[0:04] We have.

[0:06] Welcome to the AUGUST 26th

[0:08] meeting of the Regional Policy

[0:09] Committee. To manage today

[0:09] s

[0:10] meeting, I

[0:10] d like to ask the

[0:12] only committee members and the

[0:13] scheduled presenters join us on

[0:16] the zoom platform. I asked the

[0:17] other staff and interested

[0:19] community members follow the

[0:21] meeting on King County tv

[0:24] channel 22 or stream online.

[0:24] This time. I

[0:26] d like to begin by

[0:29] asking the clerk to call the

[0:30] roll.

[0:32] Thank you. Chair. Council

[0:33] member Arnaud.

[0:34] Here.

[0:38] MAY your packets. MAY your

[0:41] backs. You

[0:51] re muted. Okay. MAY.

[0:54] Council member. Robertson. MAY

[0:59] your wrath. MAY your brethren.

[1:02] Council member. Juarez. Council

[1:05] member. Len. Council member.

[1:10] Faster. Council member. Drink.

[1:13] Councilmember Baron. Here.

[1:16] Councilmember. Perry.

[1:16] Sherburne.

[1:18] Reichbauer here. Well, we

[1:19] ll go

[1:21] back and do a roll. Again, I

[1:22] know that the Sound City

[1:24] Association has had a meeting

[1:26] going on, and that they are

[1:28] concluding at this time, and

[1:28] we

[1:29] re trying to accommodate

[1:30] their schedule. Uh, I want to

[1:32] thank everyone for attending

[1:32] today

[1:33] s Regional Policy

[1:34] Committee meeting. We have two

[1:35] briefings on today

[1:36] s agenda,

[1:37] both related to the county

[1:40] sales tax funded Mid initiative

[1:42] that provides behavioral health

[1:43] programs and services to King

[1:45] County residents, which has

[1:47] been renewed to continue

[1:50] through 2034, 2030. For. The

[1:51] first briefing will cover the

[1:53] mid annual report for calendar

[1:56] year 2025. The second briefing

[1:56] will be the committee

[1:57] s first

[1:58] opportunity to hear about the

[1:58] executive

[2:01] s proposed 2028 2030

[2:03] four implementation plans for

[2:04] this initiative, which is

[2:06] proposed through a companion

[2:07] legislation to be renamed

[2:10] Behavioral Health Bridge. At

[2:11] this time, I would like to

[2:14] bring forth, um, I believe

[2:15] Isabel Jones, the acting

[2:17] director, as well as Robin

[2:19] Buren, the special project

[2:23] manager, to talk about, um, our

[2:32] item number four, 2026 0088.

[2:34] MISTER Chair, this is Miranda.

[2:35] Would you like for Sam Porter

[2:38] to provide a brief introductory

[2:39] remarks before our presenters

[2:40] begin?

[2:40] Sure.

[2:42] Absolutely. Report.

[2:43] Miranda. Thank you.

[2:45] Thank you. Chair von Reichbauer

[2:47] Sam Porter, Council central

[2:50] staff. The documents for this

[2:51] staff report begin in the

[2:54] packet on page nine of the pdf.

[2:55] I will just provide a very

[2:56] brief overview of the

[2:58] requirements of the mid annual

[3:00] report before handing it over

[3:04] to Robin Bowman. From dhs to to

[3:06] present on the materials. So

[3:09] the 2025 mid annual report does

[3:10] appear to meet the requirements

[3:13] of King County Code. Um, the

[3:15] services and programs funded by

[3:17] the Mid are evaluated by staff

[3:17] in King County

[3:18] s Department of

[3:19] Community and Human Services,

[3:21] based on data submitted by

[3:23] providers. King County Code

[3:25] requires that the Annual

[3:26] Summary Evaluation report shall

[3:28] include, at minimum, the

[3:29] following performance

[3:31] measurement statistics, program

[3:33] utilization statistics.

[3:34] Requests for proposals and

[3:36] expenditure status updates.

[3:38] Progress reports on evaluation.

[3:40] Implementation. Geographic

[3:42] distribution of the sales tax

[3:43] expenditures across the county,

[3:45] including collection of

[3:46] residential zip code data for

[3:47] individuals served by the

[3:49] programs and strategies.

