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State hospitals accredited, but civil-commitment costs and restoration-to-competency cases drive fiscal pressures
Summary
Officials told the Joint Finance-Appropriations Committee all three state psychiatric hospitals have achieved accreditation and have begun Medicaid billing, producing some federal receipts. Lawmakers were told costs for civil commitments and an increase in restoration-to-competency cases are creating supplemental pressures and higher general-fund
Department and hospital officials reported to the Joint Finance-Appropriations Committee that all three state psychiatric hospitals have achieved accreditation and begun Medicaid billing, which generated federal receipts. At the same time, rising civil-commitment costs and a large increase in competency-restoration admissions are placing pressure on the state budget.
Alex Williamson, Legislative Services Office analyst, said both State Hospital North (Orofino) and State Hospital South (Blackfoot) have received accreditation; Director Alex Adams confirmed accreditation for all three state hospitals and described billing effects. Adams said State Hospital West has billed approximately $1.6 million and received $1.3 million in federal receipts to date, reducing general-fund pressure by the same order.
Analysts told the committee the hospitals had requested receipt authority and staff increases previously to respond to changes in types and duration of patient stays. Miss Williamson presented a fiscal 2025 supplemental request of $2.6 million from the general fund for civil-commitment expenditures and described shifts between federal and general/dedicated funds related to timing of accreditation and billing rules.
Committee members asked for details about the 60-day Medicaid billing rule. Director Adams explained a federal rule limits Medicaid reimbursement to stays of 60 days or less; admissions exceeding 60 days are not eligible for federal Medicaid reimbursement and instead become a state expense. Adams said the percentage of admissions greater than 60 days has increased—from about 17% previously to roughly 37%—creating upward pressure on state costs.
Ross Edmonds, division administrator for the Department’s Division of Behavioral Health, told lawmakers that year-over-year the number of involuntary holds placed by law enforcement and health-care professionals is rising. He said civil commitments (where a judge commits an individual after hearing) remained comparatively flat, but restoration-to-competency cases grew dramatically over the last decade—“about a 600% increase”—and currently occupy a substantial share of beds. Edmonds said about 75% of State Hospital North beds are used by restoration-to-competency patients.
On staffing, Director Adams said vacancy rates vary by facility: State Hospital West showed near 0% vacancy, State Hospital South about 2.8% vacancy, and State Hospital North about 11.5% vacancy. He told the committee that higher staffing levels enable the hospitals to accept more patients and reduce use of community hospitalization, which in turn can affect Medicaid billing and community hospitalization costs.
Ending: The department asked for supplemental funds for civil-commitment and for receipt authority and fund shifts tied to accreditation and billing; lawmakers requested more data on stay-length trends, restoration-to-competency growth, and the fiscal impact of accreditation-related billing changes.
