Shasta County Board and Behavioral Health Department Director Oppose Plan for Regional Behavioral Health Campus

At a Special Meeting Held on Friday, October 24, 2025, Shasta County Board of Supervisors Voted 3-2 to Oppose True North Behavioral Health Campus Application (Signature Health) for Round 2 of BHCIP* Funds to Build a Facility in Shasta County.

Pros and Cons to the Proposed New Regional Behavioral Health Campus Were Aired at the Meeting with Many Unknowns Regarding Costs to the County.

The County Board of Supervisors weighed the risks and benefits of a private, for-profit behavioral health campus proposed for Shasta County that would serve the North State.  Christy Coleman, Director of Shasta County’s Health and Human Services Agency gave a presentation at the start of the meeting that explained why she is opposed to the True North Behavioral Health Campus (Campus) application proposed by Arch Collaborative, Signature Health, and the Shasta Health Assessment and Redesign Collaborative (SHARC) to secure BHCIP* round 2 funds. 

Coleman pointed out several important reasons she cannot support the proposal at this time.  She explained that the types of beds proposed for the Campus do not meet the needs of the County and would put massive cost increases on the County’s Behavioral Health staff. The bed types proposed include Social Rehabilitation, Crisis Stabilization Units (23-hour stays), and Psychiatric Residential Treatment Facility (PRTF)** beds.  Coleman pointed out that the County does not have a need for PRTF beds, which are extremely costly for the County at approximately $113,000 per bed per month.  She said the County uses the STRTP model*** which costs the County $17,000 per bed per month.  Coleman also stated that “Regardless of there being a contract in place from the County, the County will be responsible to provide services to the facility.”  She explained that having a facility here that serves a large geographical area outside of Shasta County, will place the burden of the facility on Shasta County alone and her department would need to increase billing teams, utilization teams, quality management teams, and patients’ rights teams for Medi-Cal patients served by the facility.  Also, there is a question about who will provide needed medical clearances.  A medical clearance is a brief evaluation by a physician or qualified medical professional (often in an emergency department) to rule out or stabilize urgent physical health issues and is required before CSU admission to ensure patient safety, comply with regulations, and prevent liability. Will this cost fall on the County’s Regional Health Emergency Department which is already overburdened?  If the facility does not have an IMD exclusion****, that will be another massive cost increase to the County. The County has current contracts with Signature Healthcare and there have been documented problems with the care they have provided to patients which has resulted in bi-weekly reporting to the State.

Coleman pointed out that she is not saying there isn’t a need for a facility here in Shasta County; however, the County’s concerns were not addressed and were not taken into account by those who prepared this proposal.  This proposal needs a letter of support from the County in order to be considered by the State according to her assessment of the criteria for awarding the grant.  Even though the role of the County is critical to the overall plan, Coleman says she has not even been given a copy of the completed application which is due to the State by October 28^th.  There is also a concern of how the facility will be able to recruit staff with the County already facing a severe shortage of healthcare professionals. 

Public comments followed Ms. Coleman’s presentation with 25 people expressing support for the Campus and six people voicing concerns or opposition. 

Dr. James Mu, Shasta County’s Public Health Officer, who had originally expressed his support for the Campus, decided to suspend his support at this time, wanting to obtain more information prior to making a final decision.

Kevin Crye stated that he does not want other counties’ mentally unstable individuals being sent here.  He is also concerned about the financial burden that will be placed on the County and is proposing a “Letter of Opposition” from the Board of Supervisors. 

Supervisor Allen Long stated we should remain neutral in this proposal for now and allow it to go forward to give us more time to assess the risks and benefits.  He did not see any problem with keeping the $200 million proposal in play at this time.

Supervisor Matt Plummer also was in favor of moving forward with the proposal despite Director Coleman’s concerns about increased costs to the County.

Kimberly Johnson, CEO of Arch Collaborative and co-founder of Children’s Legacy Center stated that the application process can go forward even without the letter of support from the County; however, it will require additional documentation given with the application of all correspondence with the County’s Behavioral Health Department.

