in effect
Jul 1–15 Monitor first enhanced federal draw Steve (CFO), Robert Vande Merwe First federal payment verification
Jul 1–31 Quality reporting requirements commence Dana Leavitt First quality report cycle
Section 4

Individual To-Do Lists

Detailed action items for every person involved, organized by role and with target deadlines.

Cascadia Healthcare Team

OH
Owen Hammond
Chief Executive Officer
Cascadia Healthcare
  1. Approve Cascadia's financial commitment to the legislative campaign budget Aug 29
  2. Review and approve all external communications, talking points, and media materials before release Ongoing
  3. Initiate personal outreach to Governor Brad Little's office — advance briefing on the Act Sep 15–19
  4. Coordinate with Steve (CFO) on Cascadia's financial modeling and assessment impact analysis Sep 5
  5. Coordinate with Tim Nelson on facility-level grassroots activation strategy across all Cascadia buildings Oct 31
  6. Make strategic decisions on political relationships — advise on sponsor recruitment priorities Sep 30
  7. Activate Cascadia facility leaders (Breanna, Jordan, Chase) for grassroots engagement Nov 15
  8. Attend Governor's office advance briefing with Robert and Riley Dec 15–19
  9. Attend key legislative committee hearings as needed — demonstrate industry CEO presence Feb 2027
  10. Participate in bill signing ceremony Mar 2027
S
Steve
Chief Financial Officer
Cascadia Healthcare
  1. Review and validate all fiscal impact numbers in the bill analysis — confirm $5.3M net state cost, $32M federal figure Aug 29
  2. Model the 3.5% → 5.5% assessment impact on each Cascadia facility — net benefit analysis Sep 5
  3. Prepare Cascadia-specific financial data for IHCA use in presentations and testimony Sep 12
  4. Budget Cascadia's share of campaign costs ($77K–$210K range) Sep 5
  5. Support independent economic study with Cascadia operational and financial data Oct 10
  6. Review independent economic study draft findings for accuracy Nov 21
  7. Assist Robert with JFAC fiscal briefing materials — provide facility-level worked examples Dec 12
  8. Prepare JFAC fiscal note response data Jan 24
  9. Design provider assessment collection mechanism post-passage Apr 30
  10. Monitor and verify first enhanced federal draw after implementation Jul 15
TN
Tim Nelson
Chief Operating Officer
Cascadia Healthcare
  1. Develop facility-level grassroots activation plan across all Cascadia buildings Oct 31
  2. Coordinate with Chase Gunderson (EVP Ops) on field engagement logistics Nov 14
  3. Identify 3-5 Cascadia CNAs willing and prepared to testify at committee hearings Dec 31
  4. Identify 2-3 Cascadia administrators for testimony — compelling personal narratives Dec 31
  5. Ensure Three Rivers facilities (Breanna's group) participate in letter-writing campaigns Dec 19
  6. Ensure Northern facilities (Jordan's group) participate in letter-writing campaigns Dec 19
  7. Coordinate with Dana Leavitt on integrating Cascadia facilities into IHCA-wide grassroots kit Dec 15
  8. Prepare testimony witnesses for committee hearing — conduct practice sessions Jan 31
  9. Support facility participation in grassroots letter campaign during holiday recess Dec 22–31
BJ
Breanna Jamison
IHCA Board Treasurer · President, Three Rivers
Cascadia Healthcare
  1. Prepare and present financial overview to IHCA Board at endorsement meeting Sep 5
  2. Vote to support board endorsement resolution (as Treasurer) Sep 5
  3. Identify one Three Rivers facility as "worked example" for testimony — real numbers, real impact Oct 31
  4. Coordinate Three Rivers grassroots activation — families, CNAs, staff writing to legislators Dec 19
  5. Recruit 2-3 family members from Three Rivers facilities for committee testimony Jan 15
  6. Attend House Health & Welfare Committee hearing as board member Feb 2–6
  7. Attend Senate committee hearing if schedule permits Mar 2–6
  8. Provide Three Rivers facility data for independent economic study Oct 15
JM
Jordan Monson
IHCA Board MI/DD Rep · President, Northern
Cascadia Healthcare
  1. Represent northern Idaho perspective during board endorsement discussion Sep 5
  2. Vote to support board endorsement resolution Sep 5
  3. Identify Northern Idaho facilities for grassroots activation — highlight rural impact Nov 7
  4. Coordinate with Region 1,2 Director Tiffany Pettit on northern Idaho grassroots strategy Nov 14
  5. Prepare potential testimony: rural/northern Idaho access-to-care narrative Jan 15
  6. Activate Northern facility networks for legislator letter-writing in Districts 1-7 Dec 19
  7. Connect with MI/DD community stakeholders for coalition support Oct 31
  8. Provide Northern facility operational data for independent economic study Oct 15

