Eleanor Slater Hospital is currently ineligible to receive millions of dollars in federal support, state officials said Monday.

The hospital, which has campuses in Burrillville and Cranston, serves as Rhode Island’s hospital of last resort for patients with complex medical and psychiatric needs. It is paid for primarily through Medicaid, the federal-state insurance program for low-income and disabled residents.

However, a complex set of regulations essentially bars most Medicaid payments to hospitals in which more than half of the patients are classified as psychiatric. Rhode Island’s Executive Office of Health and Human Services (EOHHS) said Monday that as of early December, Eleanor Slater was over that 50% threshold, classifying the hospital as an Institution for Mental Disease (IMD) and pushing it over the limit for Medicaid dollars.

“EOHHS has determined that the Dec. 1, 2021, ESH census for qualifying psychiatric patients was 55.5% of the total population,” the state’s interim Medicaid director, Kristin Sousa, wrote in a letter to Richard Charest, director of the R.I. Department of Behavioral Healthcare, Development Disabilities and Hospitals, which oversees Eleanor Slater. “As such, EOHHS determines that ESH remains in an IMD status and therefore continues to be unable to claim [reimbursement] from Dec. 1, 2021.”

Eleanor Slater remains allowed to seek federal reimbursement for patients age 65 and older.

EOHHS will next studyEleanor Slater’s census for compliance on May 1, according to a BHDDH spokesman, meaning it’s unlikely the state will be able to receive Medicaid reimbursement until at least May. It is not immediately clear how much money the state will now need to self-fund for the December-April period. However, BHDDH estimates federal reimbursements are $2.3 million lower per month when it can bill only for patients age 65 and older. If the state is ultimately not able to recoup any of the missed reimbursements, and the estimates are accurate, the state will lose roughly $11.5 million in missed reimbursements.

Eleanor Slater houses roughly 200 patients at its two campuses, treating them in its various wards for everything from mental illnesses to dementia to traumatic brain injuries to strokes.

The state has been struggling with issues at Eleanor Slater for years.

The patient mix has been problematic since at least 2019, when former hospital administrators alleged that the state was improperly billing Medicaid for Eleanor Slater patients. In response to these issues, state officials announced plans in November to spin-off part of the hospital into a state psychiatric facility for patients ordered by a court into treatment. That would, officials hope, ensure Medicaid funding by reducing the proportion of psychiatric patients in the rest of the hospital.

The hospital received a preliminary denial of its accreditation in June 2021, due to conditions that a national accrediting body said posed risk of an “immediate threat to health or safety.” The Joint Commission reinstated Eleanor Slater’s full accreditation in late December.

Rhode Island Attorney General Peter Neronha is also investigating patient care and billing issues at the hospital.

This story has been updated with additional information, including BHDDH’s estimate of reimbursements.