Nobody in Idaho Voted for This

Last month the Idaho Department of Health and Welfare handed out $3.1 million of your money. No legislator voted on it and most of us didn’t know it was happening. We found out by email, after it was decided.

The way it happened bothers me more than the award does.

Let’s start with where the money came from, because almost nobody in Idaho knows. In July 2025, Congress passed the One Big Beautiful Bill. Buried in the final hours of negotiating it was something called the Rural Health Transformation Program. It wasn’t in the earlier drafts. It was created, and then doubled from $25 billion to $50 billion, to get one senator from Alaska to vote yes (we call this a bribe). Senator Lisa Murkowski doesn’t hide this. Her own office calls her one of the lead advocates for doubling that fund, and Alaska takes $272 million a year out of it. Idaho, with nearly twice Alaska’s population, gets $186 million.

I voted no on all of it.

On taking the money, and later on the committee that was supposed to watch it. Rural Idaho needs help, and I’d vote for real help tomorrow. But money that exists because it was the price of somebody else’s vote on a federal bill doesn’t belong to the state that spends it. It answers to Washington. It always was going to.

Now here’s the part that surprises people…

This money never went through the Legislature the way you’d assume. It goes from the federal Centers for Medicare and Medicaid Services straight to a single state agency: the Department of Health and Welfare, run by Director Juliet Charron (who started in the job two months before the application went out the door). Her department wrote Idaho’s application in November 2025 and sent it to Washington. The feds approved it on December 29, 2025. By the time the Legislature convened in January, the plan was already written, already submitted, and already blessed by CMS.

So… we just showed up to a decision that had already been made.

We spent most of the 2026 session fighting about who would watch this money. Two oversight bills died. On the last day of session we passed a third and created something called the Rural Health Transformation Committee that was sold to Idahoans as “legislative oversight.”

But here’s what that committee actually does:

1. It receives a monthly summary of upcoming awards

2. Members get three business days to send questions to the co-chairs - that’s it

3. No vote on any award, no approval, no power to stop anything.

I voted against creating it because I didn’t think it would have teeth, and it doesn’t.

Instead, we built a committee whose job is to be “notified.”

In June, Health and Welfare started posting the first funding opportunities. Two of them were maternal health, which matters in a state where rural women drive hours to deliver a baby. One was called OB Readiness. The other was the Idaho Perinatal Quality Collaborative. Applications closed July 10, and both are going to Comagine Health, a woke consulting nonprofit in Portland, Oregon (about $3.1 million total).

Oh, and they believe men can get pregnant.

But Comagine wasn’t a stranger who saw a posting and applied. They were already running Idaho’s perinatal program, working alongside the same Health and Welfare office that ran this contract. So the office that already worked with Comagine decided what the contract would require, ran the “competition,” and gave it to Comagine.

If a school district did that with a superintendent’s brother-in-law, you’d hear about it on the news. But because it’s a state agency and the paperwork is boring… nobody says a word.

I don’t yet know who sat on the scoring panel. I don’t know what conflict of interest disclosures they signed, or whether anyone asked for them (those are documents, and documents can be requested).

Then there’s the question of who they picked. Comagine’s own Idaho perinatal materials describe their work as improving outcomes for “pregnant people.” Yes, we’re about to pay a Portland consulting firm $3.1 million to improve maternal care in rural Idaho, and that firm won’t say “mothers.” Their public resource library also includes health equity plan templates and a gender-affirming care guide for hospital staff. It was all sitting on their website, in public, months before anybody at Health and Welfare made this choice.

So somebody at IDHW looked at this organization and decided it was the right fit for Idaho mothers. I’d like to know who, and I’d like to know what standard they applied.

And as far I can tell, nobody asked whether a contractor’s published positions line up with the values of the state writing the check (they don’t).

But maybe there’s a boring answer. Maybe Comagine simply put in a stronger application and the department can produce the scoresheets to prove it. If so, produce them. That’d be a fine outcome and I’d say so publicly.

What I want isn’t complicated.

First, the documents: the scoring rubric, the individual evaluator scoresheets, the names and divisions of everyone who scored these applications, their conflict of interest disclosures, and every prior agreement between Health and Welfare and Comagine going back five years. If this was clean, the file will show it.

Second, contract terms with teeth. Whatever Idaho signs with an out-of-state contractor ought to bind that contractor to Idaho law and give the state approval over materials distributed to Idaho hospitals. If the current agreements don’t do that, we have a real problem, and it’s a fixable one.

Third, an oversight committee that oversees something: A committee that gets a summary and three days to comment is not a check on anything. Next session that statute should be rewritten so awards of this size require a vote before the money moves, not an email after it’s gone.

About $744 million of this money hasn’t been spent yet. Every dollar flows through one department, and every award is signed inside it. The Legislature appropriates, and then we read summaries.

Juliet Charron runs that department, and she answers to the Senate Health and Welfare Committee that I sit on. The contract starts in ten days.

Show us the scoresheets.