Md. Health Dept. Can’t Provide Data on or Costs Related to Undocumented Persons in Mental Health System

New data obtained from the Maryland Department of Health (MDH) through a Public Information Act request indicates that the state’s court-ordered behavioral health waitlist has seen minimal change throughout 2025, despite judicial findings of contempt against the state for mismanagement of its resources. Not only do the provided statistics reveal that the backlog of individuals committed to state custody awaiting treatment beds has averaged over 200 people per month since February of this year, but the State was unable to provide any records regarding the number of persons ready for discharge from DHMH commitment but held due to their undocumented status, or the cost of immigration attorneys for those persons, despite admitting in court that four attorneys had been hired. This information comes after MDH was cited in a year-end report for having considerable audit concerns.

The data illustrates a persistent issue, with the number of individuals on the waitlist hovering above 200 for much of 2025. For instance, in February 2025, there were 240 individuals awaiting placement, which decreased slightly to 197 by June, the only month below 200. By October, the number had risen again to 212, and as of November 20, 2025, the waitlist stood at 200 individuals, including six held on hospital warrants. This stagnation was noted by the Circuit Court for Washington County, which in August found clear and convincing evidence that the state had voluntarily opted to keep 141 patients deemed “eligible for release” in custody rather than making space for new admissions ordered by the court.

A central point of contention leading to the court’s contempt finding involved revelations that MDH was reportedly using “scarce resources” to hire immigration attorneys for undocumented patients who were otherwise eligible for release. The court suggested these funds could have been better allocated to expand the state’s treatment capacity and create additional beds. In an attempt to clarify the extent of these expenditures, the Public Information Act request sought official policies regarding the hiring of immigration attorneys for undocumented patients and the total taxpayer money spent on these services. However, MDH stated that it possesses no responsive records detailing official policies for these hires or the specific financial amounts spent since February 2025. This lack of documentation or policies is notable given sworn testimony from an MDH witness in August, who admitted that the department had already retained four immigration attorneys for “under and undocumented” patients, and now has admitted through their own PIA response that no policy exists specifically authorizing such actions, implying that these actions are being taking by inferring their permissibility under existing policies relating to written aftercare plans. The department appears to have inferred that hiring immigration attorneys falls under the mandate to provide “legal aid” and “social services” necessary to execute a viable discharge plan, but without comment from MDH this cannot be said for certain.

The Maryland Department of Health has further acknowledged a complete absence of records pertaining to the financial and operational impact of its immigration attorney program, despite prior indications that such metrics were tracked. This gap in documentation extends to taxpayer costs, statistics on the undocumented patient population, and the legal frameworks governing these expenditures. MDH’s assertion of holding “no responsive records” concerning the amount of taxpayer dollars spent on immigration attorneys for patients in its custody since February 1, 2025, directly contradicts sworn court testimony from August 2025, where an MDH witness confirmed the hiring of four such attorneys for “under and undocumented” patients. This lack of fiscal oversight raises questions about the transparent management of public funds, especially with MDH already stating under oath that it has hired immigration attorneys.

Furthermore, the department stated it does not have data on the number of undocumented individuals currently occupying beds in its facilities. While specific counts for this demographic are unavailable, the overall behavioral health waitlist has remained stagnant, with approximately 200 people awaiting placement as of late November 2025. This contrasts with data from 2023, which indicated that MDH previously monitored factors that made individuals “difficult to place,” explicitly including “undocumented” as a category. In the contempt finding, Judge Michael highlighted MDH’s voluntary decision to retain at least 141 release-eligible patients, some of whom were undocumented, while new court-ordered defendants were denied admission, characterizing this as a “willful and continuous” defiance of state law. The department has also failed to produce any official policy that either authorizes or governs the hiring of private immigration attorneys for individuals in state psychiatric custody, stating it has no responsive records for such policies, even while continuing to expend “scarce resources” on these services.

The inability to properly account for these expenses is yet another example of the continuing issues Maryland Department of Health is experiencing. In addition to these behavioral health concerns, a Maryland audit of MDH revealed that the department did not properly report unprovided-for general fund payables totaling at least $7.2 million to the Government Accounting Department (GAD). The audit noted that during July and August 2025, six disbursements included payments totaling $7.2 million for Medicaid claims dating back to August 2019, which were charged against MDH’s fiscal year 2026 appropriation. MDH indicated these payments were related to longstanding suspended Medicaid claims and that, as of October 2025, it was still investigating the matter to determine the appropriate funding source and whether other prior-year Medicaid claims had been paid with fiscal 2026 funds. The audit concluded that if fiscal year 2026 general funds were needed for current year expenses, MDH might require a deficiency appropriation.

MDH also faced another finding in the same report for having $280.9 million in unfunded liabilities as of June 30, 2025. Previous audits of MDH have similarly noted significant deficiencies in federal fund accounting and unrecovered funds.

As of publication, officials from the Maryland Department of Health have not responded to request for comment regarding the waitlist numbers or the absence of documentation concerning immigration attorney expenditures. The court’s previous finding of contempt against the state, combined with the lack of available data on immigration attorney costs, highlights the persistent concerns regarding MDH’s ability to properly manage or track the allocation of public resources.

The MDH response to our records request is below.

Article by Ken Buckler, based upon information from the Maryland Department of Health, and the Statewide Review of Budget Closeout Transactions for Fiscal Year 2025 from the Maryland Office of Legislative Audits

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