Behavioral health director warns of multimillion-dollar shortfall; asks board to help prioritize services and pursue funding

Humboldt County’s Behavioral Health leadership told the Board of Supervisors on Feb. 25 that the department is operating with a multi-million-dollar shortfall and warned that rising inpatient, long-term placement and crisis costs—combined with new state mandates and expanded reporting obligations—are pushing the program to a point where staff will need board direction on prioritizing services or identifying new revenue.

Behavioral Health Director Amy Botsler Rogers said the department’s fiscal-year 2023–24 accounting initially shows “about a $2,700,000 shortfall” that staff are still working to reduce through claim corrections and retroactive billing. She said the department’s total expenditures for 2023–24 were roughly $64.5 million and noted large line items that do not produce equivalent local revenue: inpatient and stabilization services (Sempervirens psychiatric unit and the county crisis stabilization unit), and long-term care placements for conservatees.

Deputy director Paul Bagnacchi told the board that LPS (conserved) patients often occupy a large share of beds on the county’s acute psychiatric unit and that those conserved patients typically require long-term placements that are costly and not substantially reimbursed by Medi-Cal or other sources. “LPS conserved individuals spend seven times more days on Sempervirens than non-LPS individuals,” Bagnacchi said, and placements outside the county have risen in cost; local locked residential options are costly and unlocked ARF placements are limited by capacity and clinical fit.

Director Botsler Rogers said much of the financial pressure is structural: the county’s maintenance-of-effort contribution for mental health has not been updated in decades and many recent state laws and programs (including Care Court, SB 43 expansions and new data/reporting requirements) require planning, staff time and systems upgrades but carry limited or no additional county-directed revenue. The director asked the board for help identifying funding and said the department would return with a budget presentation and options, including potential service prioritization or targeted investments.

Ending: Board members urged the department to return with concrete proposals and asked staff to examine partnerships with cities, other counties and service providers; the board accepted the department’s presentation 4-0.