Committee told state will renovate Essex facility to add emergency involuntary procedures suite and repurpose eight beds for forensic evaluations

On May 9, the Corrections & Institutions Committee heard from Buildings and General Services (BGS) about planned renovations at the Essex secure residential facility that would add an Emergency Involuntary Procedures (EIP) suite and repurpose eight of the facility’s 16 beds to house people awaiting court-ordered forensic evaluations.

The update, delivered by BGS project manager Sabrina Karish, said the work will add a small addition on the east wing to include an EIP room, a consultant space and an observation room. "We are adding a small addition onto the east wing of the building for that EIP suite," Karish said. She told the committee BGS is finishing design documents and expects to start construction in the fall, subject to local permitting and contractor availability: "We are in design right now... and we're hoping to start in the fall of this year."

Committee members pressed for details about how the change would affect the facility’s role as a step-down site from the Berlin state hospital. The Essex facility was built as a 16-bed secure residential step-down; Karish and committee members confirmed the facility will still have 16 beds in total but that one wing (eight beds) is being repurposed for forensic evaluations rather than adding new beds. A committee member summarized the conversion as a change in function, not an increase in bed count.

Members raised immediate concerns about Medicaid coverage and federal rules administered by the Centers for Medicare & Medicaid Services (CMS). Committee members said Medicaid rules and CMS requirements can limit Medicaid payment for mental-health beds when beds are configured or aggregated in certain ways and noted previous CMS waivers had been used to keep Medicaid funding for some facilities. One committee member said CMS limits (commonly discussed as the 16‑bed threshold for the Institutions for Mental Disease exclusion) had driven prior design and siting decisions: "If it's over 16 beds, you are termed an institute of mental disease and you do not get Medicaid," the member said. Committee members asked staff to confirm how repurposing eight beds for forensic evaluations would affect Medicaid eligibility for the remaining mental-health beds and whether a separate entrance or other physical separation would be required to protect Medicaid funding.

Members also described practical consequences if the wing is taken offline for conversion. Several said the original purpose of the 16-bed facility was to reduce a backlog at the state hospital and in emergency departments by providing a lower-acuity, secure residential step-down. Converting half the facility to forensic use, members warned, could reduce step-down capacity and recreate earlier backlogs unless alternate capacity is identified. "How is that going to impact the step down ability from the state hospital?" the committee chair asked; members asked the Department of Mental Health (DMH) to appear to explain forensic policy and operational plans.

On project finances and schedule, Karish said the work has an estimated project cost of $700,000 and that design work is under way. Committee discussion noted funds were set aside in the prior capital appropriation for preliminary design; Karish said some design costs are already encumbered and that local permitting will be required. Committee members also said some funds for the project are carried over from the original construction appropriation, and that the committee should clarify whether the remaining funds are bonded or cash. Committee members asked BGS and DMH to provide documentation on the available balance and funding source before construction starts.

Committee members requested additional testimony and information. Several asked DMH to brief the committee on forensic policy, Medicaid implications, and operational plans for housing people who are undergoing competency or insanity evaluations. The committee chair said staff would attempt to schedule DMH testimony and, if there is interest, a site visit.

The committee did not take a formal vote during the discussion; members directed staff to follow up with DMH and BGS for written clarifications on bed counts, Medicaid eligibility, separation requirements (including whether a separate entrance is required), the project budget and the construction timeline. The committee left the item open for further testimony and potential field review.