How to save money in Idaho's ballooning Medicaid program? State Health & Welfare Director Dick Armstrong said, "We already have one of the most restrictive Medicaid programs in the nation as far as eligibility. Further tightening would not help us much, even if we could." Plus, he said, "Today our reimbursement rates in most areas are dangerously low. If we further erode reimbursement rates, providers will stop seeing Medicaid patients." The only remaining option, he said, is to cut services, and focus only on "services that literally are a matter of life and death."

Disabled people may have to turn to family, friends, churches or others for services that now come from the state, Armstrong said, citing Gov. Butch Otter's comments in his State of the State address. Armstrong said he'll "work to preserve the most critical and core services." But he said the state must turn back to volunteers, as it did decades ago.