[3:50] Updated performance measurement

[3:52] targets for the the following

[3:54] year of Mid initiatives,

[3:56] programs and services.

[3:57] Recommendations on either

[3:59] program changes or process

[4:00] changes, or both, and then

[4:02] summary cumulative calendar

[4:04] year data on page 11 of the

[4:07] packet. There is a table one

[4:08] that provides an overview of

[4:11] the different sections of the

[4:13] 2025 mid Annual Report, and

[4:15] includes the page numbers that

[4:17] are associated, and I will

[4:18] leave the rest of it to our

[4:20] folks at dhs. That concludes my

[4:22] remarks. Thank you.

[4:23] Thank you very much. I want the

[4:26] record to also recognize that

[4:28] Mayor Backus, Mayor Pavone, and

[4:29] mayor. Mayor Ralph Roll here

[4:32] present as well. Um, at this

[4:33] time, uh, we

[4:34] ll go to our

[4:37] friends at, um, Isabel or

[4:38] Robin, who

[4:40] s going to start off.

[4:42] Hi. Thank you so much. Uh,

[4:45] chair and, uh, committee

[4:46] members. Um, thank you for

[4:48] having us. Uh, I will start us

[4:49] off, and I will go ahead and

[4:50] share my screen with our

[5:15] slides. Uh, one moment. Okay.

[5:19] Um, are you seeing the screen

[5:19] now?

[5:21] We are. They just popped up.

[5:22] Okay. I

[5:24] m going to start the

[5:26] slides from the beginning. Um,

[5:28] okay. Um, thank you so much.

[5:30] And I will introduce myself.

[5:31] For the record, my name is

[5:31] Isabel Jones. I

[5:32] m the acting

[5:33] director of the Behavioral

[5:35] Health and Recovery Division

[5:36] here at the Department of

[5:38] Community and Human Services.

[5:38] And I

[5:39] ll pass it to my

[5:41] colleague Robin to introduce

[5:42] herself.

[5:44] Sure. My name is Robin Forman.

[5:44] I

[5:46] m typically the mid

[5:46] coordinator. You

[5:47] ve seen me

[5:48] here before for the last

[5:49] several years. I

[5:50] m serving in a

[5:52] special duty role right now.

[5:53] And the proviso report that you

[5:56] will all receive later. Um, in

[5:59] JANUARY of 2027. But here to

[6:02] share the report this today.

[6:04] Thank you. And I will kick us

[6:07] off. I am just going to put the

[6:10] 2025 mid annual report in

[6:11] context for our next

[6:13] presentation on the renewal of

[6:14] the Mid and the bridge

[6:17] implementation plan. Um, as a

[6:19] reminder in context, the Mid is

[6:22] a one tenth of 1% sales tax

[6:24] that generates just under about

[6:26] $100 million per year in

[6:28] revenue for the county. In

[6:30] support of behavioral health

[6:32] services in our community. Um,

[6:34] in 2008, the Mid was launched

[6:36] to counter chronic state and

[6:37] federal underinvestment in

[6:39] behavioral health programming,

[6:41] providing a more stable local

[6:43] resource that strengthens our

[6:45] provider capacity and our

[6:46] behavioral health delivery

[6:49] system. The mid one and mid two

[6:50] implementation plans, which

[6:53] were the first two nine year

[6:57] cycles of the mid uh, which has

[6:58] stood for mental illness and

[7:00] drug dependency. Um, those

[7:02] investment and implementation

[7:03] plans historically focused on

[7:06] prevention, early intervention,

[7:08] diversion, recovery and reentry

[7:10] system improvement, crisis

[7:12] services and therapeutic

[7:15] courts. Um, in SEPTEMBER 2025,

[7:17] the King County Council voted

[7:19] to extend the mid sales tax.

