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State hospitals accredited; lawmakers hear rising civil‑commitment costs and surge in competency restoration cases
Summary
Department officials told the committee that all three state psychiatric hospitals have now achieved accreditation and that the state is seeing rising civil-commitment and restoration-to-competency caseloads, driving supplemental requests and fund-shift proposals.
Alex Williamson, Legislative Services budget analyst, outlined the psychiatric hospitalization budget for the Department of Health and Welfare and said the division is authorized 467 FTP, allocated across State Hospital South (Blackfoot), State Hospital North (Orofino) and State Hospital West (Nampa). Williamson described recent budget activity including one-time facility and accreditation-related costs and a fiscal year 2025 supplemental request related to civil-commitment expenditures.
Director Alex Adams told the committee he is “pleased that all 3 facilities are now accredited.” He said accreditation allows the hospitals to bill Medicaid for eligible patients, reducing general fund burden through federal receipts. Adams said State Hospital West has billed $1.6 million and received $1.3 million to date.
Officials described a supplemental request of $2,600,000 from the General Fund for fiscal 2025 to help cover increased costs linked to mental holds and commitments after Senate Bill 1327 of 2022 changed which level of government pays for those commitments. Williamson said the statutory change shifted that responsibility to the state, creating an entitlement the department must fund when holds occur.
Adams explained a technical billing threshold that affects federal reimbursement: “There’s a Federal requirement that, 60 days or less Medicaid will cover, 60 days or more, Medicaid, is out entirely,” he said. Hospital staff reported a growth in longer stays; the department noted the percent of admissions exceeding 60 days rose from about 17% to 37%, increasing state costs.
Ross Edmonds, division administrator for Behavioral Health, told lawmakers the largest growth has been in restoration‑to‑competency cases, used when an individual charged with a crime is deemed not competent to stand trial. Edmonds said restoration cases have increased dramatically over the last decade and reported that “over the last 10 years, we've seen about a 600% increase” in restoration-to-competency admissions; he said nearly all restoration cases are restored, estimating less than 5% are not restorable.
The department requested several fund-shift and transfer-exemption items: shifting federal receipt authority, moving dedicated fund splits for State Hospital West and South, a request for receipt authority associated with accreditation billing, and an exemption to the transfer limitations in Idaho Code 67-35-11 for psychiatric hospitalization. Committee members asked the director about staffing, vacancy rates and how staffing and accreditation affect the department’s ability to place patients in hospital beds and bill appropriately.
No formal committee action was recorded on the supplemental and fund-shift requests during the hearing; agency staff said the items would be considered as part of upcoming appropriation decisions.
