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Warren County officials flag rising competency-restoration costs, seek state fixes
Summary
Warren County Health Services Committee members were briefed on a spike in competency restoration expenses that exceeded $1.6 million for the year, discussed state funding changes and per-diem increases, and agreed to convene local criminal justice stakeholders to explore responses.
Warren County supervisors and Health Services staff on Monday discussed a sharp rise in competency-restoration expenses that left the county well over budget for the year.
The committee heard that charges for court-ordered competency evaluations and state facility care came in at a total of $1,600,000 for the most recent accounting period, and that the county’s 2025 budgeted amount of about $600,000 will not cover current spending patterns.
The county’s health staff and committee members tied the rise to a 2021 change in how the state allocates costs, an increase in per-diem rates charged by state facilities and a higher caseload. “The expenses have really just been off the charts this year and it came in at a total of 1,600,000,” Rob York, staff member, told the committee.
Why it matters: competence-restoration care sends defendants found unable to understand charges or assist in their defense to state-run facilities. Warren County now pays more and sees longer stays, creating a significant local budget burden and prompting calls for policy change at the state level.
What the committee heard: Staff and supervisors said several factors are driving the cost increase. Speakers reported that New York State in 2021 stopped covering an assumed portion of the expense, leaving counties to carry a larger share. Committee members also cited higher per-diem facility costs — from “a little less than $1,000 a day” to “almost $1,500 a day,” according to staff — and a roughly doubled caseload compared with earlier years.
Tammy, a health department staff member who compiled the county’s chart of historical expenses, told the committee that length of stay has increased and that some individuals remain at state facilities for more than a year. Tammy said county staff see signs that the lines between restoration treatment and longer-term institutional care have blurred and that more detailed analysis is needed.
County staff reported they have begun outreach to criminal justice partners: “We have started some meetings. Christine has called some meetings, and we're pulling in Jason Carasone, our DA, and Greg Canale, a public defender, for some of their input,” Rob York said. The committee agreed to continue those conversations to identify local steps and to inform advocacy with state officials.
Options discussed: Staff and elected officials described possible avenues, including (1) pushing the state to revisit the funding allocation; (2) studying local patterns that drive length of stay and per-diem costs; and (3) exploring legal pathways such as Jackson hearings to determine whether some long-stay individuals are restorable. Committee members noted that Jackson hearings are typically used when restoration appears unlikely; staff said the county will investigate how and when to pursue those proceedings.
What was not decided: The committee did not take formal action beyond agreeing to continue stakeholder meetings. No changes to county policy or budget were adopted at the meeting.
Next steps: County staff will convene meetings with the district attorney’s office and the public defender to review case-level drivers and will continue to work with the New York State Association of Counties and state legislators on potential statutory or budgetary remedies.
Ending: Supervisors expressed concern about the scale of the cost increase and asked staff to return with more detailed case-level data and proposals for next steps.
