The state Legislature’s embrace of Medicaid expansion has the potential to revolutionize mental health care in Washington State.
But the transition into Medicaid expansion will be rocky. Exhibit A & B are the House and Senate budgets now pending in Olympia. Each assumes Medicaid expansion will reduce the need for so-called “state only” mental health funding. For King County, the House Democrats’ budget reduces state-only funding by about $5 million in the 2013-15 biennium; the Senate assumes closer to $8 million.
State-only money covers services that Medicaid will not, including short-term psychiatric hospitalizations in facilities with more than 16 beds. That’s a particular problem in King County, because it depends heavily on Navos in West Seattle and Fairfax Hospital, which are too big to get Medicaid reimbursement.
And access to inpatient psychiatric care is already disastrous in King County. As I’ve written, and the Times has editorialized about, each night dozens of patients are “boarded” in emergency rooms because there’s no place else for them to go. The numbers are staggering – 2,160 patients in King County alone were boarded – in conditions a Pierce County Superior Court judge recently ruled were unconstitutional.
The current budget proposals will make that worse, Navos CEO David Johnson wrote in a letter to Rep. Eileen Cody, D-Seattle, chair of the House Health Care committee.
“We currently have too few beds for too many involuntary patients. Slashing funding that pays for hospitalizations is not a viable solution and will only exacerbate an already terrible problem in inadequate access to care,” he wrote.
King County mental health director Amnon Schoenfeld agreed. Medicaid expansion may help seed more care in the long term, he said, but King County has already seen state-only funding drop from $45 million five years ago to $36 million in 2012.
“They’re making all these assumptions on Medicaid expansion. I think there will be some (additional revenue), but don’t know how much,” he said.
The House budget effectively delays some state-only funding cuts to the second year of the biennium, but not enough, said Schoenfeld. “If you’re going to cut, just give us some more breathing room.”
When I reached Cody in Olympia, she sighed. “In case no one noticed, we have a budget problem,” she said.
Statewide, Medicaid expansion will add a net $26 million to the mental health budget, plus about $17 million more intended to expand inpatient psychiatric care due to account for a broadened definition of involuntary treatment. But Cody acknowledges that the cut in state-only funding hits King County harder than other counties. “No matter how we do it, there’s winners and losers.”
This post, originally published at 6:16 a.m. on June 11, 2013 was corrected at 12:51 p.m. on June 11, 2013. An earlier version incorrectly stated that a Pierce County Superior Court judge had ruled that boarding psychiatric patients in emergency rooms was constitutional. It was ruled unconstitutional.