Providers said people would die if Idaho cut this health service. 2 already have

The 36-year-old man had severe schizophrenia, but he was healthy as long as he took his meds.

For about six months, Medicaid was paying nurses from an Idaho Falls counseling practice to make sure he did just that. The nurses traveled to the rural area where he lived – sometimes with his brother, at other times on the street – to check in on him, give him his medications and make sure his health was stable.

They were gradually building trust with the man, and were on the cusp of getting him into housing, when the state cut its funding for these efforts in December, said Tom Tuller, who owns the Idaho Falls practice.

Without money for travel into rural areas, Tuller said, his team lost touch with the man around Christmas. Weeks later, the man’s brother called with grim news: He’d found his brother dead in an abandoned hotel.

To have this happen “was just tragic,” Tuller told the Idaho Statesman.

It was also predictable.

When providers across Idaho learned that the state planned to cut their program, called Assertive Community Treatment, they rushed to warn lawmakers and state officials that the results could be dire.

The program has been in place in various forms in Idaho for about 40 years, and as of November served about 200 people statewide, some through Medicaid and others through the Idaho Department of Health and Welfare’s Division of Behavioral Health, said AJ McWhorter, a spokesperson for the department.

It sought to find and help treat people suffering from severe mental illness, including schizophrenia and bipolar disorder. The program model gave priority to keeping people on their medications, many of which are monthly shots to guard against psychosis, said Laura Scuri, a behavioral health provider whose private practice contracted with the state to run the Boise portion of the program.

“We told the state. We said, ‘Look, if you do this, it’ll take five weeks for people to start dying’ ” once people’s medications wear off, Scuri told the Statesman by phone. The patients involved in the program, she said, tended to have such severe conditions that they were unlikely to come in for care on their own. They relied on providers to check in on them.

Amid state budget shortages, and a resulting call from Gov. Brad Little in August to reduce the department’s budget by 3%, Health and Welfare canceled the program anyway. It was one of few cuts the department could make without violating federal and state Medicaid requirements, McWhorter said.

Two patients died within weeks, including the man near Idaho Falls. The first was a man in his late 40s and lived near Pocatello. He died in December of an infection after receiving minor surgery, Scuri said. Without his medications, she said, he became psychotic and refused medical help, and died of complications from the procedure.

Had the state-funded program still been in place, “a nurse would have gone to his house and said, ‘You’re not OK, I’m calling an ambulance,’ or ‘I’m going to sit with you until you feel comfortable with me calling,’ or whatever we need to do to convince that person to get medical care,” Scuri said.

Providers declined to name the former patients who died, citing legal requirements around patient confidentiality.

Providers and patients sued Health and Welfare in state and federal cases in December to demand the program’s restoration. In the court documents of one of the lawsuits, Ric Boyce – who contracted with the state to oversee the Pocatello portion of the state program – called the first man’s death “preventable.”

If the program had been in place, Boyce said, the team would have maintained close contact, not only with the patient but with his family members, and “would have been aware of emerging medical risk factors.” The program’s elimination, he added, put patients “at substantial risk of institutionalization, clinical regressions, increased hospitalization, injury, illness and death.”

Both lawsuits remain active, Scuri said Monday.

Without mental health program, ‘through-the-roof’ risks

In 2012, a man was shot in the back outside a coffee house in downtown Pocatello. He survived, but he lost a substantial amount of blood, the Idaho State Journal reported at the time. He had lived in the city only two days.

The shooter, it turned out, was severely mentally ill but had been discharged from the Assertive Community Treatment program two months before amid budget cuts, Boyce told the Statesman.

During the triage of patients after the cuts in 2012, that man was deemed to be a lower-risk patient, Boyce said. But the events in Pocatello highlight the danger of cutting back care for any of the patients in the program, all of whom are severely mentally ill, he argued.

“This program is through-the-roof serious,” Boyce said. “I can only think that they didn’t know what they were cutting.”

Even now, Idaho taxpayers are starting to bear the financial burden of cutting the program, Boyce said. When it was in place, it cost the state about $7 million each year. Without it, taxpayer costs climb to about $40 million a year as former patients cycle through county jails, hospitals and court systems, he and other providers told the state in white papers on the impact of potential cuts.

Providing Assertive Community Treatment services to one person costs about $80 per day, Boyce added. If that same person is hospitalized – a common occurrence – it costs about $2,000 per day. In jail, he or she costs taxpayers about $450 a day.

It’s “a fortune,” Boyce said.

Health and Welfare is unable to determine the amount of money it’s saving by eliminating the Assertive Community Treatment program, McWhorter said Tuesday, because the cut will likely lead to increased costs in other areas. Restoring the program in fiscal year 2027 would cost the state about $4.3 million, he said. In fiscal year 2026, Health and Welfare’s appropriation was about $6 billion, about $1 billion of which came from the state’s general fund.

The Assertive Community Treatment program is an international, evidence-based model that aims to serve as a “psychiatric hospital without walls” for those with the most severe mental illness, often accompanied by substance abuse disorders, according to the website of the Department of Health and Welfare. Unlike jails and hospitals, the Assertive Community Treatment program focuses on getting patients stabilized and moving toward recovery, Scuri said.

Traditional outpatient psychotherapy, case management and periodic appointments to manage medications “historically have not prevented relapse or institutionalization among this population,” Daniel Traughber, a clinical psychologist, testified in December as part of a lawsuit against the state over the program cuts.

Assertive Community Treatment is the only model “capable of meeting the needs of individuals” with severe mental health conditions “who cycle frequently through hospitals, jails, homelessness and crisis systems,” he said.

Before Kristi Ackerman joined the Assertive Community Treatment program, she was homeless for six years. She sometimes lived with her sister in Nampa. She lived in a shelter for about a year.

During that time, Ackerman, 36, was in and out of hospitals in the Treasure Valley nearly every week, struggling with bipolar disorder, she told the Statesman in an interview.

The program gave her an “I-can-do-this” attitude, she said. In about a year, she went into the hospital only twice, and finally found stable housing in Boise.

When she learned the program was being cut, it came as a “shock,” Ackerman said.

“Everything just fell apart,” she said. “It just ended.”

Providers met with her to come up with a safety plan and ensure she had plenty of meds. She would still be able to come in for her medications, but there would be no more proactive outreach from providers.

But in many cases like hers, providers have quickly lost touch with former patients, which Rep. Marco Erickson, R-Idaho Falls, said could be devastating.

“When (patients) don’t have the eyes on them, that’s when they risk being in jail or dying,” Erickson, who worked for years as a mental health counselor, told the Statesman in an interview. “We’ve lost two that we know of. We’ve also seen an uptick of those individuals that were in services be in jail right now, moving into hospitals or jails.”

“It’s already happening,” he added. “It’s only been a month.”