A 30-year-old case challenging how severely emotionally and mentally disabled children are treated in Idaho is heading back to a federal courtroom. A ruling handed down this morning from the 9th U.S. Circuit Court of Appeals determined that "clear and convincing" evidence had not been sufficiently determined through a series of "action items" to provide a proper standard of care.

The case, which dates back to August 1980, was filed on behalf of an anonymous child, known only as Jeff D., and all indigent Idaho children suffering from severe emotional and mental disabilities. The lawsuit against then-Gov. Dirk Kempthorne and other state officials, alleged that inadequate care was a violation of the children's constitutional rights.

In the ensuing years, the parties reached agreements intended to remedy deficiencies in care. A major overhaul of Idaho Health and Welfare divisions resulted in more than 250 action items to provide adequate care for mentally disabled children. Three separate consent agreements were entered by the district court, and no less than four appeals were subsequently filed. The district court vacated the consent decrees in 2007.

But now, Jeff D. v. Clement Leroy Otter (in his official capacity as governor) is heading back to U.S. District Court because the state did not provide a standard for determining compliance to the original action plan.

You can read the full ruling here.

It's been nothing less than a heartbreaking afternoon inside the Capitol Auditorium of the Idaho Statehouse. That's where the joint committees of Health and Welfare from both the House and Senate have begun to consider House Bill 221.

More than 100 people have signed up to testify, and with scant exceptions, most witnesses are pleading with lawmakers not to advance the measure. The most controversial element of the plan is a proposal to move Idaho adults 45 and older into a category where they could lose active treatment and/or developmental therapy.

Many of those testifying have fought tears while speaking. Here's a sample:

Crystal Anderson (parent of adult male with extreme mental and physical disabilities): "My child's future is now in jeopardy. He can't function without extra help. I'm pleading with you to represent me."

Taryn Ivey (parent of adult female with pervasive developmental delay, which is a form of autism): "I'm scared to death what might happen to her. I realize that we have to have a balanced budget but I'm begging you to look at who this might affect."

Angie Martinez (niece of 63-year-old adult woman who is mentally retarded): "We never asked for help until her health had dramatically declined. But now, my husband has left his job to become her provider. But because she's 63, she would be cut off. Do we want to be known as a state that discriminates against developmentally disabled over 45?"

While the U.S. Constitution stipulates that Native American tribes be recognized as sovereign entities, Idaho House Speaker Lawerence Denney wants to require tribes to charge sales tax to any non-tribe member buying cigarettes.

Denney's measure was introduced today, the latest in a series of moves that could see Idaho sales tax on a pack of cigarettes jump from .57 to $1.25. The Idaho Council on Indian Affairs took up the issue this morning in a special meeting at the state Capitol. But tribes have asked for additional time to consider the proposal, asking for it to be tabled until March 7.

Advocates for a higher cigarette tax, including the Idaho Oral Health Alliance, are sponsoring a legislative summit Thursday at Boise's Grove Hotel. Among the speakers, Republican Rep. Dennis Lake, chairman of the House Revenue and Taxation Committee.

Idaho lawmakers said today that they want a formal audit of Molina Medicaid Solutions. Molina has been at the center of a firestorm surrounding Idaho Health and Welfare's medicaid receivable and billable system.

Beginning in July 2010, thousands of health-care providers were not reimbursed in a timely fashion. Molina reported that the medicaid backlog topped 155,000 claims last summer down to approximately 33,000 in January 2011.

The Joint Legislative Oversight Committee voted unanimously to conduct a performance evaluation of Molina. Rep. Janice McGeachin said she wants the audit done before the Legislature adjourns.

Two of this summer’s hot news stories make their way to the front burner again on today.

Governor C.L. “Butch” Otter pulls Health and Welfare Director Dick Armstrong, and the owner of Molina Healthcare Systems before the microphones later this morning to talk about Idaho’s medicaid mess.

BW readers know that since Molina Healthcare began servicing Idaho’s Medicaid billing system, a myriad of problems have surfaced: providers not being paid, lack of financial reconciliation and patient billing information being sent to the wrong caregivers. The controversy gained steam through much of July and August and today (Monday), the three men in the center of the firestorm say they'll address the issues.

In Lewiston, a court hearing is slated to consider ConocoPhilips' request to ship four massive loads of refinery equipment across US Highway 12. Conoco has officially requested transport permits from the Idaho Transportation Department, which means that if Second District Judge John Bradbury clears the way today, the loads could roll this week.

Bradbury temporarily blocked the shipments last week in response to a suit filed by three central Idaho businessmen who say the loads could threaten public safety, hurt tourism and risk a protected river corridor.

Molina, the third party administrator contracted to manage Idaho's Medicaid billing and reimbursement systems, will pay for mistakes that have resulted in thousands of caregivers not being paid in a timely fashion.

