Senate committee approves new mid-level dental provider category for reservation clinics

By Melissa Davlin, Idaho Reports

On Wednesday, the Senate Health and Welfare Committee passed legislation from the Coeur d’Alene Tribe that seeks to address gaps in dental care for American Indian tribal members, despite opposition from some dental professionals.

The bill would legalize a new type of mid-level dental provider in Idaho. Dental health aide therapists, or DHATs, are trained in a limited number of procedures like fillings and extractions.

The legislation now goes to the Senate for a vote.

Gaps in care

Nationwide, American Indian and Alaska Native children experience four times the amount of untreated dental disease compared to white children, with nearly half of American Indian five-year-olds experiencing tooth decay, according to a 2015 Indian Health Services policy brief.

American Indian adults also experience the highest rates of dental disease among any demographic, with two-thirds of adults between the ages of 34 and 49s experiencing decay and other ailments.

There are multiple reasons for that. Though 90 percent of Idahoans live within a 15-minute drive of a dentist, many of those dentists don’t accept Medicaid. In short, it doesn’t matter if you live by a dentist if that dentist won’t see you.

Generational trauma and cultural sensitivity play into the lack of care as well.

Matthew Stensgar, chairman of the Coeur d’Alene Tribe’s Marimn Health Board of Directors, told Idaho Reports in January about the terror he felt as a child when visiting the dentist.

In the past, dental providers from outside the Coeur d’Alene Reservation would treat children in mobile clinics, with the line snaking out the door, Stensgar said. Because those dentists had to treat everyone at once, they hurried patients through, sometimes drilling or pulling teeth before painkilling shots had taken effect.

“They didn’t really care about if we were in pain while we were receiving our dental care,” he said. “A lot of times the numbing shots didn’t take effect, and you could really feel them drilling.”

Dental procedures have changed, but Stensgar is still afraid of going to the dentist.

Having tribal members train to be DHATs could relieve those concerns among his fellow community members, Stensgar said.

The United States DHAT program started in Alaska to address far-flung native communities with no dental care. In other states that have adopted the program, DHATs are trained in a limited number of procedures that they can perform, unlike dental hygienists, who are limited to cleaning and preventative treatments. Dentists learn how to do about 500 procedures in four years of dental school, while DHATs learn 46 over the course of two years, plus 500 hours of supervised training after graduation.

Unlike dentists, who are required to have a four-year degree before applying for dental school, or dental hygienists, who require an associate’s degree, students can apply for the DHAT program right out of high school.

An uneasy compromise

The Idaho State Dental Association opposed a previous proposal from the tribe, citing patient safety concerns. In short, DHATs receive fewer hours of training than a dental hygienist, but have the ability to do more procedures without the direct supervision of an on-site dentist.

But in recent weeks, the ISDA worked out a compromise with the Coeur d’Alene Tribe, and is now neutral on the legislation.

“As in any good compromise, no one got everything they wanted,” said Coeur d’Alene Tribe legislative director Tyrel Stevenson.

Under the new proposal, DHATs are limited to working on federally qualified health clinics on reservations, and can do limited preventative care in facilities that are adjacent to reservations. Additionally, dentists may supervise only three DHATs at a time.

Though both the ISDA and the State Board of Dentistry are neutral on the legislation, the Idaho Dental Hygienists Association voiced its opposition, as did individual dentists who broke with the ISDA.

Ultimately, the Senate committee voted in favor of sending the bill to the Senate floor.

“I think it’s fitting to point out that not one of us (on the committee) will be affected by this bill, and that’s because we don’t live on a reservation,” said Sen. Lee Heider, R-Twin Falls. “We’re not privy to the care, or the lack thereof, that reservations receive.”

 

Watch our January 29 story on the DHAT proposal and dental care on tribal reservations at this link.

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Idaho GOP chairman Parker resigns

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Jonathan Parker. Source: idgop.org

By Seth Ogilvie, Idaho Reports

Idaho Republican Party Chairman Jonathan Parker is stepping down.

Frank Terraferma, executive director of the party, confirmed Parker’s resignation to Idaho Reports on Monday.

“Jonathan notified the state central committee that he was stepping down,” said Terraferma.

According to the GOP State Rules, current First Vice-Chairwoman Jennifer Locke now assumes all duties and responsibilities of chairman until the next GOP state meeting.

Locke was a Trump elector at the 2016 convention. She currently works as a Deputy County Clerk in Kootenai County.

According to the Coeur d’Alene Press, Locke has a bachelor’s degree in economics from the University of Southern Maine and has lived in north Idaho for almost a decade.

