Ramsey County Board Workshop on State Operated Services: Direct Care and Treatment - May 5, 2026
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Ramsey County Board Workshop on State Operated Services: Direct Care and Treatment - May 5, 2026
The Ramsey County Board held a workshop on May 5, 2026, to discuss state operated services, focusing on civil commitment processes, rising costs, and system challenges. Presentations covered the doubling of mentally ill and dangerous (MIND) commitments over the past decade, the financial burden of patients who no longer meet hospital criteria (DNMC), and extensive wait times for forensic services. No votes were taken; the session was informational and exploratory.
Discussion Items
- Civil Commitment Trends: The number of civil commitments for mentally ill and dangerous individuals has doubled in 10 years. In 2025, approximately 60 individuals were committed as MIND. The number of individuals served at the state forensic hospital (St. Peter) has decreased due to successful discharges and system strain, while the waitlist for admission has grown to over two years for some.
- Cost Drivers: Costs for state operated services have risen 103% since 2021, driven by longer lengths of stay for patients who no longer meet hospital criteria (DNMC). DNMC costs increased 266% and now account for over 50% of total costs. The county pays $77,000 per month per DNMC individual. In 2025, Ramsey County’s total cost was $17 million, with 8 MIND clients representing 37% of DNMC costs.
- Discharge Barriers: The average length of stay for DNMC patients is 357 days, compared to 33 days for those who leave when treatment ends. Barriers include lack of community placement options, criminal court holds, and insurance limitations. The federal IMD exclusion prevents billing Medicaid for state hospitals over 16 beds, and once a patient is DNMC, insurance cannot be billed.
- Wait Times for Priority Admissions: Average wait time for admission to forensic services (St. Peter) is 299.9 days from referral. Some individuals wait over 500 days. The 48-hour rule for state acceptance has been ineffective due to bed capacity issues. A 50-bed expansion at AMRTC is planned but not expected until 2028–2029.
- State and County Roles: The state’s priority admissions task force and review panel have improved data transparency and admission criteria (acuity-based), but disagreements remain over the 48-hour rule. Counties advocate for its retention to ensure state accountability, while the state argues it is unattainable given capacity constraints.
- Community Resource Gaps: There is a critical need for step-down facilities between hospital and community care. The county is exploring partnerships with housing providers, grant-funded programs (e.g., AMHI, CSP, innovations grants), and targeted case management for high-risk individuals.
Key Outcomes
- No formal decisions or votes were taken during this workshop.
- Next Steps: The board will continue cross-county collaboration to address system gaps. Potential advocacy areas include: (1) legislative action to redirect county payments ($17 million) into the continuum of care, (2) expansion of community-based step-down resources, (3) improving medical assistance eligibility processes, and (4) addressing workforce shortages. The county will also examine internal investments and partnerships to reduce reliance on jail-based care and improve discharge timelines.
Meeting Transcript
Noon, every good afternoon, everyone. And welcome back to the Ramsey County Board Workshop Part 2 or Part One. This morning we had the opportunity to do a workshop on understanding state hospital utilization and rising costs in Ramsey County. And this afternoon workshop and presentation would be on state operating services, direct care and treatment. Just a courtesy reminder that this board meeting is recorded and is live stream on Zoom webinar. There will be no votes taken during this workshop. So let's start as introductions of commissioners and presenters around the table, then the rest of the room. So we'll open up with introducing myself, Rainy Moran, Commissioner District 4. Sorry, Gemin State Commissioner District One. Nightanjong, Commissioner for District 6. Virtuary Commissioner District 3. Sophia Thompson, Social Services Director. Eric Elson Transitional League Director for Director and Treatment. Charles Gaff Manager and Social Services. Ian Zimmerman, Assistant Ramsey County Attorney and the Civil Commitment Unity. Oh, you have students and services tonight. Angela Young Right, it's the HMS on the colleagues in the software. Danny's not today. Jessica Junior. Directly behind you. I'm sure Penny Manager. Bike over here. Yep. Janelle White over soon. Welcome to thank you all for being here. I wouldn't be amiss if I don't say welcome, uh, former commissioner Nicole Father. Good to see you. Okay. So this session is a continuation of this morning's workshop on the state operating services. This afternoon, we'll give an overview of the civic commitment process. We'll review key trends and rising costs tied to the work, then discuss the challenges we're facing and was and with strategies to address them. With that, I would like to turn it over to the presenters. Thank you very much, Chair Moran. Commissioners County Manager Becker. Okay. As was mentioned, we um a reminder our goals for today's workshop. They were shared at this this morning, and so we're not gonna repeat the all of the goals. Um, but and but excuse me, they should look familiar. We hope this that this morning we were able to frame up the county's role and some of the challenges being faced with our state operated services landscape. In all of this, we hope you hear the importance of improving our system for the residents in need of care. This afternoon, we're gonna share some of those trends in this excuse me. We're seeing in this space around the individuals being served and the costs connected to their care. We'll take a closer look at significant increases in the cost of care as well as the challenges of discharging individuals from state operated services. So this morning we talked about some of what some of those barriers were. We'll talk uh a little bit about those when discharging, even when they do technically do not meet um those qualifications. We have Ann Zimmerman from the Ramsey County Attorney's Office. Um, we'll review the commitment process and the complexities of those cases. We have um Eric Adolfson, who is still with us, and he'll talk um a little bit about some of our statistics and Angela Youngerbird. We'll discuss the work of the priority admissions task force, the steps being taken to address the challenges in our systems and the opportunities for counties to consider for future improvements. So before we jump into the detailed information about a specific group of our clients and some of the cost information, this is a very brief overview of the commitments.
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