IHCA Staff

RV
Robert Vande Merwe
Executive Director
Idaho Health Care Association
  1. Prepare and deliver board presentation for endorsement vote Sep 5
  2. Draft, sign, and send formal meeting request letter to Idaho DHW Director Sep 12
  3. Lead DHW Director meeting — present concept, data, and federal compliance path Sep 22–26
  4. Draft, sign, and send CMS Region 10 pre-consultation request letter Oct 10
  5. Commission independent economic study — select firm, negotiate scope Oct 10
  6. Co-lead CMS Region 10 pre-consultation meeting in Seattle Oct 13–17
  7. Present to Interim Health & Welfare Committee with Luke Malek Nov 1–7
  8. Brief Division of Financial Management on fiscal impact Nov 1–14
  9. Oversee coalition letter collection — ensure all target organizations respond Dec 31
  10. Coordinate all IHCA staff assignments — Luke, Lindsay, Dana task management Ongoing
  11. Finalize media strategy — draft op-ed for Idaho Statesman Dec 12
  12. Attend editorial board meetings with Lindsay Dec 8–19
  13. Attend Governor's office advance briefing with Owen and Riley Dec 15–19
  14. Publish op-ed in Idaho Statesman upon bill introduction Jan 13–17
  15. Serve as primary IHCA media spokesperson — press release quotes, interviews Jan–Mar 2027
  16. Deliver primary committee testimony (18-22 minutes) at House H&W Committee Feb 2–6
  17. Deliver testimony at Senate H&W Committee Mar 2–6
  18. Report progress to IHCA Board monthly throughout campaign Monthly
  19. Advise DHW on State Plan Amendment preparation post-passage Apr 1–15
  20. Oversee quality metrics program design post-passage May 31
LM
Luke Malek, Esq.
Policy Director
Idaho Health Care Association
  1. Finalize bill draft language — legal review of all provisions Aug 23
  2. Leverage former legislative colleague relationships — identify target sponsors from Idaho House Sep 12
  3. Recruit lead bill sponsor — secure commitment with talking points package Sep 30
  4. Identify and recruit 3-5 bipartisan co-sponsors Oct 31
  5. Co-lead CMS Region 10 pre-consultation meeting with Robert Oct 13–17
  6. Prepare and deliver federal safe harbor compliance documentation (42 USC §1396b(w)) Nov 21
  7. Coordinate UPL analysis with Medicaid consulting firm Dec 12
  8. Coordinate Attorney General legal sufficiency review Nov 30
  9. Review all technical and legal documents — ensure accuracy and legal soundness Ongoing
  10. Present at Interim Health & Welfare Committee with Robert Nov 1–7
  11. Submit final bill draft to LSO through lead sponsor Dec 5
  12. Coordinate with Smith + Malek for pro bono legal support if needed As needed
  13. Prepare testimony script and responses to anticipated committee questions Jan 24
  14. Draft real-time responses to committee questions during hearing Feb 2–6
  15. Deliver policy testimony (5-7 minutes) at House H&W Committee Feb 2–6
  16. Deliver policy testimony at Senate H&W Committee Mar 2–6
  17. Manage conference committee process if House/Senate versions differ Mar 9–20
  18. Serve as IHCA representative in IDAPA 16.03.10 negotiated rulemaking Apr–Jun 2027
LL
Lindsay Likes
Director of Government Affairs, Engagement & Partnerships
Idaho Health Care Association
  1. Initiate coalition outreach — contact AARP Idaho Sep 15–19
  2. Contact Idaho Hospital Association for coalition support Sep 19
  3. Contact Idaho Medical Association, Idaho Commission on Aging, Area Agencies on Aging, Idaho Council on DD Oct 17
  4. Schedule and coordinate DHW Director meeting for Robert Sep 12
  5. Schedule CMS Region 10 pre-consultation meeting Oct 10
  6. Schedule Division of Financial Management briefing Nov 7
  7. Collect first round of signed coalition support letters Oct 31
  8. Collect all remaining coalition support letters Dec 31
  9. Coordinate grassroots activation through IHCA member facilities Dec 15
  10. Prepare media kit: press release template, talking points, fact sheet Dec 12
  11. Coordinate editorial board meetings with Idaho Statesman and other outlets Dec 8–19
  12. Schedule Governor's office advance briefing Dec 15
  13. Issue press release upon bill introduction Jan 13–17
  14. Begin legislative tracking and vote counting Jan 20
  15. Coordinate witness list and hearing logistics for H&W Committee Jan 24
  16. Brief IHCA members on legislative progress weekly during session Jan–Mar 2027 weekly
  17. Attend all committee hearings and floor debates Feb–Mar 2027
  18. Issue post-committee and post-vote press statements As events occur
  19. Coordinate bill signing ceremony logistics with Governor's office Mar 2027
  20. Issue signing announcement press release Mar 2027
DL
Dana Leavitt
Director of Member Services
Idaho Health Care Association
  1. Develop grassroots activation kit — letter templates, talking points, facility instructions Dec 1
  2. Distribute grassroots activation kit to all 80+ IHCA member facilities Dec 19
  3. Coordinate member facility letter-writing campaigns — track submissions by district Dec 22 – Jan 31
  4. Track member participation in advocacy — facility-by-facility reporting Ongoing
  5. Leverage CNA training grant experience to craft workforce fund messaging Nov 30
  6. Coordinate with member facilities to recruit family members for testimony Jan 15
  7. Coordinate with member facilities to recruit employee (CNA/nurse) testimony witnesses Jan 15
  8. Manage IHCA member communications about the bill — regular updates, FAQs Oct 2026 – Mar 2027
  9. Design and launch workforce fund implementation plan post-passage May 31
  10. Distribute provider readiness communications — rate change guidance to facilities Jun 30
  11. Initiate first quality report cycle Jul 31

