The Current System: Funding, Oversight, Administration, and Service Array
As part of their work to describe the current landscape of children and youth behavioral health in Washington State, Health Management Associates (HMA) produced a report providing an overview of the structures currently providing funding, oversight, and administration for behavioral health services and supports, including a summary of the publicly funded services and supports currently available to pregnant people, babies, children, youth, and young adults (the population referred to as Prenatal-through-Age-25 or P-25) and their parents and caregivers. Access the full report here.
Key findings
Insurance is the primary source of funding for behavioral health services and supports in Washington State. Although only 3% of the P-25 population is uninsured, differences between the range of behavioral health services covered and rates paid by publicly funded versus privately funded health insurance plans contribute to inequities in access (see pages 3-11).
Other sources of funding for behavioral health services include federal block grants, state general funds, and local funds (see pages 12-13).
These funds are overseen and administered by a range of actors (see pages 13-18).
Health Care Authority (HCA) administers the state’s Medicaid and Children’s Health Insurance Program (known in Washington as Apple Health and Apple Health for Kids), as well as federal block grants and state general funds for mental health and substance use services and behavioral health crisis services.
Other state agencies provide oversight for federal and state funds for a variety of additional prevention and intervention activities, supports, and services, some of which are not delivered through the formal healthcare or behavioral healthcare system.
Behavioral Health Administrative Services Organizations (BHASOs) administer state funds disbursed to them by the HCA for behavioral health crisis services provided to everyone living in the state, and for behavioral health services provided to people who are ineligible for Medicaid or are uninsured.
Counties may levy local taxes to fund additional behavioral health services in their communities. In some cases, a county serves as the BHASO for their region. Resources, structures, and offerings vary significantly across each county.
The current array of services offered across Washington State varies widely from region to region. In addition to the programs of services and supports administered by the state and local entities described above, numerous private and community-based actors offer a range of limited-scope programs and services, unique behavioral health collaborations, pilot programs, and outreach activities. The report provides a snapshot-in-time summary of the significant state-funded programs and services, categorized by type of intervention and various other dimensions (see pages 18-30).
Implications for the P-25 Strategic Plan
To realize Washington Thriving’s vision, the P-25 Strategic Plan will need to include the following recommendations:
Address the gap in reimbursement rates for behavioral health services and find ways to realize parity between what is covered by public and private plans
Streamline funding flows and reduce complexity and siloing between the agencies providing oversight for and administering behavioral health services and supports across the state
Articulate how state and county funds can be deployed in a complementary way to offer a comprehensive array of services in each region
Establish a centralized view of the many programs, services, and supports offered across the state (both publicly and privately funded) to reduce redundancy, ensure network adequacy, and realize equitable access for underserved communities
Thank you to everyone who contributed to this work. Although not every piece of information shared was included in the report, the Washington Thriving project team continues to refer to the notes and documents provided.