Journey Mental Health Center, the nonprofit that operates the county’s 24-hour crisis line and mobile crisis teams, says the current payment arrangement leaves it responsible for costs that Medicaid reimbursements do not cover. The organization is asking the county to replace that arrangement with a program-by-program budget based on actual expenses.

Journey CEO Sarah Valencia said the nonprofit handles about 35,000 calls and serves roughly 11,000 people each year. People can access its services without being charged, regardless of their insurance or ability to pay.

The county contracts with Journey for crisis services that state law requires counties to make available. Under the current agreement, county payments assume Medicaid will cover part of the cost. Journey says the amount Medicaid pays varies with clients’ eligibility and the services they use, leaving the organization to make up shortfalls when reimbursements are lower than projected.

Journey estimates it has subsidized about $1.8 million in required services over the past four years. Valencia said its reserves have been depleted and the arrangement cannot continue. “We’ve been subsidizing these dollars for the last few years and we can’t keep doing that,” she said.

Under Journey’s proposed model, the county would approve a budget for each program, reimburse the organization for actual costs up to those amounts and retain Medicaid revenue. Journey would no longer be responsible for covering gaps when Medicaid payments fall below estimates.

Agard’s budget, which she calls “Turning the Corner,” aims to reduce a $31.8 million budget gap by half without eliminating filled county jobs, while maintaining funding for conservation and housing. Valencia said the proposal does not resolve Journey’s reimbursement concerns.

County Board Chair Patrick Miles said the county faces difficult choices as it balances required services against limited funds. He welcomed Journey’s testimony, saying it gives supervisors information they can use to press county administrators to address the issue.

Board committees are expected to develop budget amendment recommendations this week. Those proposals will go to the Finance Committee and then to the full County Board, which is scheduled to deliberate in early November. Another public hearing will take place before the board’s final vote.

Journey has warned that without a change to the contract, the service model is unsustainable and the county may have to decide which crisis programs to reduce or cut.