IHCA Board Leadership

RS
Riley Sessions
IHCA Board President
Parke View Rehab
  1. Chair IHCA Board meeting for endorsement resolution vote Sep 5
  2. Co-sign formal Governor's office meeting request letter with Robert Dec 12
  3. Represent IHCA at Governor Little's advance briefing Dec 15–19
  4. Serve as public face of IHCA endorsement — quote in press release Jan 13–17
  5. Available for media interviews as IHCA Board President Jan–Mar 2027
  6. Attend key committee hearings — demonstrate board-level commitment Feb–Mar 2027
  7. Participate in bill signing ceremony Mar 2027
BD
Board Members & Regional Directors
Officers, At-Large Representatives, Region Directors
Idaho Health Care Association
  1. Landon Taylor (President-Elect, TanaBell Health Services): Support Riley in public-facing role; prepare to carry initiative forward if elected president; activate TanaBell facilities for grassroots Ongoing
  2. Mike Robbins (Secretary, The Gables): Record board votes accurately; distribute endorsement resolution to all members; maintain official campaign records Sep 5 + ongoing
  3. Brian Bagley (Past President, Lakeside Assisted Living): Leverage relationships built during board tenure to contact legislators; serve as mentor to current leadership on campaign strategy Sep–Mar
  4. Gary Weaver (AL Rep, Edgewood Spring Creek Overland): Activate assisted living perspective — articulate how SNF reform impacts the continuum of care Oct 31
  5. Jamie Anthony (ICF Rep, Developmental Options): Represent ICF community interests in coalition building Oct 31
  6. Graham Christensen (MI/DD Rep, Harmony House): Partner with Jordan Monson on MI/DD community engagement and coalition support Oct 31
  7. Justin Stenquist (HH/H/HC Rep): Represent home health and hospice perspective — articulate continuum of care impact Oct 31
  8. Tiffany Pettit (Region 1,2 Director, Orchard Ridge): Coordinate grassroots activation in Regions 1 & 2 (northern Idaho) — work with Jordan Monson Nov 14
  9. Angie Hillishiem (Region 3,4 Director, All Care Health Solutions): Coordinate grassroots activation in Regions 3 & 4 (Treasure Valley area) Nov 14
  10. Isaiah Hawkins (Region 5,6,7 Director, Bennett Hills Rehab): Coordinate grassroots activation in Regions 5, 6 & 7 (eastern/southern Idaho) Nov 14
  11. All Board Members: Activate their facilities for grassroots letter-writing campaigns Dec 19
  12. All Board Members: Contact legislators in their regions personally Jan 2027
  13. All Board Members: Attend committee hearings when possible — demonstrate industry-wide support Feb–Mar 2027
Section 5

Federal Compliance Checklist

Every federal requirement that must be satisfied for CMS approval of the provider assessment and State Plan Amendment.

