Here in Washington, all behavioral health services for low-income families are funded through a mixture of federal, state and local dollars. Federally, the Center for Medicare and Medicaid Services (CMS) gives funding to the Washington State Healthcare Authority to administer Apple Health which, as of 2020 covers both behavioral health and physical health services through 4 Managed Care Organizations: United Healthcare, Molina, Coordinated Care and Amerigroup. The Federal Government provides block grant funding for behavioral health services through the Substance Abuse and Mental Health Services Administration (SAMHSA).
On the state level, money is provided to local regions for behavioral health services not paid by Medicaid. In Pierce County, Elevate Health is our region’s Accountable Community of Health (ACH) and they are tasked with improving health through the Medicaid Transformation Waiver. While Elevate Health passes on much of this funding to local service providers, they also fund Pierce County behavioral health initiatives such as building a second Crisis Recovery Center in the Parkland/Spanaway area.
The diagram below illustrates the funding streams and governance of behavioral health in Pierce County.
CMS: Center for Medicare and Medicaid Services. This is the Federal Agency that administers Medicare and, in Washington State with the help of the Health Care Authority (HCA), administers the Medicaid program.
Federal Block Grants: A block grant is a fixed amount of grant funding from the federal government given to states for a specific purpose. In this case, the federal government gives Washington State two block grants to be used for behavioral health purposes—the Substance Abuse Block Grant (SABG) and the Mental Health Block Grant (MHBG) –administered by the Healthcare Authority (HCA). The HCA then passes this money on to local regions in the state to carry out the work. In Pierce County, which is its own region, the funds are administered by Beacon Health Options, our ASO (Administrative Services Organization).
WA HCA: The WA State Health Care Authority (HCA) is the state agency responsible for purchasing healthcare for “more than two million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program.” The HCA is the largest healthcare purchaser in the state and contracts with managed care organizations (MCOs) to provide Medicaid to eligible WA state residents.
DSHS: The Department of Social and Health Services is the state agency responsible for delivering social services to Washington residents. The Behavioral Health Administration, a part of DSHS, oversees the Office of Forensic Mental Health Services responsible for adult forensic mental health care through the state hospitals Western State and Eastern State. This is the same office responsible for administering the Trueblood program and Implementation Plan through the Trueblood lawsuit and settlement agreement.
Trueblood Funds: Trueblood v DSHS (Trueblood) is a case challenging unconstitutional delays by the state of WA in providing competency evaluation and restoration services to those in jail. As a result of these delays WA State was fined contempt funds which have been used to set up programs throughout the state to help individuals who are detained in city and county jails awaiting a competency evaluation or restoration services as well as individuals who have previously received competency evaluation and restoration services, who are released and at-risk for re-arrest or re-institutionalization. As part of the lawsuit settlement further programs are being stood up around the state to serve those with mental health issues who are involved in the criminal justice system. Pierce County is one of 3 regions receiving funding to administer these programs.
CJTA: The Criminal Justice Treatment Account (CJTA) began in 2002 to aid those involved in the criminal justice system gain access to substance use disorder treatment. Specifically, this funding was dedicated to support defendants with a substance use disorder — including those enrolled in a drug court program.
Medicaid Transformation Waiver: The Medicaid Transformation is a five-year agreement between the WA State HCA and the Centers for Medicare and Medicaid Services (CMS) that provides up to $1.5 billion in federal investment for regional health system transformation projects that benefit Apple Health (Medicaid) clients. In Pierce County a portion of this money was distributed to our regional Accountable Community of Health (ACH), Elevate Health.
Elevate Health: Elevate Health is Pierce County’s regional Accountable Community of Health, an entity tasked with improving health and health equity around the state through the Medicaid delivery system and the use of Medicaid Transformation Waiver dollars.
ASO (Administrative Services Organization): The ASO is the regional entity responsible, through a contract with the HCA, for all behavioral health crisis services and services for uninsured individuals in Pierce County. The ASO receives all SABG, MHBG and CJTA dollars. Beacon Health Options is Pierce County’s ASO.
MCO (Managed Care Organization): An MCO is an insurance company providing comprehensive medical and behavioral health care to Apple Health clients in WA State through a contract with the HCA. Pierce County has 4 MCOs: Molina, Coordinated Care, United Healthcare, and Amerigroup.
Pierce County Sheriff: Through Trueblood funds the Pierce County Sheriff funds the work of 6 co-responders—behavioral health crisis workers embedded within the law enforcement department to respond to behavioral health crises with specially trained officers.
Pierce County Superior Court: Trueblood funds provide several positions within the Prosecutor’s Office and the Department of Assigned Counsel including a legal assistant, a case coordinator and a defense social service specialist to aid in connecting Trueblood class members to behavioral health services.
