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Crow Wing County Board: Mental health focus of lobbying efforts

Association of Minnesota Counties Executive Director Julie Ring gives the Crow Wing County Board of Commissioners an update at its Tuesday, June 12, meeting in Brainerd. Frank Lee / Brainerd Dispatch

The Crow Wing County Board of Commissioners received an update at the board's meeting on a host of issues from the executive director of the Association of Minnesota Counties.

Julie Ring was invited to the Tuesday, June 12, meeting in Brainerd and talked at length about challenges facing the 87 Minnesota counties the St. Paul-based association represents.

"There were 80 bills signed into law this year," Ring told the board. "The big bill that was signed into law that actually contained most of our county AMC priorities was the bonding bill."

Last month, Gov. Mark Dayton signed a $1.43 billion construction bill the Democrat was not entirely happy about, but the signature resulted in salvaging one piece of the 2018 legislative session.

The Association of Minnesota Counties is a voluntary, non-partisan statewide organization assisting the state's 87 counties in providing effective county governance to the people of Minnesota since 1909, the organization states.

"Our biggest priority of the year was an investment in a grant program to create some regional mental health crisis centers," Ring said.

Mental health

The board approved at its Jan. 23 meeting an Association of Minnesota Counties mental health bonding resolution supporting state capital investments for regional behavioral health crisis program facilities and permanent supportive housing for those with behavioral health needs.

"And I want to thank you along with the other 86 counties in the state. You did pass a resolution of support for that proposal," Ring told the board Tuesday.

The resolution requested the county's support of the association's efforts in lobbying the state to loosen its purse strings to allow better treatment options of the mentally ill.

"We maxed out the number of bill authors we could get in a bipartisan way. It was a really big initiative for us this year," Ring said.

The state of Minnesota closed state hospitals and replaced them with smaller, community-based hospitals like the one in Baxter, but did not build enough community-based hospitals and chose to underfund the ones it did build, according to County Administrator Tim Houle.

The bonding bill includes $30 million for behavioral health crisis centers, including $1.9 million designated for a Scott County crisis stabilization facility. In addition, the bill includes $30 million for supportive housing for individuals with behavioral health needs.

"We see this as critical in helping counties address the mental health needs in our communities. ... Getting folks out of the Anoka Regional Treatment Center, which is a very expensive place to house people, and a place where you pay, as a county board ... really high costs," Ring said.

"You know, as the county board, that you spend a lot of money on health and human services, and in corrections trying to help people probably without the right tools."

Essentia Health-St. Joseph's Medical Center admits only voluntary patients into its Grace Unit for mental health care as of September. Essentia Health officials noted the facility is not designed nor staffed to care for involuntary patients, some of whom pose a danger to others.

"We have an awful lot of mentally ill people who end up in our jails, who end up having to be transported far away from home, often down to the Anoka Regional Treatment Center. ... By having a few regional centers, we can begin to address the issue," Ring said.

"The idea behind these crisis centers is it is a short-term place where people in crisis can go or be taken to be stabilized instead of ending up in the emergency room or in the jail."

Community Services Director Kara Terry once gave the board at its Jan. 23 meeting an example of a jail inmate booked six times—and civilly committed after the second and sixth booking—to show the financial burden the person places on the county.

"Between the state-operated services, the social services cost, the county attorney's cost and

the jail costs, we estimated that the total costs would be $223,593 for this one individual. ...

That's a pretty significant cost to the county and to the taxpayers," Terry said at the time.

The Central Minnesota Housing Partnership was recently before the Baxter City Council seeking support for a development called White Oak Estates. The affordable housing project in Baxter seeks to provide apartments for those with a mental illness.

County Community Services Programs Manager Tami Lueck said what is attractive about the proposed housing model is someone would be at the front desk around the clock that could call mental health professionals as needed.

The Central Minnesota Housing partnership is a regional nonprofit originally created and incorporated in 1993. The partnership was designated as a Community Housing Development Organization by the Minnesota Housing Finance Agency the following year.

Bonding bill

Ring said in the bonding bill there was funding for counties for local roads and bridges, local wetland replacement programs and more.

The Legislature included $15 million from the general fund in the Omnibus Supplemental Finance bill for the Border-to-Border Broadband Grant Program, but Dayton's veto means funding for broadband is at zero for 2018.

"We know broadband expansion is critical for economic development across the state, so we're disappointed we're going to have to wait a year before we see any more investment in broadband," Ring said.

"When it comes to Medicaid work requirements, which did not pass this year, for us as a statewide association, this is a really controversial issue," Ring told Thiede.

Medicaid provides health coverage to millions of Americans, including children, pregnant women, parents, seniors and people with disabilities. In some states, the program covers all low-income adults below a certain income level, according to Benefits.gov.

"We have county commissioners across the state who think work requirements are a good idea, and we have commissioners who think they're a bad idea," Ring said.

"We don't have a policy position on the underlying policy matter whether there should be a work requirement to receive Medicaid. What I know is a concern to counties is the cost to counties to administer this, and I'm extremely concerned about that, we did express that concern."

It would cost about $120 million to counties across the state annually to implement work requirements, according to Ring.

"AMC's testimony throughout this session was if the state believes this is good public policy, if the Legislature decides this is good public policy that people should work if they receive this benefit, the state has to figure out how to pay for the administration of that as well," Ring said.

"The numbers we saw, the estimates of what it would cost us to implement the bureaucracy would cost more than the state would potentially save by the number of people who would no longer be receiving Medical Assistance."

Identifying trends

Ring said the Association of Minnesota Counties identified three key things it will focus on for the next couple of years.

"The topline one is around workforce, county workforce specifically—our ability to recruit, retain, promote county workers, so that you have the staff to do the work that you are required to do by law. ... It's a real concern for many of our counties," Ring said.

"The second trend is around infrastructure ... our ability to maintain what we are required to maintain, whether it's roads, bridges, buildings ... making sure that we are being creative about how we do that in the most cost-effective way."

The 10 districts of the association select delegates to serve on the association's five policy committees, with district meetings occurring at least two times per year to refine policy positions and provide information on specific county issues.

"I'd like for this trend to go away sometime in my lifetime, but it's around health and human services cost shifts and increasing health and human services costs to counties. This is an issue that every county is concerned about," Ring said.

"And I think we hopefully can help bring to bear some creative solutions. We do that by helping counties share ideas amongst themselves, and there are public policy things we can do at the Capitol around mandate reduction."

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