Governor Inslee recently released a five-year plan to transform Washington’s mental health system, calling for the transition of care from large mental health institutions (Western and Eastern State Hospitals) into smaller, regional state-run facilities. Patients referred to the hospitals by civil courts or regional mental health systems would move into the smaller facilities and private community hospitals. The two state hospitals would still hold patients ordered into the system by criminal courts and other hard-to-place patients civilly committed into care. The shift to a community-based model would result in about a dozen new 16-bed psychiatric facilities. The progress of this proposal will be an issue to watch in the 2019 legislative session. Substantial additional funds are needed to address the deficits throughout our behavioral health system.

In the other Washington, the House Energy & Commerce Committee has been busy on opioid legislation. Last week, they advanced over 32 bills, adding to the 25 they passed the prior week. One of the bills moving forward, HR 5797, would allow states to receive federal matching funds for Medicaid enrollees receiving up to 30 days of inpatient opioid abuse treatment in an Institution of Mental Disease (IMD)(through 2023). The current “IMD exclusion” prohibits federal funds for inpatient treatment of adults (age 21-64) at IMDs with more than 16 beds. States can apply for a five-year waiver from the IMD exclusion for substance use disorder; Washington State applied for such a waiver in March. If approved, this legislation would eliminate the need for a protracted waiver process. The Center on Budget and Policy Priorities raised concern that repealing the exclusion could lead to “overreliance on residential treatment and underinvestment in other services and in community-based alternatives that are often more appropriate and cost effective.” The legislation goes to the House floor next.