Budget Cuts in Idaho Mental Health Care Could Cost $150 Million

Health care providers in Idaho have raised alarms over budget cuts that took effect on December 1, 2023, affecting programs for individuals experiencing mental health crises and those with severe disorders. These reductions, estimated at around $20 million, are projected to cost the state upwards of $150 million within the first year due to increased reliance on emergency services, law enforcement, and other social support systems.

According to a report by the Idaho Association of Community Providers and the Idaho ACT Coalition, the cuts could lead to significant financial and staffing challenges for local governments and mental health agencies. The report indicates that the anticipated costs will stem from higher usage of emergency services, involuntary psychiatric holds, and other associated expenses such as homelessness.

Programs Facing Elimination

The cuts include the termination of critical services such as Assertive Community Treatment (ACT), in-home residential treatment, Partial Hospitalization Programs, Early Serious Mental Illness teams, and peer support programs. Ric Boyce, co-director of the Idaho Association of Community Providers, highlighted the implications, stating, “By the time you calculate increases in predictable state program usage, hospital usage, that’s gonna cost $150 million to $180 million on the very conservative end.”

In Region 2, which encompasses Nez Perce, Latah, Clearwater, Lewis, and Idaho counties, the estimated financial burden on local governments could range from $12 million to $16 million annually. These cuts are part of a broader 4% reduction in Medicaid provider payment rates, aimed at addressing a state budget shortfall of approximately $58.3 million, as reported by the Idaho Capital Sun.

Community Impact

Sara Bennett, owner of Riverside Recovery, which operates in Lewiston and Orofino, expressed deep concern over the impact of these cuts. Her team previously managed the regional ACT program, which was designed to provide intensive support for individuals with severe mental illnesses who had not benefited from traditional services. Bennett explained that ACT has been shown to significantly reduce hospitalizations for patients with conditions such as schizophrenia, severe bipolar disorder, and major depression.

“ACT is that kind of aggressive outreach,” Bennett said. “Helping engage that individual in the community or in the setting that they’re in, and helping them stabilize within that environment.” Before the cuts, Bennett’s team served approximately 42 individuals through ACT, while statewide, around 400 patients relied on the program. With the funding changes, these individuals are now left without the essential support they previously received.

Bennett noted that the restructuring of services, referred to as “unbundling,” effectively dismantles the program. “With what they call ‘unbundling’ of ACT, nursing isn’t even a billable service,” she added. Her staff is now attempting to connect affected individuals to less effective traditional mental health services, a transition that raises concerns for the well-being of those who have relied on ACT for years.

Boyce anticipates that as many as half of the 400 patients statewide may not transition effectively to outpatient mental health counseling. He articulated the challenges faced by this vulnerable group, stating, “These are people who can barely answer their door consistently to us. Realistically, these unbundled services are not the appropriate services. They’re not the evidence-based services that will keep those individuals out of hospitals, out of jails, out of homelessness.”

Local officials, including Tom Lamar, chairperson of the Region 2 Behavioral Health Board, expressed fears that the cuts will place additional strain on local crisis centers, mental health providers, and law enforcement agencies. Lamar remarked that by cutting services previously bundled under Medicaid, the state has effectively transferred financial responsibilities to local programs.

In a letter addressed to Governor Brad Little and state lawmakers, the Idaho Sheriffs’ Association warned that the elimination of these stabilization programs would likely result in an increase in emergency calls, involuntary holds, and other legal issues. “County sheriffs’ offices, especially rural agencies, already operate with thin margins,” the letter stated. “The loss of these stabilization programs will not reduce the overall cost to the State of Idaho. Instead, it will shift those costs directly onto county budgets, jails, E.M.S. agencies, and local taxpayers.”

Lamar also noted that the Nez Perce County Jail may experience an uptick in inmate numbers, adding further strain on local resources. He highlighted that Latah County has recently transitioned its jail to a court holding and booking facility, creating additional challenges for managing inmate populations effectively.

Bennett remains hopeful that legislators will reconsider and reinstate these essential programs in the coming year, emphasizing that the most vulnerable individuals require effective, evidence-based treatment. “These are the individuals with the highest needs, and this is the only evidence-based treatment that we offer,” she said.

The Region 2 Behavioral Health Board plans to convene on Thursday to discuss these issues with local legislators and their representatives, aiming to advocate for the restoration of critical mental health services in Idaho.