State hospitals accredited but civil-commitment costs prompt supplemental request

Alex Williamson, presenting the Division of Psychiatric Hospitalization budget, said the three state hospitals — State Hospital North (Orofino), State Hospital South (Blackfoot) and State Hospital West (Nampa) — provide short- and long-term residential care and that the division is authorized roughly 467 full-time positions to staff those facilities.

Williamson described a fiscal‑year 2025 supplemental request for $2.6 million from the general fund to cover increased costs for mental holds and commitment services. She said Senate Bill 1327 of 2022 changed the state’s responsibility for payment: the state assumed costs previously borne by counties, and the department now requests supplemental authority to cover the higher expenditures.

Director Alex Adams told the committee that all three hospitals have since been accredited, which allows billing Medicaid for eligible patients. "State Hospital North was the most recent to get accredited," Adams said, adding that early billing from State Hospital West has produced receipts that reduced general-fund needs: "They've so far billed $1,600,000; they've received $1,300,000, so that's arguably $1.3 million less that we otherwise would have had to ask for on the general fund."

Adams explained the 60-day Medicaid rule: Medicaid will reimburse for hospital stays of 60 days or less but provides no federal reimbursement for stays exceeding 60 days. "If the patient is not ready to be released back into the community at day 59, the medical and clinical need will override the billing realities," Adams said. He reported that the percentage of admissions exceeding 60 days rose from about 17% to 37%, increasing state general-fund exposure.

Ross Edmonds, division administrator for behavioral health, told members the department has seen a steady annual increase in law-enforcement and health-provider holds (civil holds) and a pronounced rise in restoration-to-competency commitments. "Over the last 10 years, we've seen about a 600% increase in the restoration to competency increases," Edmonds said, and he added that restoration cases fill a substantial share of state hospital beds (about 75% at State Hospital North, he said).

Committee members asked about staffing and vacancy rates. Adams said vacancy rates at the state hospitals are generally below the agency average: State Hospital West had 0% vacancy in the department’s figures, State Hospital South about 2.8%, and State Hospital North about 11.5%. Adams credited compensation adjustments made through committee-approved cost‑of‑employment actions for improved staffing outcomes.

Why it matters: the transfer of civil-commitment costs from counties to the state (Senate Bill 1327) and rising long-stay admissions have increased general-fund exposure. The department asked for a one-time supplemental and recommended transfer‑authority changes to help manage billing shifts between federal, dedicated and general funds. Officials said they would supply additional data on billing, receipts and capacity.