State hospitals accredited; DHW seeks $2.6M for civil-commitment costs as commitments rise

Department of Health and Welfare officials told the Joint Finance-Appropriations Committee that all three state psychiatric hospitals — State Hospital North (Orofino), State Hospital South (Blackfoot) and State Hospital West (Nampa) — have achieved accreditation and have begun billing Medicaid, producing federal receipts that reduce general-fund needs.

Director Alex Adams and Ross Edmonds, administrator for the Division of Behavioral Health, described ongoing pressures tied to civil commitments and a surge in commitments to restore criminal defendants’ competency. Adams said State Hospital West has billed about $1.6 million and received roughly $1.3 million in Medicaid receipts after accreditation and that the hospitals’ ability to bill Medicaid reduces general‑fund exposure.

Why it matters: The department asked for a $2.6 million one‑time general‑fund supplemental to cover increased civil‑commitment expenditures after Senate Bill 1327 (2022) changed the state’s responsibility for those costs. Adams said the department now pays for mental holds and related transportation and hospitalization costs that counties covered previously. Those civil commitments are legally created when law enforcement or a health provider places a patient on a hold.

60‑day Medicaid rule and long stays: Adams explained a federal rule that Medicaid will reimburse inpatient psychiatric stays of 60 days or less; stays exceeding 60 days receive no Medicaid reimbursement. The department reported that the share of admissions exceeding 60 days increased from about 17% to about 37%, which increases general-fund costs because federal billing is not available for the longer stays.

Restoration to competency surge: Ross Edmonds said that, over the last decade, restoration-to-competency commitments have increased by about 600% and now occupy a large share of state‑hospital bed use. He said State Hospital North has approximately 75% of its beds occupied by restoration-to-competency cases. Edmonds also told the committee that nearly all psychiatric restoration cases are ultimately restored; he estimated fewer than 5% are not restorable.

Staffing, vacancies and capacity: Adams reported low vacancy rates at State Hospital West (0%) and South (2.8%) but a higher vacancy rate at State Hospital North (11.5%), which he attributed in part to the facility’s remote location. He said staffing, licensing and accreditation affect how quickly patients can move from community hospitalization to state hospitals and thus affect community hospitalization costs.

Next steps: The department asked the committee to consider the supplemental and also requested transfer-exemption authority similar to other DHW divisions to allow more flexibility in moving funds between object classes. Officials said the department will continue to provide data to the committee and that the Medicaid budget hearing will include additional IBHP and hospital billing details.