Marquette County human services staff report staffing shortfalls, costly out‑of‑county placements ahead of budget review

Marquette County Health & Human Services staff warned the county committee on Wednesday that staffing shortages, long wait lists and costly out‑of‑county placements are pressuring the department as it prepares its budget for September.

Director Mandy (speaker 5) and clinical services manager Dawn (speaker 4) told the committee the department has filled some vacancies but remains short of key clinical staff. "We have filled our vacant billing specialist position," Mandy said, and named Linda Glass as the internal candidate who will move into a quality‑assurance role. She said interviews are scheduled to backfill other positions and that a contracted nurse is providing 16 hours of weekly coverage.

The presenters described heavy demand for crisis and placement services. Veteran service officer Brandon (speaker 1) reported closing 20 cases since the last meeting, with 101 active cases, 12 new cases and 11 matters at the Board of Veterans' Appeals; he said the VA's updated appraisal and Community Care policies should reduce delays for veterans. "This is huge," Brandon said about the VA changes.

Dawn outlined clinical services’ scope and limits: the county clinic serves Marquette County residents who have Medicaid or no insurance, and the crisis program must respond to any person physically located in the county. She described core programs — outpatient counseling, psychiatry and medication management, two case‑management tracks, and crisis intervention that includes phone assessments and mobile response contracted through Northwest Connections.

Staffing gaps have forced program adjustments. Dawn said the county recently eliminated the outpatient counseling wait list by assigning crisis workers to create short‑term plans and scheduling intakes; to do so the county removed therapist caseload caps. "We had them capped at about 40 clients, and we just… we're not gonna cap them," Dawn said, noting the county is currently operating with two therapists who are handling multiple intakes per week and are "pretty overworked."

Placement costs and geography are a continuing strain. Dawn cited daily placement rates that have ranged from about $400 to $1,100 for long‑term residential settings and gave examples of hospitalization or stabilization fees: she reported Winnebago at about $1,756 per day and Fond du Lac Healthcare at about $1,700 per day. The department also described difficulties finding local beds and the operational burden of transporting and monitoring clients placed outside the county.

Mandy described the department's mix of funding — county tax levy, OWI surcharge funds, Medicaid billing, client fees and grants — and reminded the committee that a statutorily required public budget survey is open and closes this week; the results will inform the department's September budget presentation. She said the department participates in broader county budget planning and is preparing materials for an executive/finance review of department budgets.

Committee members discussed school‑based services and regional provider capacity. Dawn said the department will not provide school‑based mental health services this year because of therapist shortages; she recommended schools pursue private agency contracts or virtual options as alternatives. Members noted Noble Clinics and Northland as regional providers that see privately insured patients and suggested the county continue coordinating with partner agencies.

The committee set a tentative focus on budget work for its September meeting and discussed canceling the August meeting; members said the clerk will confirm a September 15 meeting if scheduling permits. There were no votes on policy changes or budget authorizations during this meeting.

The committee adjourned at the end of the session.