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Jesse Turnipseed shouldn’t have died in the “trash-choked closet” of a bug-infested apartment, but he did.
He is among the preventable casualties that stacked up almost immediately following the December elimination of Idaho’s assertive community treatment – or ACT – a Medicaid-funded program that provided intensive, in-home mental health care to the state’s most severely ill residents.
Sometimes dubbed “a hospital without walls,” according to the New York Times, the program sent teams of clinicians into patient’s homes to closely monitor their health, ensure they took their medications to remain stable, and build trust through sustained relationships to keep people with serious mental illness alive and out of crisis.
Established in the 1970s, ACT has been shown to reduce emergency hospitalizations by 40% to 80% and costs the state roughly $4 million a year.
But a string of income tax cuts stretching from 2021 to 2025 eliminated $4 billion in Idaho’s revenue, with the state projected to lose an additional $1.3 billion annually going forward — a figure equivalent to 24% of the state’s general fund.
Congressional passage of Trump’s “Big Beautiful Bill” in July 2025 has further compounded fiscal strain, reducing federal spending by $1 trillion over the next decade, including $665 billion in funding to states for Medicaid.
With a state Constitution prohibiting deficit spending, the double whammy of major cuts pushed Idaho Gov. Brad Little to issue an executive order last August, compelling each state agency to reduce spending by 3%, in preparation for the federal cuts.
Under the pressure of the time crunch, Idaho’s Medicaid contractor, Magellan, chose to eliminate ACT. The consequences were swift and devastating.
“We have had four deaths that you can pinpoint directly back to these programs that were done away with,” said Sen. Kevin Cook, a Republican from Idaho Falls, with one sheriff reporting that involuntary psychiatric commitments more than doubled in his county, as crisis centers saw a 28 percent spike in demand. “Our sheriffs, our ERs and our courts are dealing with the same individuals over and over again,” Cook added.
The fallout alarmed Idaho legislators enough to act. In an unexpected reversal, Republican lawmakers — not Democrats — led the charge to restore funding, citing both the human toll and a financial argument that proved hard to ignore: cutting mental health services doesn’t eliminate costs; it transfers them. The state ultimately allocated $10.4 million from opioid and tobacco settlement funds to resume the program.
But though funding for ACT has been restored, no easy reversal of circumstances is on the horizon. Clinicians actually report an uphill battle to resume operations after just four months of pause. Staff shifted or left when the program was defunded, and patients scattered, losing touch.
Those still on the job, like nurse practitioner Meredith Sievers, worry about how to rebuild trust in the system that abandoned them. “Why would they believe you?” she said.