AUGUSTA — Department of Health and Human Services Commissioner Mary Mayhew told lawmakers on Monday that the state will likely have to absorb the cost of running Riverview Psychiatric Center unless major changes are made.

Mayhew asked for guidance on whether Maine should continue to accept federal funding or whether lawmakers would prefer using state funding for the $24.5 million it will cost to keep Riverview open through June 2017.

Maine could already be on the hook for $30 million, possibly plus interest, that the federal Centers for Medicare and Medicaid Services has already paid for Riverview operations between the hospital’s decertification in September 2013 and last month. Mayhew told members of the Legislature’s Appropriations Committee on Monday that if they don’t want to risk more financial liability to the federal government, they appropriate $24.5 million to keep the hospital running through June 2017.

Last month, a federal judge ruled against a DHHS appeal in the matter, though the federal government has so far not requested a refund.

“Given the recent legal decision, I am requesting the Appropriations Committee, as the appropriators of state general funds, to provide the department with a decision on how you wish us to proceed regarding the ongoing use of federal funds,” said Mayhew, reading from a lengthy written statement. “Should you determine that the future liability and risk is too great to continue to draw down these federal funds, we would request an appropriation of $10.5 million for the remainder of this fiscal year and $14 million in fiscal year 2017.”

At issue is the fact that Maine uses Riverview for two purposes: as a hospital for civilians with severe mental health problems and as a forensic treatment facility for patients referred by the Department of Corrections. The latter include violent offenders who have been deemed not criminally responsible by reason of insanity by the courts.

The Centers for Medicare and Medicare services has taken the stance that it will not pay to hospitalize patients, such as some of those who came to Riverview because of the court system, who might not need hospitalization and could be cared for in a secure but less intense treatment facility.

“The bottom line is that we have too many people in Riverview who do not belong in Riverview,” said Jay Harper, the hospital’s superintendent. “[The Centers for Medicare and Medicaid services] has been very clear when they’ve said ‘when you put someone in a hospital who is not appropriate for a hospital level of care, we’re not going to pay.’”

Monday’s hearing at times devolved into tense exchanges between Mayhew and some Democratic lawmakers who accused her and Republican Gov. Paul LePage of trying to shift blame for the problems at Riverview to the Legislature.

While lawmakers contend that the Legislature has provided emergency funding to Riverview five times during LePage’s tenure as governor totalling $5 million, the department cast the blame back at the Legislature for rejecting its proposals to convert the facility to total state funding in 2012 and to allocate $3.8 million per year to create a treatment facility outside Riverview for forensic patients, which Mayhew said would satisfy the feds.

Lawmakers said they rejected the latter proposal because it was short on details.

“No one can say that the department has not received funding or consideration due to politics,” said Sen. Linda Valentino, D-Saco. “I take a little bit of exception to everybody blaming the Legislature. Do you think there is a confidence or credibility crisis? Are we at a juncture that we need an independent agency to come in and tell us what to do?”

Rep. Gay Grant, D-Gardiner, presented Mayhew with a list of questions about creating a separate system for forensic patients.

“If you as an administration are asking us to take a severe departure from the way that we treat and care for mentally ill patients, to go to a privatized, separate system, we need adequate details about how that system will be operated,” said Grant.

Mayhew, after critical questions from Grant, Valentino and others, took exception to the tone of the meeting.

“I came here to provide information,” she said. “I am not going to sit here and listen to an attack or be questioned about the executive branch’s role.”

The Appropriations Committee meets again in October, but most of the solutions on the table for Riverview require approval by the Legislature, which isn’t scheduled to return to Augusta until January.