Locke did not respond to requests for comment immediately.

In a statement sent out Tuesday morning, Parker cited family as his reason for stepping down.

“(M)aintaining a full-time job and being a fully engaged Father has been harder than I imagined, so much so that I have reluctantly decided that I should no longer continue to serve as Chairman of the Idaho Republican Party so that I can focus on the priorities I place above all others,” Parker wrote.

According to the party rules, the Idaho Republican Party will likely vote on a new Chairman at the party’s June summer meeting.

 

 

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Less than a week left for Medicaid expansion

By Seth Ogilvie, Idaho Reports

Idaho has five days to submit its plan on Medicaid expansion to the federal government. Monday, February 18th is 90 days after Proposition 2 was certified, and the clock started ticking.

“Work is in progress and continuing,” said Niki Forbing-Orr, Public Information Manager for the Idaho Department of Health and Welfare. “It may change between now and when it is submitted.”

Looming in the background of this due date is another possible government shutdown and an Idaho bill that would put time restrictions on Medicaid eligibility for people in the gap population as well as an optional training element.

Draft Eligibility_Page_1IDHW doesn’t believe the government shutdown will impact their deadline. “The shutdown does not impact HHS,” said Forbing-Orr. “We will submit prior to the 90 day requirement in Idaho code.”

Adding a training element or a time restriction, however, could be more complicated. Health and Welfare may need to apply for an additional waiver from the federal government. “It would depend on the specific legislation,” said Forbing-Orr.

That could add uncertainty into the system. Over the next week, Idaho will submit a plan to the federal government that, in its current draft, looks like a “clean” Medicaid expansion with no sideboards. That plan will take effect on Jan 1, 2020, if approved by the federal government. That plan would then be the policy “unless the legislature modifies this section of Idaho Code,” said Forbing-Orr.DRAFT_Page_1

The current bill, proposed Sen. Mary Souza, would change Idaho code, but it doesn’t change the deadline, and that bill will likely not be signed by the governor before next Monday.

That could put Health and Welfare in an awkward position. If Souza’s bill, or something like it, passes after the department submits its plan, the department would likely have to ask for a waiver if its current plan is approved. It’s also possible the department will have to resubmit its plan entirely to comply with the new section of Idaho Code.

That theoretically could leave the state of Idaho with an approved Medicaid expansion plan that does not comply with Idaho code, if a federal waiver is not granted for new legislation passed after the department submits a clean program. In other words, it could be a mess.

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Medicaid bill would void expansion if feds change funding structure

By Melissa Davlin, Idaho Reports

The next round in the fight surrounding Medicaid expansion has begun.

On Monday, Sen. Mary Souza introduced legislation that would void expansion if the federal government changes its 90/10 cost-sharing formula and establish a voluntary workforce training requirement program. Read the bill here.

The proposal would also direct the department to provide subsidies for insurance plans through the insurance exchange for those in the gap who are above 100 percent of the federal poverty line instead of enrolling them in Medicaid. That part of the proposal would require a waiver from the federal government.

Another section instructs the Idaho Department of Health and Welfare to seek waivers to use Medicaid funds for substance abuse and mental health care. The idea behind this, Souza said, was to help lessen the impact for counties who may receive less financial help for these services through catastrophic health care and indigent funds.

I believe these are not restrictions on Medicaid expansion,” Souza said. “These are protections and enhancements.”

Ultimately, the Senate Health and Welfare Committee was split 5-4 on whether to allow a hearing on the proposal, with Senators Fred Martin, Lee Heider, David Nelson, and Maryanne Jordan voting no.

My preference has always been simply to fund it,” Martin said.

 

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Former director of Idaho’s teachers union accuses the president of sexual harassment

By Seth Ogilvie, Idaho Reports

In October, Sue Wigdorski left her position as the executive director of the Idaho Education Association without much explanation. But in January 2018, she penned a letter to the IEA board that accused Kari Overall, now the IEA president, of sexual harassment against the teacher union’s employees.  She also implied her departure was partially due to her working rapport with Overall.

“There was a formal sexual harassment complaint lodged against your IEA president,”  wrote Wigdorski in her Jan. 25 letter to the board. “Senior staff were made aware of this complaint, communicated their concerns to me, and requested that there be a formal investigation.”

IEA on Tuesday told Idaho reports in a prepared statement that “The letter written and improperly distributed by a former Idaho Education Association employee contains false information and inaccurate, unsubstantiated claims.”

