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Officials tell appropriations committee state hospitals are accredited but civil‑commitment costs are rising
Summary
Department of Health and Welfare officials said all three state psychiatric hospitals have achieved accreditation, have begun billing Medicaid for eligible stays, and are nonetheless seeking a one‑time $2.6 million supplemental because civil‑commitment costs have increased since the state assumed county costs following 2022 legislation.
Alex Williamson, Legislative Services Office budget analyst, briefed the committee on the Division of Psychiatric Hospitalization budget and noted the division had $62.6 million in expenditures in fiscal year 2024, driven primarily by personnel and operating costs.
Director Alex Adams confirmed all three state hospitals — State Hospital North (Orofino), State Hospital South (Blackfoot) and State Hospital West (Nampa) — have received accreditation. Adams said accreditation allows the hospitals to bill Medicaid for eligible patient stays and that billing has begun: State Hospital West "has billed $1,600,000 and received $1,300,000," Adams said, showing early federal receipt recovery.
Nonetheless the department is seeking a $2.6 million one‑time general fund supplemental for civil commitment expenditures in fiscal 2025. Williamson and Adams told the committee that Senate Bill 1327 (2022) shifted responsibility for mental holds and civil commitment costs from counties to the state; the department now pays transportation and hospitalization costs for holds and has limited control over the number of holds. Adams said, "Civil commitments have remained fairly flat, but it's that gap space that... continues to grow," and Ross Edmonds, division administrator, cautioned the number of holds from law enforcement and health providers has increased year over year.
Committee members asked about the 60‑day Medicaid billing rule. Adams explained that Medicaid reimburses for stays of 60 days or less; stays longer than 60 days are not reimbursed by Medicaid, which can create general fund exposures when patients exceed 60 days. The percentage of admissions exceeding 60 days has grown from about 17% to 37%, Adams said, which increases state costs.
Ross Edmonds told legislators that restoration‑to‑competency cases have driven a substantial increase in hospital load: "Over the last 10 years, we've seen about a 600% increase" in restoration‑to‑competency commitments; those cases occupy a meaningful share of hospital beds (Edmonds said about 75% of beds at State Hospital North were filled with restoration‑to‑competency patients at the time of his remarks). Edmonds said nearly all psychiatric restoration cases are ultimately restored to competency within the statutory timeframes; he estimated roughly "5 percent or less" are not restorable.
The department also requested a transfer exemption (no additional restrictions beyond Idaho Code §67‑3511) to allow shifting funds to address emergent needs. Committee members asked for additional detail and historical accounting related to prior supplementals and the effect of accreditation on general fund savings.
Williamson referenced the budget book (pages begin at 2‑97) for supplemental details and fund‑shift specifics. Adams said the hospitals' accreditation has reduced reliance on general fund dollars by allowing federal receipts, but that accreditation timing means full year savings may not be realized immediately.