Provider Assessment Requirements (42 USC §1396b(w))

State Plan Amendment (SPA) Requirements

Tribal Consultation (5 Idaho Tribes)

Upper Payment Limit (UPL) Analysis

Non-Supplantation Documentation

FMAP Verification

Section 6

Idaho State Compliance Checklist

State-level procedural requirements from bill drafting through implementation.

Legislative Services Office (LSO) Drafting

Idaho Administrative Procedure Act (IDAPA) Compliance

Joint Finance-Appropriations Committee (JFAC) Process

Health & Welfare Committee Procedures

Floor Vote Requirements

Governor's Signature Process

Post-Passage Rulemaking (IDAPA 16.03.10)

Section 7

Campaign Budget

Estimated costs for executing the full legislative campaign. Range reflects minimum viable effort through comprehensive approach.

Line Item Low Estimate High Estimate
Independent Economic Study
Commission university or consulting firm to produce independent fiscal impact analysis. Critical for credibility with legislators and JFAC. 		$25,000 $50,000
Medicaid Consulting Firm (UPL/SPA)
Specialized Medicaid policy firm for Upper Payment Limit analysis, State Plan Amendment technical assistance, CMS preprint preparation, and federal compliance documentation. 		$30,000 $60,000
Lobbying / Government Affairs (Supplemental)
Supplemental lobbying support beyond IHCA staff capacity. May not be needed if IHCA staff (Luke, Lindsay) handle all legislative engagement. Contract lobbyist for vote whipping if needed. 		$0 $50,000
Media / Public Relations
Op-ed placement, press releases, media training, editorial board preparation, digital advocacy content, and media monitoring. 		$10,000 $25,000
Grassroots Coordination
Activation kit production and distribution, letter-writing campaign management, testimony preparation and witness coaching, advocacy day logistics. 		$5,000 $10,000
Travel / Meetings
CMS Region 10 meeting travel (Seattle), legislative session attendance, facility site visits by legislators, coalition meetings. 		$5,000 $10,000
Printing / Materials
Fact sheets, one-pagers, testimony binders, committee hearing packets, facility posters, constituent letter templates. 		$2,000 $5,000
Total Estimated Campaign Budget $77,000 $210,000
Funding Strategy: Campaign costs should be shared across IHCA membership through existing assessment or special assessment. Cascadia Healthcare, as the largest member, will bear a proportional share. Owen Hammond to approve Cascadia's specific commitment by August 29, 2026. The $77K–$210K investment generates $32M+ in annual federal funds for the state — an extraordinary return on investment that should be communicated to all funding contributors.
Cost Avoidance Note: IHCA's in-house staff (Robert, Luke, Lindsay, Dana) represent significant cost avoidance. Luke Malek's former legislative experience and existing Statehouse relationships reduce or eliminate the need for supplemental lobbying. Lindsay's government affairs role covers coalition building that might otherwise require an external firm.
Section 8

Risk Register

Top 10 risks to successful passage and implementation, with likelihood, impact, mitigation, and ownership.

