December 2015, and what it cost
Federal surveyors visited Osawatomie State Hospital repeatedly between October 2014 and December 2015 and kept finding the same kinds of problem, and in December 2015 the Centers for Medicare and Medicaid Services terminated the hospital's Medicare funding for failing to comply with federal regulations on staff and patient safety[4]. Post Audit put the cost of the loss plus the work to fix the deficiencies at an estimated $15 million as of June 2016[4].
The repair took years and it split the institution. Federal inspectors required renovations before funding could resume, the campus was reorganized into two independently operating hospitals under one superintendent, and Medicare money came back in 2017 for the renovated unit only, which is called Adair Acute Care[5]. Nine years after the termination the older hospital was still uncertified and still funded entirely by the state[5].
A license, a cap and a closed door are three separate things
The 2016 audit is precise about a distinction that is easy to lose. Osawatomie was licensed for 206 beds. Because buildings were closed for renovation the hospital limited its census to no more than 146 patients, which the auditors describe as 60 fewer than the licensed capacity, and the department planned to seek recertification for 60 of the 206[4]. A license is what the state permits, a census cap is what the hospital will accept, and a certified bed is what the federal program will pay for.
A fourth thing happened in the same period and it is the one that shut the door. In its August 2021 audit of mental health and substance abuse initiatives, Post Audit records that in 2015 the hospital imposed a moratorium on voluntary admissions because of insufficient space and staff[3]. The observation that this pushed demand onto community services is attributed in that report to a few of the providers the auditors interviewed rather than stated as an audit finding[3].
The Legislative Research Department later described a new provider category, state institutional alternatives, developed in 2020 by the agency that runs the two hospitals together with KDHE, which licenses them, in response to the lifting of that moratorium[6]. Those are private or community hospitals paid a daily rate to take patients who have been screened for state hospital admission, and the memorandum reports ten contracted facilities with seven of them admitting patients as of October 2023[6].
What the state counted in 2023
The clearest single snapshot of adult capacity in the reachable record is the Legislative Research Department's 2023 briefing article on adult mental health beds. It counts the whole ladder, not just the two hospitals.
| Setting | Beds |
|---|---|
| Osawatomie State Hospital and Adair Acute Care, combined | 174 |
| Larned State Hospital, Psychiatric Services Program | 90 |
| Private psychiatric hospitals statewide | 330 |
| Crisis stabilization centers statewide | 95 |
| Crisis intervention centers, not then operating | 62 |
The numbers on either side of that table
The 174 above is a 2023 figure and it does not survive contact with the documents either side of it. The December 2024 performance audit says the older hospital has capacity for 116 patients and housed 108 in August 2024, and that Adair Acute Care can accommodate 60 and housed 39 in the same month[5]. The January 2026 budget summary, arguing for a $3.5 million remodel that would take one building from 15 patient rooms to 45, says the work would increase capacity at Osawatomie from 159 to 189 by the end of fiscal year 2028[7].
116 plus 60 is 176, which is neither 174 nor 159. This publication cannot reconcile the three from the documents it can reach, and it will not manufacture a reconciliation. Each figure is given above with the document that prints it and the date that document carries. The body that could say which measure each one is, and therefore which of them answers a given question, is the department that runs the hospitals, and its state hospital pages refuse automated retrieval.
The same record cannot even agree on when the hospital opened. Post Audit gives 1863, the Legislative Research Department's briefing article gives 1866, and its memorandum on mental health services gives 1855[5][1][6]. That is a small thing and it is a useful warning about the rest.
At Larned the gap is inside one page
The other state psychiatric hospital serves 61 western counties through its psychiatric services program, which was authorized in 1914 and which admits patients only after a community mental health center has screened them[8]. The program is built as a 30-bed crisis stabilization unit and two adult treatment units budgeted at 30 beds each[8].
The same page then says what the budget does not buy. The program has a budgeted bed capacity of 90 and, in the document's own words, acuity and staffing shortages mean the available beds are currently 74[8]. Sixteen funded beds that nobody can be admitted to is the practical form the shortage takes, and the hospital's own budget page is where that is written down.
The waiting list has a name in the budget and no number in it
A waiting list appears twice in the January 2026 Larned budget summary, in both the revised estimate and the request. The hospital asks for money to reopen a competency unit in its state security program, which it says would add 30 beds, improve its ability to fulfill court orders from counties across the state, and reduce the wait list for the program[2]. Neither passage gives a number for that list, and the hospital's performance-based budgeting pages warn only that if district court beds were reduced the pending admission list would grow and people would wait longer in county jails[8].
That is as close as the reachable record comes. No count of people waiting for a state hospital place on a stated date appears in the six Legislative Research Department documents or the three Post Audit reports read for this article. The figure exists inside the Department for Aging and Disability Services, which has management and oversight of the five state hospitals[7] and to which they report staffing and patient data annually[5]. Publishing it is that department's to do.
What the December 2024 audit was and was not about
The most recent independent look at Osawatomie was an audit of staff safety, authorized by the Legislative Post Audit Committee at its meeting on April 24, 2024 and reported that December as R-24-017[5]. Its scope was physical security, personnel and management culture, drawn from records between January 2022 and September 2024, and its answer to its own question was that the hospital does not adequately ensure the safety and security of its staff[5]. That conclusion is the auditors', and this publication reports it as theirs.
Two of its measurements bear directly on beds even though beds were not the subject. Turnover among state staff averaged 37 percent a year across the three years reviewed, against 16 to 30 percent for Kansas hospitals generally in a 2023 association survey of 110 hospitals the auditors used for comparison[5]. The state staff vacancy rate was about 43 percent on September 1, 2023 and 39 percent a year later, against 45 percent reported for Larned and 24 percent for the state hospital at Parsons[5].
An audit is not a waiting list, and this one says nothing about admissions capacity. The rural care section, which the front page lists with the other three, sets out the distances involved in reaching any hospital at all in western Kansas. The count this page went looking for is in none of the nine documents read for it.