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State hospitals accredited; committee hears rising civil-commitment costs and pressure on beds
Summary
Analysts and the Department of Health and Welfare reported that all three state psychiatric hospitals have accreditation and are billing Medicaid, but the committee heard that civil-commitment costs and restoration-to-competency cases have grown substantially and are driving supplemental funding requests.
Alex Leanson, Legislative Services Office budget analyst, presented the Division of Psychiatric Hospitalization budget and told the committee all three state psychiatric hospitals—State Hospital South (Blackfoot), State Hospital North (Orofino), and State Hospital West (Nampa)—provide short- and long-term care and rely heavily on personnel and operating funding.
Department of Health and Welfare Director Alex Adams confirmed the three facilities have accreditation and said that accreditation allows hospitals to bill Medicaid, producing federal receipts that reduce general-fund need. Adams told the committee State Hospital West has billed about $1.6 million and received $1.3 million to date, reducing general-fund demands on that hospital.
The department asked for a $2.6 million one-time general-fund supplemental for civil-commitment expenditures in fiscal 2025 because Senate Bill 1327 of 2022 shifted responsibility for mental holds from counties to the state. Director Adams and agency staff described civil-commitment expenditures as an entitlement driven by the number of holds initiated under statute, which the department cannot control. “We offloaded those costs from the counties, we took those costs on as a state, and like many fiscal notes involving the department, optimistic assumptions are used and the costs were underestimated,” Adams said.
Committee members asked for details about an observed rise in long stays. Adams and Ross Edmonds, division administrator for behavioral health, explained a federal billing rule limits Medicaid reimbursement for some admissions to 60 days; stays longer than 60 days receive no federal reimbursement and become a state general-fund obligation. Edmonds said the share of admissions longer than 60 days rose from roughly 17% to about 37%, increasing state exposure. Adams noted that some stays cannot be shortened because clinicians determine patients are not ready for release.
The committee also heard about a major increase in restoration-to-competency commitments, which Edmonds said have risen roughly 600% over the last decade. He said restoration-to-competency cases now occupy a large share of hospital beds; at one hospital about 75% of beds are used for those cases. Legislators and agency staff discussed vacancy and staffing levels: State Hospital West reported a 0% vacancy rate for staff, State Hospital South about 2.8%, and State Hospital North about 11.5%, and panelists linked staffing, accreditation and billing to the state’s ability to reduce community-hospitalization costs.
Why it matters: civil-commitment expenditures and the growth in restoration-to-competency cases have shifted costs and bed use, and the department asked for supplemental funding and transfer authority to manage those costs. The committee requested follow-up details; no formal vote on the supplemental occurred during the hearing.