Pierce County Human Services: Pierce County Trueblood funds are administered through Human Services.
Pierce County Executive: Through a contract with the HCA, Pierce County agreed to become a mid-adopter region for Integrated Managed Care (IMC). As part of that contract Elevate Health received mid-adopter incentive funds over and above Medicaid Transformation Waiver dollars to aid the region in implementing IMC.
Integration Oversight Board: The Integration Oversight Board was created as part of Pierce County’s agreement with HCA to be an IMC mid-adopter. It was stood up to act as a central coordinating body to provide regional coordination of behavioral health services and oversee the progress of integration in our region. Its membership includes members of the Pierce County Council, Executive’s Office, Human Services, Elevate Health, 2 regional behavioral health providers, and the HCA.
Regional System of Care Committee (RSCC): The RSCC is a subgroup of the Integration Oversight Board specifically tasked with aligning and expanding behavioral health resources in Pierce County.
Opioid Task Force: In 2017, as a joint initiative of City of Tacoma and Pierce County, Tacoma City Councilmember Connor McCarthy and Pierce County Councilmember Derek Young convened representatives from multiples sector and created the Pierce County Opioid Task Force to fight the opioid epidemic in our community. Elevate Health, the Tacoma Pierce County Health Department, First Responders, the Puyallup Tribe and WA State Policy Advisors are all key players in the work.
Learning Network: As part of their transformation work in our community, Elevate Health has created the Learning Network, a group of behavioral health providers who meet regularly to discuss and solve problems related to Integrated Managed Care in Pierce County.
Care Continuum Network: The Care Continuum Network (CCN) is a group of programs funded by Elevate Health connecting vulnerable and under-served populations to services and resources for whole-person health and community advocacy. These programs include Community Health Action Teams, the Pathways HUB and Health Homes.
CJ Steering Committee: The Pierce County Executive’s Office hosts a monthly meeting bringing together Pierce County Courts, Behavioral Health providers, payors and all those involved with those at the intersection of behavioral health and the criminal justice system.
MCIRT: Mobile outreach wraparound program which provides community-based intervention to assist in connecting high utilizers of emergency services with stable, long-term, non-crisis services.
MOCT: The Mobile Outreach Crisis Team (MOCT) is managed by MultiCare and partly funded by Pierce County. MOCT provides crisis outreach services, including face-to-face evaluations. Members of the MOCT team provide initial assessments to determine if the individual in crisis will accept a less restrictive alternative to hospitalization. If the individual appears to meet involuntary detainment criteria (danger to self, danger to others, gravely disabled), the MOCT will refer to the Designated Mental Health Professional (DMHP) or refer to the Emergency Department.
Pierce County Co-Responders: Designated Crisis Responders (DCRs) employed by MultiCare’s MOCT team but embedded with Pierce County Sheriff Deputies to increase earlier identification of and intervention with community members with mental illness and co-occurring disorders who have contact with law enforcement.
Trueblood Diversion: An array of services, provided through funding from Trueblood fines, which seek to divert individuals with behavioral health conditions from jail to therapeutic treatment, and to create more effective re-entry support those returning to the local community. These services are implemented through a partnership with Pierce County Human Services, District and Superior Court and outside behavioral health providers.
Crisis Recovery Center: A short-term behavioral health stabilization facility where law enforcement, EMTs, and families can bring those suffering from mental health crises – such as suicidal thoughts and delusional disorders—to receive immediate and appropriate care. A CRC facility is currently operating in Fife with another planned to open late summer 2020 in Parkland/Spanaway.
Pierce County Drug Court: A judicially supervised court docket providing substance use treatment as an alternative to traditional sentencing for those who are currently charged with a non-violent felony and do not have any history of violent or sexual charges. The program is a minimum 12-month program with treatment services provided by Pierce County Alliance.
BHAB: Convened by Beacon Health Options, the Pierce County Washington Behavioral Health Advisory Board (PCWA BHAB) is a voluntary and community driven group that advises the Pierce County Washington region on local behavioral health priorities.
Crisis Collaborative: Convened by Beacon Health Options, the Pierce County Crisis Collaborative is a group of providers and payors who come together to identify gaps in the Crisis System of Care and identify strategies and solutions to address those gaps including making recommendations to system providers and payers.
Crisis System: The behavioral health crisis system in Pierce County is managed by Beacon Health Options and consists of the MOCT team (adult) and Catholic Community Services (youth) who oversee the Designated Crisis Responders (DCRs), and the Crisis Line to connect those in crisis with support services and DCRs.
Service Providers: Those providing direct behavioral health and social services to community members.