The Joint Finance-Appropriations Committee voted unanimously today to approve a supplemental appropriation of $255,400, including $127,700 in state general funds, to cover the first step in reconfiguring children’s mental health treatment in Idaho as part of the settlement of the long-running Jeff D lawsuit. The supplemental appropriation includes 11 new positions. There’s also an annualization request in the mental health budget for next year that will bring the full annual cost up to about $940,000. It’s part of a move of the program to Medicaid to allow its services to children with serious emotional disturbances to more than triple, thanks to roughly $3 million in annual federal matching funds that would be added to the state spending.

The vote on the supplemental appropriation came at the end of a week of hearings on health and human services budgets, with the Jeff D changes a highlight. The class-action lawsuit, filed in 1980, came because Idaho was commingling children and adults at State Hospital South, which led to abuse of children and a lack of educational and treatment services they needed.

“This agreement is intended to improve mental health services for children in Idaho, and to help prevent similar situations from occurring again,” legislative budget analyst Jared Tatro told JFAC.

Among other issues that have come up in recent days’ budget hearings:

CRISIS CENTERS: A report on Idaho’s four behavioral health crisis centers – located in Idaho Falls, Coeur d’Alene, Twin Falls, and Boise – found that they’ve already served close to 5,000 people statewide. The oldest, in Idaho Falls, has been open for two years; Coeur d’Alene, one year; Twin Falls just opened in November; and Boise’s is in the process of opening.

“I can tell you that the Twin Falls crisis center has served 75 people already, and that was as of the first of the year,” said Ross Edmunds, behavioral health division administrator for the Idaho Department of Health and Welfare. “So pretty successful in just a month’s worth of service. … We feel pretty pleased with that.”

He shared a story: “In the first week of operation at the Twin Falls crisis center, there was a person who came there, and a week later came back with her husband, and said, ‘You saved my life last week. I was going to die, and there’s no doubt in my mind I would have killed myself if this place wasn’t open.’”

Sen. Mary Souza, R-Coeur d’Alene, said she’s talked with law enforcement in her district about how difficult it is to estimate cost savings from having a crisis center. She said they told her that “even just one suicide that was prevented by a crisis center” avoids intense, lengthy and costly investigations. “But, as you say, the most important savings is in the human life and the suffering that is prevented, and I appreciate that,” she told Edmunds.

The Coeur d’Alene crisis center, in its first year, has been able to document $1.7 million in savings just in diverting people from the hospital emergency room, Edmunds told the lawmakers. Sen. Shawn Keough, R-Sandpoint, said, “I think we have seen the benefits of the investment.”

Sen. Mark Nye, D-Pocatello, said, “There is a screaming, screaming need for a crisis center in my area.”

The state’s program for establishing crisis centers in each of the seven regions of the state calls for those already established to move to 50 percent local and other matching funding, freeing up part of their state funds to pay for new crisis centers in other regions. Next year’s budget proposal from Gov. Butch Otter proposes completing the partial funding granted last year for the Twin Falls and Boise centers. No new centers are planned until funding is freed up from the others through matching funds; the Idaho Falls center has just submitted its plan to the state for getting to that 50 percent mark on matching funds. It takes about $1.5 million to start up and operate one crisis center for a year.

Keough told Nye, “Motions are in order when we start setting budgets, if you can find the money.”

DOCTORS’ PAY: Otter is calling for granting the Health and Welfare Department’s request for an additional $243,900 in state funds next year to increase pay for physicians at State Hospital North and State Hospital South. In the past year, State Hospital North has lost two doctors: One who took a job in the private sector and received a $100,000 raise; and another who left to return to a position in her home country that paid $200,000 a year more.

“What we’re seeing on average is a 50 to 100 percent salary increase for folks to leave our state hospitals and come work in the private sector, so it’s a real challenge for us to compete,” Edmunds told JFAC. “We have a good benefit package … but that salary is a bit of a hangup. So with this, we believe we’ll be a little more successful in being able to recruit and retain more physicians.”

SECURE MENTAL HEALTH FACILITY: Otter also is proposing a big shift in psychiatric hospitalization, moving the state’s psychiatric adolescent hospital from State Hospital South in Blackfoot to a new $10.3 million facility to be constructed in the Treasure Valley, to be called State Hospital West; and converting the old adolescent unit in Blackfoot into a 20-bed secure facility for adults.

“Sixty-five percent of those adolescents are right here from this valley,” Edmunds told JFAC. Plus, he said, “There’s some reason for taking those high-risk, challenging adults and moving them to a community that’s outside the hub that they’re used to working in.” Some, he said, “like to abscond,” a risk that would be minimized with the new Blackfoot facility.

MENTAL HEALTH SERVICES FOR PROBATIONERS: Otter is recommending $11.2 million next year to provide mental health services to about 7,400 felony probationers and parolees who are deemed at risk for reoffending without continued services, which they received while they were behind bars, before they were released into the community. It’s part of the state’s Justice Reinvestment Initiative. Edmunds told JFAC that Idaho state law requires the Department of Health & Welfare to pay for mental health services for the felony probation and parole population. “The individuals who get those services are determined not by us, but by the court system,” he said.

Last year, as required by law, Health & Welfare and the Idaho Department of Correction commissioned a “gap analysis” for the services from WICHE, the Western Interstate Commission for Higher Education. That provided the numbers on who needed the services, and prompted the request. “It’s a result of that gap analysis and a result of the code,” Edmunds said.

Rep. Melissa Wintrow, D-Boise, asked about Idaho’s health coverage gap, the 78,000 people in the state who make too much to qualify for Medicaid but too little to be eligible for subsidized health insurance through the state’s insurance exchange. Pondering the $11.2 million for the parolees and probationers – which all would have been covered if Idaho had expanded Medicaid to cover the full 78,000 population – Wintrow said she was “wondering if that money  could be used to leverage … and include all these people as well.”

Edmunds said the proposal for the parolees and probationers allocates only $126 per person per month, to be delivered through a contract. “We believe we can do this very efficiently,” he said.

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