[7:20] The collection of the sales tax

[7:21] for an additional nine years

[7:24] through 2034. Um, and since

[7:26] that time we have been working

[7:28] on an implementation plan for,

[7:30] uh, sort of the next iteration

[7:33] of the mid, uh, which we are

[7:34] now calling the bridge, which

[7:38] we transmitted in JULY of 2026

[7:39] and is under consideration by

[7:41] the council at this time. Um,

[7:43] so our following presentation,

[7:45] uh, will provide additional,

[7:47] uh, context related to the

[7:49] bridge implementation plan. But

[7:49] today

[7:51] s presentation, um, with

[7:55] Robin is focused on 2025 and

[7:57] the mid investments of 2025 and

[7:58] some of the accomplishments of

[8:03] the mid, um, in the last year,

[8:05] 2025. Um, with that, I

[8:05] m going

[8:06] to turn it to Robin.

[8:08] Great. Thank you for that

[8:13] introduction. So. I will just

[8:15] be starting on this slide. Um,

[8:18] wanted to share the outcomes.

[8:21] The 2025 mid accomplishments.

[8:22] You can see on this. These are

[8:25] signature measures um for Mid

[8:26] initiatives for which jail

[8:28] bookings, emergency department

[8:29] admissions and inpatient

[8:31] psychiatric hospital admissions

[8:33] are assessed. Outcome data

[8:34] demonstrated a consistent

[8:36] impact in reducing the use of

[8:38] these system among mid

[8:39] participants over the long

[8:41] term. Um, three years after

[8:43] initiating initiating Mid

[8:45] services, we can see that the

[8:48] 63% of participants had fewer

[8:51] recorded crisis episodes, 29%

[8:53] had fewer emergency department

[8:54] admissions. Jail bookings were

[8:57] down 33% in psychiatric

[8:59] hospital admissions were down

[9:03] 41% over the long term, and 89%

[9:04] of youth in related programs

[9:06] had no new juvenile legal

[9:08] system. Charges filed after

[9:15] enrolling in mid services. Next

[9:20] slide. Let

[9:22] s go. In 2025. Mid

[9:24] serve just over 30,000 people

[9:27] across 52 initiatives. Um this

[9:29] slide displays the demographic

[9:30] information of people served by

[9:33] Mid initiatives. Last year. And

[9:33] we

[9:35] ve included the percent of

[9:37] the population living below the

[9:39] federal poverty level, which we

[9:41] use often as a proxy for need

[9:44] to provide the additional

[9:51] context. Next slide. These maps

[9:52] show the geographic

[9:54] distribution of individuals

[9:56] served by Mid. Also, compared

[9:58] to the federal poverty level.

[10:00] And while Mid serve residents

[10:02] across all of King County,

[10:04] service recipients were more

[10:06] often rated in zip codes with a

[10:08] higher percentage of families

[10:11] living below the poverty line

[10:12] aligning with Mid School to

[10:14] serve those most in need. Next

[10:21] slide. And last year

[10:21] s

[10:23] financial report reflects a

[10:25] single year budget. You are

[10:27] very well aware of that. We

[10:31] adjusted to a new biennium um,

[10:37] in 2025 mid expended 115.8

[10:44] million of its budgeted $128.2

[10:47] million, or 90% of our planned

[10:49] expenditures. And as you are

[10:50] also likely where mid to

[10:52] funding obligations are

[10:54] starting to outpace projected

[10:55] revenues. The behavioral health

[10:57] Bridge Implementation Plan

[10:59] presents the opportunity to

[11:00] realign programming and planned

[11:02] expenditures to anticipated

[11:06] revenue beginning in 2028, and

[11:08] lastly, I just encourage you

[11:10] all to visit the data

[11:11] dashboard. It

[11:11] s truly worth

[11:13] diving into if you want to

[11:14] learn more about mid to

[11:16] programming. The hyperlink is

[11:17] included on the slide and is

[11:19] embedded throughout the online

[11:21] version of the report. And now

[11:21] I

[11:22] ll turn it back to Isbell for

[11:24] some concluding remarks. Thank

[11:25] you.

