News release

For immediate release
Thursday, December 26, 2019

Washington finishes five-year journey to integrate physical and behavioral health for Apple Health (Medicaid) clients

Work continues to build community behavioral health system


OLYMPIA – On Jan. 1, 2020, the Health Care Authority (HCA) will finish a multi-year effort to integrate physical health, mental health and substance use disorder treatment services into one system for nearly 2 million Apple Health (Medicaid) clients.

Before care was integrated, Apple Health clients with co-occurring disorders had to navigate three separate systems in order to access the physical and behavioral health services they needed to stay healthy. The physical health, mental health, and substance use disorder treatment services delivery systems often didn’t communicate about clients’ care, which led to duplication of services, poorly coordinated care, worse health outcomes, and a frustrating experience for our states’ Apple Health clients and the providers who serve them.

At the request of Gov. Jay Inslee, the 2014 Legislature passed Senate Bill 6312, which required this change so that the community behavioral health system was fully integrated into a managed care system by January 2020.

“This effort has been the result of years of collaboration and partnership between communities, providers, counties, state government agencies and many others,” said HCA State Medicaid Director MaryAnne Lindeblad. “It has been complex and it has been hard, but it also has been worth it. The result is a transformation of our delivery system to focus on whole-person health and no longer separating care for the mind and the body. Work continues to build our community behavioral health system, but this is a key milestone in that journey.”

Under the transformed system, managed care organizations are responsible for physical and behavioral health services for the Apple Health clients they serve. In addition, behavioral health administrative services organizations deliver crisis services that are available to all, and manage regional functions, such as employing an ombuds and managing a community behavioral health advisory board.

Several of the nine regions around the state chose to integrate care ahead of the mandatory January 2020 deadline:

  • Southwest region: April 2016
  • North Central region: January 2018
  • North Sound region: July 2019
  • Greater Columbia, King, Pierce, and Spokane regions: January 2019

The final three regions integrating Jan. 1, 2020 are Thurston-Mason, Great Rivers, and Salish.

Integrated Managed Care Map

The Department of Social and Health Services Research and Data Analysis Division has been tracking key metrics in Southwest compared with the rest of the state, and found the region has performed better in several areas, including substance use disorder and mental health treatment penetration, follow-ups after emergency room visits for mental illness and employment.

Many states have or are moving to integrated managed care for Medicaid. In Washington, it is part of our value-based purchasing roadmap, in which HCA as the state’s largest health purchaser has set the goal of shifting 90 percent of our state-financed health care to value-based payment by 2021.