According to the letter, Overall was ordered through a settlement to change her behavior. “There was a written settlement agreement reached with the employee,” Wigdorski wrote. “The agreement specified that your IEN president would need to agree to modify her behavior in several ways… She also agreed to attend sexual harassment training.”

Wigdorski claimed the alleged inappropriate actions were not an isolated incident. “Your president began to behave in similar inappropriate ways with other staff from both the IEA and the state Department, ” Wigdorski wrote. “This behavior was the source of conversation with stakeholders and was a source of embarrassment, stress and constant vigilance by me.”

In their statement to Idaho Reports, the IEA did not rule anything out in response to the Wigdorski. “The IEA will pursue all avenues necessary to protect the integrity of the association and its president.”

Wigdorski closed the letter implying her continued employment at the IEA was put in jeopardy by her relationship with Overall.

“(Overall) informed me that she was not inclined to recommend me for another contract because ‘I did not respect her enough,'” Wigdorski wrote.

“I apologize once again for not keeping the IEA Board informed about the behaviors of their leader,” Wigdorski added. “I did not understand what it would cost us all.”

The IEA told Idaho Reports in their statement they will not be distracted by this letter. “The IEA remains committed to advocating for our members and our students and will not be distracted by these false claims from a former employee.”

Idaho Reports reached out to Wigdorski for comment on her letter. “I do not have a statement at this time,” said Wigdorski.

 

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Idaho Supreme Court upholds Medicaid expansion

By Melissa Davlin, Idaho Reports

Updated 5:48 pm Feb. 5

The Idaho Supreme Court upheld Medicaid expansion in an opinion released Tuesday.

The opinion states Medicaid expansion does not delegate lawmaking authority to the federal government, as plaintiff Brent Regan argued in his November lawsuit.

Read the opinion, written by Chief Justice Roger Burdick, at this link.

Here are my initial takeaways:

-Justices didn’t buy the argument that the state is delegating its lawmaking authority to the federal government. “Idaho’s ongoing participation in Medicaid, even prior to expansion, requires a yearly appropriation of funds from the legislature,” the opinion says. Through that annual appropriation, the Idaho legislature will control the ongoing nature of Medicaid.  “Additionally, as the United States Supreme Court has said, ‘[t]hough Congress’ power to legislate under the spending power is broad, it does not include surprising participating States with post-acceptance or ‘retroactive’ conditions.’“

In other words, Congress can’t suddenly withdraw the 90/10 match for Medicaid funding. If that change happens, states will get plenty of notice.

-Almost everyone wanted a say. It’s normal to have a unanimous opinion; It’s also normal to have a dissenting opinion. This ruling has the majority opinion written by Chief Justice Roger Burdick, a concurring opinion by Justice John Stegner, an opinion that concurs in part and dissents in part by Justice Robyn Brody, and another concurring-dissenting opinion by Justice Greg Moeller. The only justice who didn’t weigh in was Justice Richard Bevan, who, incidentally, was also the only justice who didn’t ask questions during last week’s oral arguments.

Remember, too, how new this court is. Of the five justices, only Burdick has been there longer than two years; Three have been there less than a year. We may be getting a peek at how this dynamic is going to shake out.

-The dissents don’t agree with Regan; If anything, some of the arguments are more strongly worded. Both Moeller and Brody both say they would have rather the Supreme Court not heard Regan’s lawsuit, with Brody saying she would have sent the case to a lower court, and Moeller saying he would have dismissed it outright on its procedural weaknesses.

In his dissent, Moeller says Regan’s petition “suffers from serious justiciability defects,” going on to argue Regan is asking the court to weigh in on political and philosophical arguments instead of constitutional ones.

“This became readily apparent at oral argument, when counsel for Regan, in urging the Court to strike down the new law, argued that what the Supreme Court is really being asked to do is to decide whether this state will “act or be acted upon” when it comes to its relationship with the federal government,” Moeller writes. “Counsel (Bryan Smith) began his presentation with this phrase, and later repeated it when asked by the Chief Justice whether the state could simply “opt out” of Medicaid expansion if the federal government changed the current standards. Such arguments are largely ideological and dogmatic in nature—not legal—and demonstrate that the intent behind the petition is to have this Court redefine the proper role of federalism in Idaho. In sum, this Court is not really being asked to address an urgent constitutional issue created by the passage of section 56-267; rather, Regan is asking this Court to take sides in an ideological debate concerning political philosophy. “

-The court does cite a section of code as unconstitutional — just not the one Regan had been hoping for. Regan argued he had standing to sue as a “qualified elector” under Idaho Code section 34-1809(4). That statute “attempts to broaden this Court’s jurisdiction,” Burdick writes, creating a separation of powers issue.

