The Virgin Islands Health Department presented lawmakers with an overview of its financial and operational priorities Thursday during a Senate Budget, Appropriations and Finance Committee hearing, highlighting the strain of missing vendor payments, rising off-island care costs, and behavioral health needs.
The department’s proposed financial plan for fiscal year 2025 includes $29.8 million from the General Fund, $27.2 million in federal funds, $1.5 million from the Health Revolving Fund, and $1.6 million in non-appropriated funds. Personnel services remain a central expense, with $11.8 million coming from the General Fund and $10.8 million from federal sources. Fringe benefits, supplies, and other operational costs make up the remainder.
VIDOH employs 332 full-time equivalents, nearly evenly divided between the St. Thomas-St. John and St. Croix districts. Of those, 176 positions are funded by the General Fund, and 156 by federal grants. The department currently faces 40 vacancies and has launched structured onboarding efforts and volunteer initiatives to close staffing gaps.
The department’s federal grants portfolio totals nearly $98 million, supporting 34 core projects and 93 single-account budgets. The Office of Federal Grants continues to manage a diverse funding stream while pursuing additional resources to support mental health services and technology upgrades.
As part of its modernization efforts, the department launched a universal data warehouse in April 2024 using $2 million in ARPA funds. The $6.75 million project aims to create a secure, unified system for real-time disease tracking, emergency response, and streamlined federal reporting. Currently paused due to exhausted ARPA funding, the department is seeking $4.75 million to complete it, calling the system key to breaking down data silos, improving coordination, and enabling evidence-based decisions.
Off-island care — the practice of sending patients to mainland facilities for specialized treatment when it’s unavailable locally. The department now spends $9.4 million annually on these placements, a number that has steadily increased over the past two decades.
Beyond the financial burden, off-island care strains staff resources, limits investment in local solutions, and places added stress on families who must navigate treatment far from home, Health officials said. Lawmakers and health leaders have called for greater local capacity, improved budgeting practices, and a long-term strategy to reduce reliance on out-of-territory placements.
In FY2024, 38 patients received off-island care. That year, the department was allocated $6.4 million, but actual costs totaled $7.8 million, resulting in a $1.45 million shortfall. For FY2025, 48 patients are in off-island care, and as of June 30, the outstanding balance reached $4.6 million. The department also faces $7.5 million in unpaid vendor bills — $5.5 million of that tied to off-island services — prompting threats from some facilities to stop accepting patients.
“It’s clear that, in terms of meeting our obligations for vendor payments, that is woefully inadequate,” said Sen. Kurt Vialet. He also pointed out that the Health Department operates 30 across 19 different locations, resulting in $967,000 in rent costs, and questioned whether consolidating operations could reduce expenses and improve efficiency.
In response, Assistant Health Commissioner Nicole Craigwell-Syms said, “Our goal is really to have an area like a one-stop shop for services. So, we are working to identify an area that could be large enough, but at the same time, we want to be fiscally responsible in terms of finding a location. And once we’re able to do that, we should be able to consolidate a lot of the divisions into one area.”
Meanwhile, the Behavioral Health Division continues to see a rise in both demand and complexity of care. Over the past year, the division served 676 patients, primarily diagnosed with schizophrenia, bipolar disorder, or other psychoses. Sixty-one percent of the patients were male, and most patients fell within the age range of 24 to 64. The territory currently lacks a dedicated crisis mental health facility.
“Overall, the data indicates a growing and evolving patient population with increasing clinical complexity and sustained demographic diversity. These trends reinforce the need for targeted services, planning culturally sensitive responses and expanded support for populations experiencing serious mental illness,” said Craigwell-Syms.
Efforts to expand care have been hindered by the loss of $3.1 million in federal ARPA grants, which previously funded 16 staff positions, including four in behavioral health. While some personnel were reassigned, officials acknowledged that service expansion has slowed due to the funding gap. Despite these challenges, the Elder Shelter Branch remains fully operational, housing 32 residents at an annual cost of nearly $1.5 million.
Community outreach programs remain a priority. School-based initiatives reached over 6,000 students and 575 educators across the territory through workshops on mental health, substance use, and emotional well-being. Homeless outreach teams connected with 52 individuals on St. Thomas and St. John, many of whom were referred to outpatient or transitional services. DOH is currently working to establish a mobile crisis response team, as mandated by Act 8957, but this is pending funding and implementation.
“We owe it to this community to really address this particular issue,” Sen. Novelle Francis told officials. “We will keep pushing at every opportunity to make this happen.”