# Risk Likelihood Impact Mitigation Strategy Owner
1 "Tax increase" framing — opponents label provider assessment as a tax hike High High Pre-emptive messaging: "Not a tax — it's an industry self-investment that generates $6 in federal funds for every $1 of state cost." Deploy independent economic study. Emphasize 45+ states already do this. Brief editorial boards early. Have bipartisan sponsors ready to rebut. Robert, Luke
2 No viable bill sponsor — unable to secure committed lead sponsor by session Low High Luke's former colleague relationships are primary asset. Start early (Sep). Target multiple candidates simultaneously. If House sponsor elusive, pivot to Senate. Engage Governor's office to suggest champions. Bipartisan approach broadens pool. Luke Malek
3 Governor opposition or neutrality — Governor Little does not actively support Medium High Owen's personal outreach to Governor's office (Sep). Riley + Robert advance briefing (Dec). Frame as fiscal responsibility — recovering federal funds Idaho already pays into. Highlight economic impact: jobs, facilities staying open. No general fund increase narrative. Owen Hammond
4 Committee defeat — H&W Committee votes "hold" or "return to sponsor" Medium High Pre-hearing vote counting (Lindsay). Grassroots pressure on committee members from their districts. Strong testimony package — real CNAs, families. Independent economic study as credibility anchor. Offer to address any committee concerns with amendments if needed. Lindsay Likes
5 Industry opposition — subset of nursing facilities oppose increased assessment Medium Medium Early education campaign through Dana's member communications. Show facility-by-facility net benefit analysis (Steve's models). Demonstrate that all facilities benefit from rate floor and federal draw. Address concerns through IHCA board process. Rate floor protects smallest operators. Robert, Dana
6 CMS rejection of SPA — CMS declines to approve State Plan Amendment Low High Pre-consultation with CMS Region 10 (Oct) specifically to identify any concerns before bill is drafted. Design assessment to be clearly within safe harbor. Engage experienced Medicaid consulting firm for SPA preparation. 45+ states have approved similar SPAs. Luke Malek
7 Federal policy changes — Congress or CMS alters provider assessment rules or FMAP Low High Monitor federal legislation actively. Build bill with flexibility provisions. Include effective date contingency language. Track CMS rulemaking through AHCA/NCAL federal advocacy. 5.5% rate provides 0.5% buffer below safe harbor. Luke Malek
8 Hostile floor amendments — poison pill amendments during floor debate Medium Medium Identify potential opposition amendments before floor vote. Prepare sponsor talking points for each scenario. If amendment is acceptable, negotiate pre-floor to avoid surprises. If hostile, mobilize bipartisan opposition to amendment. Luke Malek, Lindsay
9 Weak grassroots turnout — insufficient constituent engagement Medium Medium Early activation (Dec) using Dana's kit. Tim coordinates Cascadia facilities for baseline participation. Region Directors (Tiffany, Angie, Isaiah) own their territories. Track participation by facility — follow up with non-responsive. Use family stories — more compelling than industry data. Dana Leavitt, Tim Nelson
10 Implementation delay — rulemaking or SPA process delays July 1 effective date Medium Low Begin DHW engagement early (Sep 2026). Negotiate with DHW on parallel processing of SPA and rulemaking. Bill can authorize temporary rules for July 1 start. Build 90-day contingency buffer into implementation timeline. CMS typically processes SPAs in 90 days. Robert, Luke
Section 9

Success Metrics

Key Performance Indicators (KPIs) for each phase — how to measure progress and identify when corrective action is needed.

Phase 1 — Foundation (Aug–Sep)
Board & Sponsor Secured
  • ☐ IHCA Board endorsement resolution passed unanimously or near-unanimously
  • ☐ Lead bill sponsor confirmed with public commitment
  • ☐ DHW Director meeting completed — no fatal objections raised
  • ☐ Cascadia financial commitment approved
  • ☐ Facility-level financial modeling complete for top 10 facilities
Phase 2 — Build Support (Oct–Nov)
Coalition Breadth & Federal Alignment
  • ☐ ≥ 5 coalition support letters collected (AARP, IHA, IMA target)
  • ☐ ≥ 3 bipartisan co-sponsors committed
  • ☐ CMS Region 10 pre-consultation completed — no disqualifying issues
  • ☐ DFM briefed — fiscal note range communicated
  • ☐ Independent economic study engaged — preliminary results on track
  • ☐ Interim committee presentation received positively
Phase 3 — Pre-Session (Dec)
Session Readiness
  • ☐ Bill draft submitted to LSO
  • ☐ Independent economic study complete and reviewed
  • ☐ UPL analysis complete
  • ☐ Grassroots kit distributed to ≥ 60 of 80+ member facilities
  • ☐ Media kit finalized — op-ed, press release, talking points ready
  • ☐ Governor's office briefed — no opposition signaled
  • ☐ ≥ 8 coalition support letters collected
Phase 4 — Session Opens (Jan)
Bill Filed & Public Launch
  • ☐ Bill formally introduced — bill number assigned
  • ☐ Press release issued — ≥ 3 media outlets cover story
  • ☐ Op-ed published in Idaho Statesman or equivalent
  • ☐ Vote count tracker shows ≥ 40 likely "yes" in House
  • ☐ ≥ 5 testimony witnesses confirmed and prepared
Phase 5 — Committee (Feb)
Committee Advancement
  • ☐ H&W Committee hearing completed — testimony well-received
  • ☐ "Do pass" recommendation achieved
  • ☐ No hostile amendments adopted in committee
  • ☐ Post-hearing media coverage positive
  • ☐ ≥ 100 constituent letters received by legislators
Phase 6 — Floor & Crossover (Feb–Mar)
Legislative Passage
  • ☐ House passes bill with ≥ 40 votes (supermajority preferred)
  • ☐ Senate committee "do pass" recommendation
  • ☐ Senate passes bill with ≥ 20 votes
  • ☐ No poison pill amendments survive
  • ☐ Both chambers pass identical version (or conference committee resolves differences)
Phase 7 — Governor (Mar)
Signature
  • ☐ Governor signs bill into law
  • ☐ Signing ceremony held with industry representatives
  • ☐ Signing press release distributed
Phases 8–9 — Implementation (Apr–Jul)
Operational Launch
  • ☐ SPA submitted to CMS within 60 days of signing
  • ☐ Negotiated rulemaking initiated within 30 days
  • ☐ Rules finalized by June 15
  • ☐ New rates take effect July 1
  • ☐ First enhanced federal draw confirmed within 30 days of effective date
Reference

