Ramsey County will review fees it charges residents for crisis mental health services

Ramsey County Board Chair Victoria Reinhardt on Tuesday said the county will review its practice of billing patients for mental health crisis services, including its mobile crisis response, after the charges came under scrutiny.

Ramsey County provides mental health services through its Mental Health Center, St. Paul walk-in Urgent Mental Health Care and mobile crisis team. While some Minnesota counties foot the bill for crisis care when residents don’t have insurance or insurance doesn’t cover the cost, Ramsey County bills patients in these instances — fees mental health advocates criticize.

“As is common with medical care, there are fees for these services, and they are billed to insurance whenever possible,” Reinhardt said at a County Board meeting Tuesday. “If insurance doesn’t cover all of the services or the patient does not have insurance, financial assistance options are available.”

Last week, Fox 9 reported Ramsey County residents had received bills for mental health crisis care, including one man who received an unexpected bill for $342 after crisis services intervened when he was contemplating suicide. At that time, Fox 9 reported there was no mention of fees for crisis response on Ramsey County’s website.

The county told Fox 9 the fees were federal and state requirements, but later recanted and apologized. The county also acknowledged it provided Fox 9 an outdated fee schedule.

Data from Ramsey County show that in 2023 and so far this year, Ramsey County logged 2,712 “encounters” with its mobile crisis response teams. Of those, 58% were covered by public insurance such as Medicaid or Medicare, 15% were covered by commercial insurance and 27% were billed to individuals.

Sue Abderholden, the executive director of mental health advocacy group NAMI Minnesota, said she is troubled by Ramsey County’s crisis care fees and said she’s not aware of other counties billing patients directly for such services.

Abderholden said Hennepin County doesn’t charge residents for crisis services. Dakota County spokeswoman Mary Beth Schubert confirmed Dakota County doesn’t. Other counties contacted for information did not respond Tuesday.

Abderholden said her organization has advocated for mental health crisis response teams and for grant money to fund them so counties don’t bill individuals — and so people and families in crisis aren’t incentivized to call police, who are not trained mental health practitioners but don’t charge to respond.

“The whole point of developing these services was to have an alternative to police,” she said. “So we would have a mental health response to a mental health crisis.”

The county says it has updated its website clarifying fee and payment information, added information on fees to mental health crisis phone staffers’ scripts and added inserts to invoices that include information about payment plans and resources.

Reinhardt acknowledged the county has received feedback criticizing the fees. She said it will conduct a review to look at best practices.

“This is an opportunity for Ramsey County to do better,” Reinhardt said. “We really want to make sure that we have this right, that we have all of the information, and then we can make informed decisions as we move forward.”