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County staff detail efforts to restart CCS, expand CLTS and rein in out‑of‑county psychiatric costs
Summary
Health and Human Services staff reported progress reestablishing Comprehensive Community Services (CCS), shifting CLTS cases and pursuing local solutions to reduce lengthy, expensive out‑of‑county psychiatric placements such as Winnebago; staff said a Medicaid waiver and other funding mechanisms could change the cost picture.
County behavioral health staff told the Sawyer County Health and Human Services board on Oct. 7 that they are reestablishing CCS services, reallocating CLTS caseloads and exploring local step‑down housing as a way to reduce lengthy, costly out‑of‑county psychiatric placements.
Alicia, a behavioral health staff member, said the county recorded a surge in OWI assessments this month (eight in the month) and has done 46 assessments year to date. She said CCS enrollment requires Medical Assistance eligibility and that one recent referral failed that rule because the person had private insurance.
The county has recruited at least one CCS‑qualified therapist. Alicia said Caitlin Myron is CCS certified and is willing to provide psychotherapy services; Myron will contract through the regional NCRCCS consortium. Staff also plan to shift some CLTS (Children’s Long Term Support) clients to service facilitators who are already county staff so the county can provide services directly and capture related Medicaid billing.
Staff described program and capacity numbers: CLTS had about 59–60 clients at the time of reporting, with multiple transfer clients received in single days; CST had six clients; the county was working through functional screening to identify appropriate program placements. Alicia warned that restarting CCS and reassigning CLTS clients will be labor intensive at a time the department is also adopting a new electronic health record.
Several speakers described high-cost, out‑of‑county placements. County staff said multiple Sawyer County residents are in long‑term mental health commitments out of county (including at Winnebago), and the county has clients in residential care and treatment foster care. Staff are holding weekly meetings with Winnebago to try to establish placements and to explore transitional housing and step‑down facilities to bring clients back to the county. One option discussed is using Community Support Program (CSP) services and local transitional housing to reduce hospital and out‑of‑county residential days.
Staff referenced statutory commitment procedures (chapter 51 and chapter 55 as discussed in the meeting) that can require law enforcement presence until placement is secured and noted the burden placed on county resources when placements cannot be found quickly. Staff also described the possibility that a federal Medicaid waiver or other federal action might allow Medicaid payments for stays at certain facilities (an IMD-related waiver was discussed in the meeting), which would reduce county costs if approved and implemented.
Finance staff said billing for case management (where eligible) and operating CCS with county staff can generate revenue streams the county has not previously captured; CCS was described in the meeting as a program that is “100% funded” for medically eligible clients, meaning Medical Assistance covers services. Board members asked about aligning centralized referrals to improve screening and avoid spending staff time on ineligible referrals.
No specific board vote was taken on program changes at the meeting; staff described hiring and contracting steps already underway and said they will continue weekly placement coordination and pursue contractual arrangements to reintroduce CCS services and expand local capacity.
