Improving access to behavioral health care for Washington’s children and youth

April 29, 2022

Over the last decade, WSHA has strongly advocated for increased access to behavioral health care. We are especially pleased – after five years of advocacy – that Medicaid will be expanding coverage of outpatient services to children and youth.

The behavioral health care system is chronically underfunded in the United States, including in Washington. Due to the impact of living with severe and persistent behavioral health conditions, many individuals with these conditions are insured by Medicaid. Unfortunately, Medicaid reimbursement does not cover the full cost of providing health care services. Over time, this lack of funding has led to a shortage of necessary behavioral health services across the continuum of care, with Washingtonians in need of behavioral health services unable to access them.

For hospitals, this also results in patients with behavioral health conditions who do not need a hospital level of care being unable to transition to step-down services due to lack of availability, which in turn results in a shortage of hospital beds for those who do need a hospital level of care. Additionally, the lack of community behavioral health services can lead to these conditions going untreated and worsening, resulting in avoidable hospitalizations. Many of these systemic challenges can be addressed at the root of the issue, which is the need for accessible and available behavioral health services for children and youth.

In the 2022 legislative session, WSHA and its members successfully advocated for passage of several bills to improve access to children’s behavioral health services.

  • 2SSB 5736 – Adds partial hospitalization and intensive outpatient treatment programs (PHP/IOP) as covered Medicaid benefits for children and youth with behavioral health conditions.
  • 2SHB 1890 – Requires the Children & Youth Behavioral Health Workgroup to develop a comprehensive statewide strategic plan for children and youth behavioral health.
  • SHB 1800 – Requires the Health Care Authority (HCA) to convene stakeholders to develop a parent portal to provide current information on behavioral health policy and services for children and youth.

Read below for a comprehensive summary of these new laws and WSHA’s legislative advocacy:

Partial hospitalization and intensive outpatient treatment programs 

WSHA led advocacy efforts on 2SSB 5736, which requires the HCA to take the steps necessary to add partial hospitalization (PHP)/intensive outpatient treatment (IOP) programs for children under 18 years old as a covered benefit under the Medicaid state plan by Jan. 1, 2024.

As a vital part of the mental health continuum of care, PHPs and IOPs focus on teaching and building effective coping skills to improve self-management of care, enabling participants to continue treatment in a family and community setting.

PHP and IOP patients generally meet several times a week and work with a multidisciplinary team of professionals, such as psychiatrists, psychiatric nurse practitioners, masters-level licensed therapists and mental health technicians. Each follows treatment regimens tailored to the patient’s specific needs. Participants also engage in motivational group and individual therapy sessions, develop cognitive and dialectical behavior therapy skills, and receive medication management consultations. IOPs are usually part-day programs (up to 3 hours a day, 2-to-3 days a week); PHPs are usually full-day programs (anywhere from 3-to-8 hours a day, up to 5 days a week).

Passage of this legislation allows Washington to join the majority of other states in offering Medicaid coverage for PHP/IOP programs. The bill’s passage follows years of advocacy by WSHA and our member hospitals as well as a successful pilot program in two children’s hospitals. This will provide more equitable access to behavioral health services for Washington’s children and youth and increase inpatient capacity for those who need that level of care.

WSHA also successfully advocated for expansion of the PHP/IOP pilot to a third site in 2022. This will help the HCA gather necessary data to develop the new Medicaid benefit and appropriate Medicaid payment rates for PHP/IOP providers.

WSHA anticipates the HCA will request an additional year for full implementation of the benefit expansion, and the agency will begin taking steps necessary to amend the Medicaid State Plan over the next several years. WSHA will stay engaged in HCA’s process and communicate the agency’s progress.

Comprehensive statewide strategic plan for children and youth behavioral health

With the understanding that complex problems require complex solutions, WSHA made development of a statewide strategic plan for behavioral health services a budget priority in 2022. The Children & Youth Behavioral Health Workgroup advocated for legislation (2SHB 1890) to develop such a plan for behavioral health services for children and youth. WSHA strongly supported this bill.

Under the new law, the Children & Youth Behavioral Health Workgroup will create a subcommittee on developing a strategic plan that must hold its first meeting by Sept. 1, 2022, submit annual progress reports to the legislature, and provide a draft strategic plan to the larger workgroup by Oct. 1, 2024.

Our hope is that this final product will be integrated with ongoing behavioral health crisis system strategic planning work to provide the basis for a comprehensive statewide strategic plan for behavioral health services across the continuum of care.

Parent portal to provide information on behavioral health services

Behavioral health services can be difficult for patients and families to navigate. SHB 1800 addresses these challenges by requiring the HCA to dedicate at least one full-time employee to convene stakeholders, including families, behavioral health providers, and educators, and develop a parent portal to provide easy-to-navigate resources about behavioral health services. The HCA must report on its progress to the legislature by Nov. 1, 2024.


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