CLEVELAND, Ohio — When Cuyahoga County leaders voted to put $7 million toward building a new crisis center downtown, they did so on faith that the money needed to run it long-term would eventually follow.

Eric Morse, president of The Centers, which will operate the facility, reassured council members that the project will prove itself and that “the funding needed will materialize” after the county stops contributing. He suggested that hospitals, in particular, might eventually be compelled to chip in, given the potential savings from fewer psychiatric patients crowding their ERs.

He pointed to Columbus as an example, saying hospitals there are contributing to Franklin County’s new crisis center. However, a closer look at the model found that Franklin’s crisis center was also built and opened before the funding was fully worked out – and hospitals are playing a lesser role than Morse suggested.

Columbus hospital systems, including Mount Carmel, OhioHealth and Ohio State University Wexner Medical Center, did pitch in $8 million toward construction of Franklin County’s crisis center, but they have not pledged to keep funding it, according to Jonathan Thomas, CFO of the Alcohol, Drug and Mental Health Board, which is funding the crisis center.

While he said some hospitals may be considering the “value of the investment” and whether to keep contributing, “as of today, there’s been no commitments from health systems funding the operations of the crisis care center.”

Instead, the ADAMH Board is counting on insurance reimbursements and passing a new levy to sustain operations. The Board has a 10-year, 3.35-mill replacement levy on the November ballot, which includes a 0.5 mill increase that would specifically generate revenue for the crisis center.

If passed, the levy would take effect in 2027 and cost property owners $68.91 annually for every $100,000 of taxable value – $17.50 more than what they’re paying now. It’s expected to raise nearly $116 million annually, most of which would go toward supporting ADAMH’s other services, with $25.6 million generated from the increase going to the crisis center.

“It was determined that the .5 mills increase was most appropriate to balance maintaining our current investments in the community, fully delivering the crisis care center but also not overburdening the taxpayer,” Thomas said, noting the board had initially considered a higher increase.

Franklin County last increased the levy millage in 2020. At that time, “we knew that Franklin County residents needed the best crisis care services available and that we currently weren’t able to provide that,” Thomas explained. They talked of raising funding again for a crisis center, but the pandemic hit, and the Board delayed waiting to see if promised reforms to Medicaid reimbursement for crisis services panned out, he said.

“Well, now, here we are in 2025. We still don’t have the crisis reimbursement reform, yet the demand for services has not lessened,” he said. “Our commissioners recognized that, and that’s why they supported an additional increase to ensure that we can deliver on this promise to our residents.”

The crisis center itself is expected to cost $11 million this year, $25 million next year and up to $29 million once it’s fully operational, Thomas said. The ADAMH’s Board is only expecting to fund a portion of it, even with the new levy.

The Board is budgeting $10-12 million for operations next year and $18 million in 2029, Thomas said. The remaining balance is expected to be covered by billing insurance, with more levy funding in reserves if reimbursements fall short.

If the levy should fail, Thomas said the Board will have two more chances to pass it. But, worst case scenario, if funding doesn’t come through, he predicted services would be scaled back to fit within the budget. That was the benefit of a phased approach to opening the crisis center, he said, parts can be added or delayed based on funding availability.

How does that compare to Cuyahoga County?

Eric Morse has made a similar case for Cuyahoga County’s crisis facility, saying it too will be opened in phases that provide more flexibility based on funding. But Cuyahoga County is also in a very different funding situation.

In Cuyahoga County, The Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board doesn’t have its own levy. Instead, it relies, in part, on a hefty subsidy – $41 million in recent years – from the county to be able to distribute funds to other community providers.

The ADAMHS Board was already planning to pull back about $10 million of that money from mental health and addiction providers, including eliminating subsidies for two other psychiatric facilities run by FrontLine Service Inc., and MetroHealth Hospital, so it could divert funds to the new crisis center. MetroHealth’s CEO Christine Alexander-Rager announced this week that she will close the new psychiatric emergency department in Cleveland Heights by the end of the year because of it.

In better times, the ADAMHS Board might have appealed to the county to increase its annual subsidy from the Health and Human Services Levy, so that it could maintain existing services – and potentially MetroHealth’s subsidy – while still funding the crisis center. But Cuyahoga County Executive Chris Ronayne largely eliminated that option when he proposed cutting the ADAMHS Board’s subsidy over the next two years to help balance the county’s budget.

Under Ronayne’s recommended budget, the ADAMHS Board would receive $37 million in 2026 and $36.5 million in 2027.

That could further jeopardize the future of the crisis center, which is largely counting on the ADAMHS Board’s continued subsidy to help pay its bills, along with insurance and Medicaid reimbursements, especially after county funding runs out. Cuyahoga County has pledged up to $12 million to support the center during its first three years — but not beyond — leaving questions about what sources might cover potential shortfalls after that.

County officials say they’re trying to bring partners to the table to work through the funding issues, but if the money doesn’t materialize as promised, some councilmembers have worried that the crisis center could become another financial drain on the county’s already tight budget.

Councilman Patrick Kelly, who voted against funding the crisis center, said he fears it could turn out like the Diversion Center, which ate up over $32 million in county dollars with little to show for it and now is being replaced by the $28 million crisis center. Kelly also worries about the other behavioral health services that might be lost in the process – gaining crisis beds in one place just to lose them in another.

“On its surface, the Behavioral Health Crisis Center seems like a good idea, until you start asking questions that can’t be answered,” Kelly said in a texted statement to cleveland.com and The Plain Dealer. “There is no long-term sustainable funding plan for this facility beyond the third year of operations. This is an irresponsible allocation of county dollars.”

How is Columbus’ crisis center working?

Columbus opened the first part of its crisis center in early September, a 23-hour observation unit where up to 40 people can come to be assessed and linked to additional care. In its first few weeks, it served more than 325 people, 60% of them brought in by first responders, Thomas said.

The other two components of the crisis center will be added in phases, he said. They plan to open the urgent care in 2026 and expand capacity in the observation unit to 60 people, and then follow with a 16-bed psychiatric unit in 2027.

Once fully operational, the facility is expected to help more than 34,000 people a year.

The Centers’ plan for Cleveland’s crisis center is similar. It is being marketed as a “no wrong door” hub where people in crisis can walk in, be brought in by police or EMS, or be transferred from crowded ERs and immediately receive care.

It is expected to have an area for rapid stabilization – within 23 hours, a detox wing and short-term psychiatric care. Morse has said it could serve 12,000 to 14,000 residents a year.

For now, both counties are moving forward on faith — Franklin’s in voters, Cuyahoga’s in shaky funding and the hope of future hospital buy-in. Thomas acknowledged that voters in Franklin have long supported ADAMH’s levies, potentially making their investment less of a risk there, but said he’s still confident the gamble will pay off regardless, especially for those residents who need the services most.

“The ultimate goal is that individuals who are having arguably one of the worst days of their life can receive care in a warm, welcoming setting – without unnecessary involvement with emergency departments or first responders or law enforcement,” he said. “And that through offering that crisis stabilization care and then linking those individuals back into a robust network of community-based behavioral health services, they can achieve optimal wellness and live their best life without further undue stress of crisis episodes.”