The meeting concluded with a motion passing 3-2 to approve a letter which supports the Shasta County Health and Human Services Agency, Behavioral Health Director’s opposition to the True North Behavioral Health Campus application proposed by Arch Collaborative, Signature Health, and the Shasta Health Assessment and Redesign Collaborative, to secure GHCIP Round 2 funds. 

Footnotes:

*BHCIP funds refer to grants awarded through California's Behavioral Health Continuum Infrastructure Program (BHCIP), a state initiative administered by the Department of Health Care Services (DHCS). Launched in 2021 via budget legislation (AB 128, SB 144), the program provides competitive grants to address critical shortages in behavioral health facilities, including mental health and substance use disorder (SUD) treatment infrastructure. These funds support the construction, acquisition, rehabilitation, and expansion of properties to create a full continuum of care—from crisis stabilization and residential treatment to supportive housing and mobile crisis services—prioritizing underserved populations like those experiencing homelessness, Medi-Cal beneficiaries, youth, veterans, and Tribal communities.

**Psychiatric Residential Treatment Facility (PRTF) is a specialized, non-hospital residential program that provides intensive, 24-hour therapeutic care for children and adolescents (typically under age 21) with serious emotional, behavioral, or mental health disorders. These facilities offer a structured environment combining psychiatric treatment, therapy, education, and daily living support when less restrictive settings (like outpatient care or foster care) are insufficient.

Key Features of PRTF Beds:

• Level of Care: Higher than therapeutic group homes but below inpatient psychiatric hospitalization.

• Staffing: Includes psychiatrists, therapists, nurses, and direct care staff on-site around the clock.

  
  

***STRTP beds refer to beds in Short-Term Residential Therapeutic Programs (STRTPs), a type of licensed residential facility in California's child welfare and mental health system. Established under the Continuum of Care Reform (CCR) via Assembly Bill 403 (effective January 1, 2017), STRTPs replaced most traditional group homes to provide short-term, intensive therapeutic care for youth with serious emotional or behavioral disorders. These programs emphasize "treatment, not placement," focusing on stabilization, family reunification, or transition to lower levels of care rather than long-term institutionalization. STRTPs are regulated by the California Department of Social Services (CDSS) for licensing and the Department of Health Care Services (DHCS) for mental health certification.

STRTP beds are part of the broader behavioral health continuum, serving as a step-down from more restrictive settings like Psychiatric Residential Treatment Facilities (PRTFs) or acute inpatient units. They align with federal requirements under the Family First Prevention Services Act (FFPSA), where STRTPs function as Qualified Residential Treatment Programs (QRTPs), requiring accreditation and individualized assessments by a Qualified Individual (QI) within 30 days of placement.

Key Features of STRTP Beds

Feature	Description
Target Population	Youth ages 6–21 (including non-minor dependents up to 21) who are dependents of the court, probation-supervised, or at risk of harm to self/others due to mental health needs. Often includes trauma, abuse/neglect histories, or co-occurring substance use.
Bed Capacity	Typically 6–20 beds per facility (e.g., home-like ranch-style settings); statewide, ~1,500–2,000 beds as of 2025, with ongoing expansions via BHCIP grants.
Length of Stay	Short-term: 6–12 months average, with a focus on permanency (e.g., reunification within 12 months under FFPSA).

****The Institutions for Mental Diseases (IMD) exclusion is a longstanding federal policy in the U.S. Medicaid program that prohibits states from receiving federal matching funds (typically ~50% of costs, known as the Federal Medical Assistance Percentage or FMAP) for most services provided to Medicaid-eligible individuals aged 21–64 who are patients in certain large inpatient mental health or substance use disorder (SUD) facilities. Enacted as part of the Social Security Act in 1965 (§ 1905(a)(30)(B)), this rule was originally intended to prevent states from offloading the costs of large state-run psychiatric asylums onto the federal government and to encourage a shift toward community-based care over institutionalization.

An IMD is defined as any facility with more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care for persons with mental diseases, including psychiatric hospitals, nursing facilities, or other residential treatment centers offering medical attention, nursing, and related services. This includes both mental health and SUD-focused settings. The exclusion is unique in Medicaid law because it denies coverage based solely on the type of illness (mental health/SUD) and facility size, rather than medical necessity—unlike coverage for physical health conditions.