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Reconsidering Medicaid

Krystal wants to be "civilized" Idahoan. When her PSR counseling was cut, she lost her job.


Krystal Esterline wants to be, in her words, "a civilized Idahoan." Esterline, soon to turn 23, wants to live independently. She wants to work. She wants to be able to buy things like clothes and food. And she even wants to pay taxes.

When the 2011 Idaho Legislature cut $35 million from the Medicaid budget, resulting in the loss of almost double that amount when matching federal funds evaporated, Esterline said she was given a choice: either lose her primary therapy or lose her psychosocial rehabilitation services. By eliminating her PSR counseling, Esterline was not afforded the skills she required to keep her catering job.

Esterline has a diagnosis of fetal alcohol syndrome, struggles with bipolar disorder and an intellectual disability. At the age of 12, one year before her mother died, Esterline was placed into foster care and for the next six years was pulled in and out of 18 foster homes across Idaho.

She endured, due in large part to her adult guardian, Nikki Tangen, who stepped in when Esterline was dropped from foster care on her 18th birthday. Esterline earned a high school diploma and began building a new life, living in her own apartment and holding down a job. But, she said, that help included daily therapy and PSR counseling.

"I really like to earn my own money," said Esterline. "It makes me feel like I have some control in my life."

However unless the 2012 Idaho Legislature reconsiders a choice it made a year ago to cut Medicaid funding, Esterline may not have access to PSR again soon.

Tangen said when PSR counseling evaporated, Esterline "began to let people into her home, gave her keys out to strangers, and the police had to get involved."

When Esterline spoke with BW of better days, her smile was ear-to-ear. In the cruelest bit of irony, it hurts when she smiles, with pain coming from tooth decay and gum disease, a manifestation of her fetal alcohol syndrome. But she can't get that taken care of, Tangen said, because Esterline's Medicaid-funded dental care was cut, along with her PSR hours.

That is, unless the 2012 Legislature, in the coming weeks, reconsiders its 2011 decision and its effects on the nearly 600 Idahoans with developmental disabilities, mental illness or both.

Esterline said she doesn't hold any grudges. She just wants to be civilized.