County costs skyrocket from mental health commitments

Casey S. Elliott
Wednesday, November 16, 2022

The Montana State Hospital’s Medicare and Medicaid decertification in April is breaking the bank for counties needing mental health commitments.

Costs for court-related mental health commitments from Beaverhead County to the hospital in Warm Springs are well over budget three months into the fiscal year, Beaverhead County Clerk of District Court Carly Anderson told the county commissioners Nov. 7.

“My budget pays for when they are sent to Warm Springs after their first hearing, to when the second hearing happens and the judge says they are to either be committed or go home,” she said. “Those costs have gone up drastically, and I did not budget for that....This is a bigger problem than just our county.”

The costs ranged from $2,000 to $5,000 per case in Beaverhead County, she said. Those costs have now doubled, in the range of $11,000 to $17,000 so far this fiscal year. Anderson said the Lewis and Clark County district court clerk received a $65,000 bill for one person, which is well above anything they are used to in their county.

“It’s a bigger problem than just our county,” she added. “It’s a statewide problem.”

The expense increases are due to the state hospital’s decertification by the federal Centers for Medicare and Medicaid Services (CMS) in April. Before that, Montana governments and agencies could seek financial reimbursement from the federal government for patients covered by Medicare and Medicaid. That is not possible now, and won’t be an option until the state hospital becomes certified again.

The state hospital lost its certification when inspectors determined the facility did not have measures in place to prevent COVID-19 infections and serious falls among patients, leading to four deaths, according to Montana Public Radio (MTPR). CMS warned the hospital in February about decertification if it did not correct the problems, and it failed to do so in the timeline required.

All medical providers must meet specific guidelines to be able to accept reimbursements from Medicare and Medicaid, and those facilities are inspected annually to retain that certification, Beaverhead Deputy County Attorney Jennifer Morgan said.

“It’s hard to do, to lose your Medicare and Medicaid certification – this is a big deal,” she said.

A Montana Department of Health and Human Services (DPHHS) spokesperson told MTPR the state hospital received approximately $7 million in Medicare and Medicaid reimbursements annually.

Beaverhead County Attorney Jed C. Fitch and Morgan said the problem is compounded due to the lack of mental health services in the county, forcing people who need that care to go to the emergency room in a crisis, and not be able to get any follow up counseling or assistance with their needs the way they used to be able to do.

“It’s a multi-layered problem, and it’s not getting solved. And the problem is on our budget, because it’s not solvable,” Morgan said. “We can’t do anything about this, we can’t solve this. We can try to figure out a way to help the budget piece of it, but the state hospital piece we can’t solve.”

The county recently withdrew from a contract to provide mental health evaluations with Western Montana Mental Health, as the agency removed its local office and has not been providing the mental health evaluations it used to do. The county contracts for those evaluations now from other providers.

The Beaverhead County Commissioners intend to bring the issue up to the Montana Association of Counties, who advocate for county governments at the state level. Commissioner and Chairman Mike McGinley asked Anderson and Fitch to speak to their representatives at the clerk’s and the county attorney association to also stress the issue. Fitch said he already spoke with House District 72 Rep. Tom Welch about the problem.