Project seeks to improve Medicaid service
Published 9:00 pm Friday, January 23, 2004
Over the next six months, a closely-watched pilot project will get under way in Snohomish County, quietly setting in motion what may be a revolutionary new approach in social and health services funded by the state-federal Medicaid program.
Most of us think about doctors and hospitals when we hear the word Medicaid. But the reach is far greater. Those dollars — matched about 50-50 between the state and the federal governments — support not just medical treatments, but nursing home costs, drug abuse treatment and prevention programs, public school and tribal outreach programs that identify children with unmet needs, health examinations and preventive care for foster children, mental health treatment and home health care, among many other services.
Today, Medicaid funding has a direct impact on the vast majority of clients in the state Department of Social and Health Services, and most of those clients need more than one of those services. Yet to access those services, they also have had to deal with different programs, sometimes different requirements, and often, different staff from different parts of the agency.
Complicating the matter even further, many of these clients fall into the category of high-risk, which means they are not just our most fragile clients, but among our most expensive. They should be our highest priority for timely and coordinated care.
n Aged and adult disabled clients comprise more than 15 percent of DSHS’ 1.3 million clients.
n Medical, mental health, long-term care, and substance abuse treatment for this population accounts for almost one-third of DSHS’ budget.
n Prescription drugs represent one-fifth of all the money DSHS spends on medical, mental health, long-term care and substance abuse treatment services for these clients.
When DSHS was created in the early 1970s, the state of Washington consciously centered a vast and complicated array of programs in the agency, figuring correctly that it would pay dividends in service delivery. Those planners were right. In fact, DSHS today is a model for many states struggling to protect vulnerable populations with competing state agencies and overlapping programs. At DSHS, we often field calls from staffers in other states’ legislatures, assigned to look into centralizing state services.
But when Dennis Braddock was named DSHS secretary three years ago, he quickly identified the other side of the coin: From a client’s perspective, services themselves have not been integrated over the years. In particular, Medicaid funding over the years has become so intertwined with different parts of the agency that it almost defies unraveling. Braddock’s charge to the agency was for DSHS’s seven separate administrations to reach across the gaps and the boundaries between them and create new partnerships that will center directly on client needs.
That is the project that is quietly getting under way in Snohomish County this year. In February, DSHS will select a contractor to implement the Washington Medicaid Integration Partnership (WMIP) for up to 6,000 Snohomish County clients who volunteer for the program. A DSHS workgroup has mapped coordinated care arrangements that can integrate Medicaid medical treatments, mental health care, and alcohol- and drug-abuse treatment.
This summer, the new contractor will begin coordinating these client services and working directly with providers to support their efforts. While long-term care will not be part of the mix this summer, it remains a possibility as the effort moves ahead.
The move toward Medicaid integration is not without questions. In particular, some Snohomish County mental health providers have expressed fear that the funding change — with dollars no longer channeled through the multi-county Regional Services Network — will cut support, not improve it. In truth, systemic change is often uncomfortable and some short-term disruption is possible. But the workgroup’s research shows that a new managed-care, integrated approach will improve access and delivery of services, not erode them.
An important immediate outcome for these Snohomish County clients is that they will move from fee-for-service status (which means they must find their own health-care provider) to managed care, where they will be assigned to a single primary care provider. In a county where health-care access has been problematic for many low-income residents, this will be a new guarantee. They will not lose care but gain a primary health-care provider with access to and influence on all of their needs.
On Monday, the WMIP partners will hold the first of several community meetings on the project. The meeting will be held in the Everett Public Library auditorium, 2702 Hoyt Ave., from 1-3:30 p.m. It will include a project overview and brainstorming session, with time for questions and answers. While this meeting is intended to be informational, the project team is hoping to answer questions and brainstorm with participants.
Space is limited, and we have already been contacted by a number of Snohomish County residents and providers who would like to attend. Please be assured that we will be holding additional meetings in coming weeks, including a better opportunity for public testimony on the project and an exchange of concerns.
MaryAnne Lindeblad is the director of the Division of Program Support in DSHS. Readers who want to attend Monday’s meeting should RSVP by e-mail (brunema@dshs.wa.gov). Additional information is listed on the WMIP Web site, maa.dshs.wa.gov/mip.