In BW's reporting we've told you how Molina won the bid to manage Health and Welfare's massive billing and disbursement operations. Since early July—when Molina officially took over the process—doctors, therapists, nursing homes and thousands of providers have been paid very little of amounts due, and in some cases, not at all. In addition, BW has also reported missing or insufficient reconciliation of disbursements, leading to bookkeeping nightmares across the state. And in some instances, patient billing information was mailed to the wrong providers.

On Aug. .4, a regional Health and Welfare representative said the department's contract with California-based Molina stipulates that if it does not perform as expected, Molina can be penalized, either by withholding funds or a fine.

"We are planning on penalizing them," said Ron Beecher, Health and Welfare administrator.

On Friday, Aug. 6, Molina officials are expected to be in Boise for an in-person meeting with Health and Welfare officials to discuss the situation. Additionally, Health and Welfare is planning on building a new webpage to help Medicaid providers track progress. The site is expected to be up by next week.

The company in the center of the hurricane that is Idaho's Medicaid mess is reporting a tidy profit in its latest financials released late Wednesday.

Molina disclosed quarterly premium revenue of $977 million, up 6 percent over 2009. Specifically, Molina's Medicaid solutions division contributed $5 million to the company's overall operating income, resulting in an operating profit margin of approximately 24 percent.

Shares of the company closed at $31.71 Wednesday on the New York Stock Exchange.

Like many Western and rural states, suicide statistics coming out of Idaho are anything but optimistic. According to the Idaho Department of Health and Welfare, suicides increased by 22 percent between 2008 and 2009, from 251 to 307. Idaho’s rate of suicide by firearm is higher than the national average and calls to the national suicide prevention hotline are also on the rise. Rural areas are at the highest risk for suicide; Lemhi County had the highest rate, followed by Caribou, Minidoka, Custer and Valley Counties.

Idaho lost its suicide prevention hotline in 2007. Community members and health professionals who want to learn more about reducing Idaho’s suicide rate can register to attend the Idaho Suicide Prevention Network’s 10th annual suicide prevention conference Sept. 8-10.

On Sept. 8, Idaho State University’s Institute of Rural Health is hosting a free preconference session titled, “It Can be Done: Moving from Awareness to Action in Suicide Prevention.” During the session led by Director of Public Policy for Mental Health America of Wisconsin Shel Gross, attendees who have ideas for suicide prevention programs will learn how to make their ideas a reality.

The conference's keynote speaker is Florida State University psychology professor and author Dr. Thomas Joiner. The featured speaker is Ellis Amdur. Amdur will speak on emergency responses to parasuicide and people with borderline personality disorder. Other featured speakers include Mayor Dave Bieter; Idaho Council on Suicide Prevention chairperson Kathie Garrett; BSU Dean of Social Sciences and Public Affairs Melissa Lavitt; and State Department of Education Superintendent Tom Luna.

The conference, which costs between $80 and $100 to attend, will be held at the Boise First Community Center. To register and see the full schedule, visit the Idaho Suicide Prevention Network's website.

It's formally known as pertussis. Idaho's top epidemiologist warns that in the first six months of 2010, 77 cases of whooping cough have been diagnosed in the Gem State, compared to 45 for the same period last year.

Dr. Christine Hahn said there's great reason for concern and is urging families to keep their vaccinations up to date. "We know that in many cases, it's the mom, dad, grandparent, or sibling that infects the babies that end up getting so sick," she said.

According to Idaho's Department of Health and Welfare, about one in 20 infants with pertussis get pneumonia. About one in 100 infants will have convulsions. A current pertussis epidemic in California has caused six infant deaths in that state.

The Joint Finance-Appropriations Committee (JFAC) heard a presentation today from Michelle Britton, Administrator of the Family and Community Services department of Idaho Health and Welfare.

Her presentation and handouts outlined the areas her department focuses on, namely foster care for children and state sponsored public adoption.

She presented multiple data sheets showing the effects of budget reductions at Health and Welfare. Britton attempted to expound the effects of the growing costs of doing business with FY ’09 expenses at $2.4 million for all funds and at $3.7 million in FY ’10.

The committee was less interested in the effectiveness of her organization and more concerned with the amount of money the state gives families who adopt children from Idaho State agencies. Rep. George Eskridge of Dover asked if the handouts encourage families to adopt many children in order to make money.

Britton explained the funds given to adoptive families are roughly $300 per month, saying the practice was unlikely, considering the fees involved with adoption. She attempted to reaffirm that cutting from Health and Welfare now will cost more money in the future.

“When we hit hard times financially, we dig a hole that’s expensive to get out of,” said Britton.

Britton said that foster care entry numbers have shrunk from 1,577 in 2007 to 1,279 in 2009. She attributes this decline to the success of Idaho’s Meth Project, which helps keep children out of the Health and Welfare system.