State hospitals’ accreditation and rising civil-commitment costs draw committee scrutiny

Ross Edmonds, administrator for the Department of Health and Welfare’s Division of Behavioral Health, and Director Alex Adams briefed the Joint Finance-Appropriations Committee on psychiatric hospitalization funding, accreditation, billing and civil-commitment costs.

Alex Williamson (LSO) said psychiatric hospitalization is organized into community hospitalization and three state hospitals — State Hospital South (Blackfoot), State Hospital North (Orofino) and State Hospital West (Nampa). The division is authorized for 467 FTP. The department asked for a targeted fiscal 2025 supplemental of $2,600,000 from the General Fund to cover increased civil-commitment expenditures after Senate Bill 1327 (2022) shifted billing responsibility to the state.

“Civil commitments and state coverage for civil commitments was a deliberate policy choice that this legislature made in 2022,” Adams told the committee, explaining that the statute shifted costs from counties to the state and that the department has no control over how many holds are placed. “Earlier I talked about entitlement versus not entitlement. The Department of Health and Welfare has 0 control over holds. We don't determine if a healthcare professional puts somebody on a hold… If they're on a hold, it creates a legal entitlement for me to pay for them regardless of how many people come through the front door.”

Adams said delays in accreditation previously reduced the state’s ability to bill Medicaid for some patient stays. He reported that all three hospitals have since received accreditation and that State Hospital West has begun billing Medicaid: the hospital billed $1,600,000 and has received $1,300,000 in federal receipts to date. Adams told lawmakers that such Medicaid billing reduces general‑fund exposure because federal Medicaid matching funds cover a portion of costs.

Committee members asked about length of stay and billing rules. Adams explained a federal rule tied to reimbursement: stays of 60 days or less can be billed to Medicaid, but stays exceeding 60 days may not be reimbursable under Medicaid rules; clinical decisions about readiness for discharge drive those outcomes. The division reported that the share of admissions exceeding 60 days has increased from roughly 17% to 37%, which increases state costs when federal reimbursement is unavailable.

Ross Edmonds described trends in commitments and court-related admissions. He said civil commitments have been relatively flat but that restoration‑to‑competency commitments — where an individual charged with a crime is evaluated and treated to become competent to proceed — have risen dramatically, roughly 600% over 10 years, and fill a large share of state hospital beds in some hospitals.

Lawmakers asked about vacancy and capacity. Adams said State Hospital West showed 0% vacancy, State Hospital South 2.8% vacancy and State Hospital North 11.5% vacancy; he attributed higher vacancies in Orofino to recruitment challenges for clinical staff in that location. The committee asked for further data on billing receipts, waitlists and historic trends.

The agency presented transfer‑exemption language similar to the mental-health discussion asking that psychiatric hospitalization not face additional transfer restrictions beyond Idaho Code 67-35-11. The committee did not take a formal vote during this presentation; the requests will be considered in future budget decisions.