Summary

Funding for core Medicaid behavioral health care in King County will be slashed by $18 million next year, according to an analysis released this week by the state Department of Social and Human Services. Revised rates based on the 2017-2018 state operating budget reveal significant cuts to mental health and substance use disorder services. Impacts in King County could be widespread.

Story

After the Legislature hurriedly approved a biennial budget after a third Special Session in June, King County warned that it appeared to underfund the rates that support frontline community behavioral health care in King County.

Now, the state’s own financial analysis confirms that the budget includes significant cuts to Medicaid mental health and substance use treatment funding, which will reduce vital services for low-income residents across King County.

Medicaid-eligible mental health and substance use disorder service rates are reduced by $18 million for King County in fiscal year 2018 alone. In its adopted budget, the state House of Representatives included more funding to narrow this gap. However, the final state budget reduced funding for core Medicaid services by eight percent compared to fiscal year 2017 funding. Many other counties across the state face similar reductions.

“The state budget takes us in the wrong direction. This may have not been the Legislature's intent, but the fact is that we will be forced to reduce mental health and substance use disorder treatment at a time when King County is fighting homelessness, a heroin epidemic, and an already critical need for mental health services,” said King County Executive Dow Constantine. “If the Legislature does not fix this next year, it will have a devastating impact on our residents and the health of our communities.”

The Medicaid rate cut undermines the entire behavioral health system. King County is doing all it can to mitigate the impact but there is no way the County can prevent these cuts from hurting people in need of care.

Essential community-based services in King County that are funded by Medicaid and could be impacted by this cut include:
• outpatient treatment for people who need care but lack resources;
• residential care that helps keep people with serious conditions out of hospitals; and
• medication-assisted treatment that helps people recover from opioid addiction.

King County and behavioral health providers will work with state legislators to find a solution to the funding cut as soon as possible in the next session.

Quotes

The state budget takes us in the wrong direction. This may have not been the Legislature's intent, but the fact is that we will be forced to reduce mental health and substance use disorder treatment at a time when King County is fighting homelessness, a heroin epidemic, and an already critical need for mental health services. If the Legislature does not fix this next year, it will have a devastating impact on our residents and the health of our communities.

The key to quality services for people with complicated mental illness and substance use disorder symptoms is individualized attention by our psychiatrists, nurses, social workers, and other behavioral health staff.  We have struggled to keep our caseload sizes low with current payment amounts.  A decrease in payments reduces our time available to provide services to individuals in our care, hurting our effectiveness and outcomes.

My job is very demanding. We work with some of the most vulnerable clients in the county and make sure we meet all of their basic needs in order to stay healthy and housed. With the lack of funding and high turnover we end up stretched too thin to deliver the care our clients deserve. This is an emergency, and it will only get worse until we solve it the only way it can be solved: by paying the full value for the treatment people need to get better. If we keep avoiding this, we will only pay more for high turnover and worse outcomes in emergency rooms, jails, and loved ones lost.

My co-workers and I are fighting to take care of our vulnerable clients but it is increasingly hard to continue doing this work and provide this care when lack of funding means we can’t afford to live in the city, pay our student loans, or take care of ourselves and our families. The coworkers left behind see their caseloads go up. With salaries that start at $33,000 and caseloads of 60-70 clients we can’t get people housed, address the opioid epidemic, or care for people experiencing severe mental illness.