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State hospitals accredited; department requests civil-commitment supplemental after billing and bed-shift changes
Summary
Analysts said all three state hospitals have achieved accreditation, enabling Medicaid billing that reduced general-fund exposure; the Department of Health and Welfare asked for a $2.6 million one-time supplemental to cover rising civil-commitment (mental-hold) costs tied to policy changes from 2022.
Alex Williamson, budget and policy analyst with the Legislative Services Office, reviewed the Division of Psychiatric Hospitalization budget and told the committee that all three state hospitals — State Hospital North (Orofino), State Hospital South (Blackfoot) and State Hospital West (Nampa) — are shown on the hospital roster and that recent accreditations affected billing patterns.
"Both of them have received accreditation at this point," Williamson said when asked about accreditation status; Director Alex Adams confirmed all three facilities are now accredited and said that State Hospital West had billed and received federal receipts that reduced general-fund needs.
Williamson presented a fiscal-year 2025 request including a one-time supplemental related to civil-commitment expenditures of $2,600,000. She said the supplemental responds to increased costs since Senate Bill 1327 of 2022 changed where responsibility falls to pay for mental holds.
Adams explained the fiscal mechanics and legal limits the department faces. He told the committee there is a federal billing threshold tied to patient length of stay: Medicaid will provide reimbursement for stays up to 60 days but will not reimburse for stays of 60 days or more. "There's a Federal requirement that, 60 days or less Medicaid will cover; 60 days or more Medicaid is out entirely," Adams said. He said admissions lasting more than 60 days have grown as a share of total admissions and that this increase reduces available federal receipts.
Committee members asked about staffing and occupancy. Adams and Ross Edmonds, administrator for the Division of Behavioral Health, said staffing and accreditation both affect the hospitals' ability to bill and to move patients from community hospitalization into state hospitals. Adams reported vacancy rates of 0% at State Hospital West, 2.8% at State Hospital South, and 11.5% at State Hospital North; Edmonds added that restoration-to-competency cases — individuals evaluated as not competent to stand trial — have increased roughly 600% over ten years and now make up a substantial share of inpatient beds at State Hospital North.
Edmonds said most restoration-to-competency cases are restored within the statutory timeframes; "nearly all of them" are restored, he told the committee, and estimated under 5% are not restorable. He said restoration commitments are a major driver of bed usage and the need for additional capacity.
Williamson also described shifts in fund sources tied to delayed accreditation. In past years, accreditation delays meant hospitals could not bill at the expected federal split; as a result, some federal fund authority shifted to general fund and dedicated fund authority to cover costs until billing eligibility was available. The department requested receipt authority and other adjustments in the 2025 budget to reflect the new billing posture.
The committee asked for further details on realized savings since accreditation and for the department to supply follow-up numbers; Director Adams said State Hospital West had billed $1.6 million and received $1.3 million to date, and that full-year impacts would be visible after a longer billing period.
No formal vote was taken during the hearing; the supplemental and transfer-exemption requests were presented for committee consideration in forthcoming budget actions.
