Medicaid Letter
Community-Based Medicaid Therapy Cap & Medicaid Funding for School-Based Services
Dear Parents and Guardians,
You are receiving this letter to share important information about a recent announcement from the Idaho Department of Health & Welfare dated January 8, 2026, regarding a new limit on certain Medicaid therapy services provided in community settings. We want to clearly explain what this change means—and just as importantly, what it does not mean for your child. While this update affects some community-based therapy services, it does not change the school-based services your child receives through their Individualized Education Program (IEP). Bonneville School District remains committed to providing all required school-based supports and services necessary for your child to benefit from their education.
Below are frequently asked questions and the answers to help families better understand what these changes mean and what to expect.
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The Idaho Department of Health & Welfare announced a limit on certain community-based Medicaid therapy services.
“Effective for claims with dates of service on and after January 1, 2026, each therapy discipline will be capped at twenty (20) visits per calendar year. This includes occupational therapy, physical therapy and speech-language pathology services. Additional visits can be requested by prior authorization from the Medical Care Unit. All services must be medically necessary. Requests for prior authorization must adequately document the medical necessity for the services provided and requested.”
“Services provided by home health agencies, the Infant Toddler Program, and school-based providers are not subject to these limitations.”
Starting January 1, 2026:
- Each therapy type is limited to 20 visits per calendar year
- This includes:
- Occupational Therapy (OT)
- Physical Therapy (PT)
- Speech-Language Pathology (SLP)
More visits may be approved if the provider requests prior authorization and shows the services are medically necessary. -
No. This cap does not apply to services provided:
- Through your child’s IEP
- By school-based providers
- By home health agencies
- Through the Idaho Infant Toddler Program
Your child’s school services will continue as written in the IEP. -
School-based Medicaid services are designed to provide healthcare within schools or school-like settings. These services help students benefit from their education and are reimbursed by Medicaid when families give consent. School-based services DO NOT affect the families/child’s community benefits or allocation.
Community-based services are provided outside of school, such as in clinics, therapy offices, or private practices. These services are broader and fall under the new 20-visit therapy cap.
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In Idaho, school-based Medicaid services are governed by the Individuals with Disabilities Education Act (IDEA).
Under IDEA:
- Schools must provide health-related services only when they are needed for a student to benefit from their education.
- Services must support a student’s Free Appropriate Public Education (FAPE)
- Services are not optional and are not based on reimbursement
- Decisions are made by the IEP team
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Possibly — Bonneville School District has been in contact with various community-based providers to better understand how this cap may affect students. In some cases, an IEP team meeting may be needed to review whether school supports should be adjusted.
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No. This is your choice.
- You must give written consent
- You can withdraw consent at any time
- Your child will still receive all required services at no cost to you
Schools may not:- Require Medicaid enrollment
- Charge co-pays or deductibles
- Reduce family benefits
- Affect eligibility for other services
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Bonneville School District #93
Special Services Department – Medicaid Services
3549 N. Ammon Road
Idaho Falls, ID 83401
(208) 557-6893
TamayoA@d93.k12.id.us
Idaho State Department of Education
Special Education Department
650 West State Street
Boise, ID 83702
Toll-Free: (800) 432-4601