Small counties fight for voice in state health integration

As the state combines mental health and chemical dependency services, small counties like Island County are doing some creative jockeying to remain at the table.

“Small counties have to be diligent or we will get left in the cold,” said Jackie Henderson, Island County’s director of human services.

Island County has the advantage of being part of North Sound Behavioral Health during this integration process which began with a state task force early last year.

The task force recommended that similar Behavioral Health Organizations (BHO) be instated state-wide by next year which would replace already established groups like North Sound Behavioral Health.

This may work to Island County’s advantage.

A county or health organization needs to have about 60,000 Medicaid-eligible residents to ensure the programs are properly funded. Island County had only 12,021 Medicaid eligible residents in November 2014 and Sea Mar, which contracts with the county for chemical dependency counseling, serves only about 100 chemical dependency patients, according to numbers issued by the state.

“They will never make money in Island County (alone),” Henderson said, without the assistance of partner counties. Under the umbrella of the BHO — which will continue to include Island, San Juan, Skagit, Snohomish and Whatcom counties — the grouping contains 213,708 Medicaid eligibles.

This makes the North Sound BHO the second largest in the state next to King County’s 339,005 Medicare eligibles.

That will help give Island County the voice it needs to fight for necessary services, Henderson said.

Not all counties are so lucky.

At the end of 2014, the Chelan, Douglas, Lewis, Pacific, Wahkiakum and Grays Harbor counties all fell well below the 60,000 requirement within their existing Regional Support Networks, according to state figures.

Island County is slightly ahead of the game in that it already has regional relationships, according to island County Commissioner Jill Johnson, who serves on the North Sound Behavioral Health board.

The real issue for the county is if services can be provided and maintained under the new paradigm in smaller communities.

“Do we have a model that will deliver services in remote or rural areas?” Johnson said. “It’s going to come down to how the BHO chooses to invest its money. There’s a lot of unknowns.”

The state’s goal is to combine mental health and chemical dependency services by April 2016, and then further combine that with the state’s Medicaid-funded physical health program by 2020.

Under the new system, all mental, physical and chemical dependency health programs will be paid for through new fee-for-service Medicaid programs.

Currently, the three services are billed under different umbrellas and the move is intended to create efficiency and cost savings, Henderson said.

Throughout this process, Henderson said, the state is “looking at the health system and seeing how it can be improved.”