Boy, that was fast. I was under the impression the Supreme Court wasn’t bound by any timeline regarding this decision, even if the Idaho Department of Health and Welfare had to meet a deadline for submitting Medicaid plan amendments and the Legislature had to fund it. We discussed this on last week’s Idaho Reports with Idaho Supreme Court Administrative Director Sara Thomas.

Still, the justices cited the deadlines and 2019 legislative session as a reason to take up the case, and rule quickly: “(W)e recognize the need for a determination of the constitutionality of section 56-267 during the 2019 legislative session given the fast-approaching 90-day window for the Department to submit any necessary plan amendments, and the Legislature’s need to consider funding for Medicaid expansion. Accordingly, due to the urgency of the alleged constitutional violation and the urgent need for an immediate determination, we will exercise our original jurisdiction over Regan’s petition.”

Well, I’ve been wrong before.

 

I’m still awaiting comment from the Idaho Freedom Foundation. In the meantime, here are reactions from other stakeholders. I’ll continue to update as I receive comment:

Rep. Fred Wood, chairman of the House Health and Welfare Committee: “I’m not an attorney, but I think it’s a good decision.” As to whether this would speed up some of the discussions surrounding Medicaid funding, he said he didn’t think the pending court decision had slowed down the Legislature.

Luke Mayville, Co-Founder of Reclaim Idaho: “I am ecstatic…. We know it was upheld in the court of public opinion by the voters, but it’s an extra boost for the cause of securing health care for 62,000 Idahoans by having the court uphold it as well.”

“With the court having ruled, there is no longer any excuse for inaction on the part of the Legislature. Their job is clear to fund Medicaid expansion and to allow it to be implemented without restrictions.”

Mayville also noted it was a “special joy” to see the ruling the day after the Medicaid expansion advocacy day at the statehouse, at which advocates met with lawmakers to encourage them to expand Medicaid without sideboards like work requirements. “It’s a special prize for them, for all the advocates who worked for this, to now have this sense of relief that knowing the constitutionality of Medicaid expansion is secure.”

 

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Idaho is one of seven states without a maternal death review panel. This proposal would change that.

Updated Feb. 8, 8:10 am

By Melissa Davlin, Idaho Reports

A proposal by the Idaho Medical Association would establish a review panel to track maternal deaths in Idaho.

Idaho’s maternal death rate of 27.1 deaths per 100,000 births is higher than the United States rate of 26.4, said Susie Pouliot, CEO of the Idaho Medical Association. That US rate is also more than twice as high as most European countries.

According to the Centers for Disease Control and Prevention, Idaho is one of seven states without a maternal mortality review panel, and, as of December, was one of just two states without a plan to implement one.

A 2008 legislative effort to establish one didn’t go anywhere, though Idaho does track maternal deaths.

Currently, Idaho death certificates have a checkbox to indicate the pregnancy status of women who have died between the ages of 10 to 54 years, said Niki Forbing-Orr, spokeswoman of Idaho Health and Welfare, in a December e-mail to Idaho Reports.

The checkboxes are: Not pregnant within the past year; pregnant at the time of death; not pregnant, but pregnant within 42 days of death; and not pregnant, but pregnant 43 days to 1 year before death.

The death certificate doesn’t always indicate at what point during the pregnancy the woman’s death occurred.

According to IDHW, between 2008 and 2017, there were 121 deaths to Idaho women who were reported as either pregnant or pregnant within one year before death. Of those, 70 were determined to be pregnancy-related, 34 were from accidents, 7 were from suicide, 7 were from homicide, 1 was undetermined, and 2 were from all other causes. Of the 34 accidental deaths, 10 were from drug overdoses.

There were also racial disparities, with American Indian women experiencing the highest maternal death rates in that time period.

pregnancydeathratesrace

Source: Idaho Department of Health and Welfare

Though IDHW tracks maternal deaths, no entity exists to make recommendations to improve Idaho’s maternal death rate.

The proposed panel would be funded by a four-year grant from the Centers for Disease Control and Prevention, Pouliot said, and would include physicians, a coroner, a labor and delivery nurse, and others. The panel would have the ability to look into deaths with records and make recommendations regarding medical care, but would not have disciplinary powers.

The House Health and Welfare voted to print the bill on Thursday.

Chairman Fred Wood, R-Burley, supported the panel during a Monday meeting. “(The death rates are) an embarrassment, and we need to find out why,” he said.

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