Serious and Persistent Mental Illness Program Cuts

Idaho is preparing to eliminate or defund the core high-acuity behavioral health programs that stabilize individuals with Serious and Persistent Mental Illness (SPMI)—ACT, HART, Peer Support, ESMI/CSC, half-day PHP—and to weaken IOP by reducing reimbursement. These programs serve mutually exclusive populations, each representing a distinct and non-overlapping tier of psychiatric risk. Decades of research show that these cohorts deteriorate rapidly in the absence of the intensive, bundled, team-based models that these programs require [1–31]. 

Idaho proposes replacing these evidence-based models with standard outpatient codes (therapy, case management, CBRS, crisis, medication visits) that cannot fund the high-frequency, multidisciplinary, in-community or in-facility interventions required for ACT, HART, or CSC fidelity [1–12,13–17,24–31]. This change is not a “reimbursement shift”—it is the functional elimination of every intensive psychiatric program in the state. 

Read more about this issue in this white paper.