Contact Directory

Key contacts for campaign execution — internal team and external stakeholders.

IHCA Office

RV
Robert Vande Merwe — Executive Director
IHCA, 13945 W Wainwright Dr, Ste 101, Boise, ID 83713 · (208) 343-9735
LM
Luke Malek, Esq. — Policy Director
IHCA · Also: Smith + Malek PLLC, Coeur d'Alene, ID
LL
Lindsay Likes — Dir. of Gov't Affairs
IHCA · (208) 343-9735
DL
Dana Leavitt — Dir. of Member Services
IHCA · (208) 343-9735

Cascadia Healthcare

OH
Owen Hammond — CEO
Cascadia Healthcare, Boise, ID
S
Steve — CFO
Cascadia Healthcare, Boise, ID
TN
Tim Nelson — COO
Cascadia Healthcare, Boise, ID
BJ
Breanna Jamison — President, Three Rivers
Three Rivers (7 facilities) · IHCA Board Treasurer
JM
Jordan Monson — President, Northern
Northern (12 facilities MT/ID/WA) · IHCA Board MI/DD Rep
CG
Chase Gunderson — EVP Operations
Cascadia Healthcare, Boise, ID

IHCA Board of Directors

RS
Riley Sessions — President
Parke View Rehab
LT
Landon Taylor — President-Elect
TanaBell Health Services
MR
Mike Robbins — Secretary
The Gables
BB
Brian Bagley — Past President
Lakeside Assisted Living
GW
Gary Weaver — AL Rep
Edgewood Spring Creek Overland
JA
Jamie Anthony — ICF Rep
Developmental Options
GC
Graham Christensen — MI/DD Rep
Harmony House
JS
Justin Stenquist — HH/H/HC Rep
Home Health / Hospice / Home Care

Region Directors

TP
Tiffany Pettit — Regions 1 & 2
Orchard Ridge · Northern Idaho
AH
Angie Hillishiem — Regions 3 & 4
All Care Health Solutions · Treasure Valley
IH
Isaiah Hawkins — Regions 5, 6 & 7
Bennett Hills Rehab · Eastern/Southern Idaho

State of Idaho — Government Contacts

GOV
Governor Brad Little
Idaho State Capitol, 700 W Jefferson St, Boise, ID 83702 · (208) 334-2100
DHW
Idaho DHW — Office of the Director
450 W State St, 10th Floor, Boise, ID 83702 · (208) 334-5500
MCD
Idaho DHW — Division of Medicaid
450 W State St, Boise, ID 83702
DFM
Division of Financial Management
304 N 8th St, Suite 139, Boise, ID 83702 · (208) 334-3900
LSO
Legislative Services Office
472 W Washington, Boise, ID 83702 · (208) 334-2475
AG
Idaho Attorney General
700 W Jefferson St, Suite 210, Boise, ID 83720 · (208) 334-2400

Federal

CMS
CMS Region 10
701 5th Avenue, Suite 1600, Seattle, WA 98104

Coalition Partners

AA
AARP Idaho
3655 W Overland Rd, Boise, ID 83705
IHA
Idaho Hospital Association
802 W Bannock St #500, Boise, ID 83702

Materials & Resources

Research Hub: All supporting materials — panel study, fiscal analysis, bill draft, state comparison data, and executive briefs — are available at medicaid-panel-study.vercel.app
Idaho Health Care Association
13945 W. Wainwright Drive, Suite 101 · Boise, ID 83713 · (208) 343-9735

CONFIDENTIAL — This document contains strategic planning information intended for authorized IHCA and Cascadia Healthcare personnel only.
Version 1.0 · August 2026 · Prepared by IHCA Strategic Planning