Speaking to the joint budget committee Monday, Bonneville County Commissioner and Catastrophic Health Care Fund Board Chairman Roger Christensen said counties have seen an increase in the number of people requiring emergency care or interacting with law enforcement.

“The difficulties we’ve seen coincide with reductions in mental health services at the Department of Health and Welfare,” Christensen said. “Any of you who are involved with mental health knows they try to control the disease with medication. We’re noticing an increase in cases because individuals aren’t necessarily receiving the monitoring they need (to ensure they take their medication).”

If that results in a psychotic episode, he said, “it may turn to a violation of the law and we end up dealing with them in jail. That seems to coincide with a decrease in access to (community mental health) services.”

The state spent more than $27 million on indigent care in fiscal 2012; Idaho’s 44 counties paid another $28.2 million, or a maximum of $11,000 per individual.

The combined cost of the program has risen 24 percent since fiscal 2010, to $55.3 million last year. The mental health caseload accounts for almost 40 percent of that increase: The number of cases has doubled and the costs have more than doubled during that time period, from $2.82 million to $7.04 million.

Mental health accounts for about 13 percent of the total catastrophic health care program costs — slightly more than car crashes and other accidents combined. The bulk of the costs, however, go toward treatment of chronic health conditions.

Christensen noted that the definition of “indigent” depends more on the seriousness of someone’s condition and the cost of their treatment than the size of their income.

“If you don’t have enough disposable income to pay off (the bill) in a five-year period, you can be defined as medically indigent,” he said.

The catastrophic health care fund is requesting $38.2 million in state funding for fiscal 2014, which begins July 1. That’s about $1.7 million more than the current fiscal year.

Part of the increase relates to federal health care reform.

When Congress approved the Affordable Care Act, it included language establishing a temporary insurance pool to help people with pre-existing conditions.

That pool is supposed to go away at the end of 2013, when people transition to an expanded Medicaid program. However, if Idaho doesn’t accept the Medicaid expansion, Christensen said, they’ll fall back under the catastrophic health care program.

The catastrophic health care fund shifted about 130 cases to the federal insurance pool over the past year, he said, because it was cheaper to pay their insurance premiums than to pay for the treatment.

“We paid about $250,000 in premiums to save $9.6 million,” Christensen said.

Those savings go away when the insurance pool is eliminated in 2014.

Expanding Medicaid eligibility would reduce the state and county costs of indigent health care, but Gov. Butch Otter has indicated that he wants to postpone that decision until at least next year, to give the state time to pursue a broader set of Medicaid reforms.