[11:28] Thank you. Um, so the

[11:29] behavioral Health Bridge is

[11:30] very much building on the

[11:32] learnings, the investments, the

[11:35] community engagement, um, that

[11:37] has occurred over the life of

[11:38] really both mid one and mid

[11:40] two. Um, there are a couple,

[11:43] uh, kind of key points that we

[11:45] are bringing from mid over to

[11:46] the bridge, which is to

[11:48] strengthen our data reporting

[11:50] and accountability. Um, by

[11:52] having performance expectations

[11:53] within each of the five new

[11:56] strategy areas, including

[11:57] performance measurement and

[11:58] accountability that we apply to

[12:00] some of the programming. About

[12:04] 25% of the mid programming that

[12:05] is actually administered by

[12:08] county agencies. Um, we

[12:08] re also

[12:10] emphasizing alignment and

[12:11] integration across service

[12:13] areas and increasing

[12:14] coordination and cross system

[12:16] connectivity. Um, one of the

[12:17] ways that we intend to do that

[12:20] is by managing the mid, um, the

[12:22] goal level rather than a more

[12:24] narrow individual initiative

[12:27] level as we did in mid one and

[12:29] two, which we found kind of

[12:31] created, um, more silos and

[12:33] challenged our ability to have

[12:35] integration across programming.

[12:37] Um, and then continuing to

[12:39] invest where needs are

[12:40] greatest. According to data,

[12:42] community engagement and

[12:45] subject matter input. Um, and

[12:46] with that, that actually

[12:48] concludes our mid 2025 annual

[12:50] report presentation. Uh,

[12:52] however, our next presentation

[12:54] will continue on this topic as

[12:55] we transition to the bridge

[12:57] implementation plan.

[13:09] All right.

[13:11] And I think I will turn it back

[13:14] to you, chair, perhaps to Sam.

[13:15] Thank you. I thought you were

[13:17] going to continue. Although my

[13:19] colleagues. Any questions? I

[13:22] know. Um, this has been a

[13:24] beginning process for many of

[13:25] us. I

[13:26] m checking any raised

[13:28] hands. I feel free to speak up

[13:33] if I MISS You on the zoom

[13:36] outline. You know, it looks

[13:39] like we have no questions for

[13:41] my colleagues. Isabelle, where

[13:43] do you want to go from here?

[13:45] Um, I believe I will pass it to

[13:47] Sam Porter, who is going to do

[13:50] a staff briefing on the bridge

[13:51] implementation plan.

[13:53] Excellent. Sam, can you proceed

[13:55] with the, um, executive

[13:57] transmitted behavioral health

[13:59] Bridge implementation program

[14:00] and companion legislation?

[14:02] Yes, certainly. Thank you.

[14:03] Chair. Von Reichbauer Sam

[14:05] Porter, Council central staff.

[14:06] Um, so if you don

[14:06] t mind, I

[14:06] m

[14:08] going to begin with the mid

[14:10] renaming ordinance and then go

[14:11] into the implementation plan.

[14:13] The mid renaming ordinance is

[14:15] fairly brief and leads into the

[14:17] implementation plan because

[14:17] it

[14:19] s renaming the Mid. So the

[14:20] materials for this ordinance

[14:23] begin on page 65 of the packet.

[14:25] Proposed ordinance 2026 0174

[14:27] would rename and revise the

[14:28] mental illness and drug

[14:30] dependency for Mid Fund and

[14:31] Advisory Committee to the

[14:32] Behavioral Health Bridge Fund

[14:34] and Advisory Committee, and

[14:35] make additional changes to the

[14:37] Advisory Committee. This

[14:39] legislation is a mandatory dual

[14:41] referral to this committee and

[14:42] the health, Housing and Human

[14:44] Services Committee. The term

[14:46] behavioral health encompasses

[14:47] both mental illness and drug

[14:49] dependency, also referred to as

[14:51] substance use disorders. The

[14:52] transmittal states that the

[14:54] proposed name change is because

[14:56] the terms mental illness and

[14:57] drug dependency no longer

[14:58] reflect the values and

[15:00] priorities that guide

[15:01] behavioral health work today,

[15:02] and that the terms contribute

[15:04] to stigma. Executive staff

[15:05] indicate that the new name is

[15:06] responsive to community

[15:09] feedback. Section one of the

[15:10] proposed ordinance makes

[15:11] changes to the advisory

[15:13] committee and updates reference

[15:15] to expired portions of King

[15:17] County Code and references to

[15:18] groups that no longer exist,

[15:20] including all home and regional

[15:22] Human Services Levy, Citizen

[15:24] Oversight board. The proposed

[15:26] ordinance. Um, one of the key

[15:27] issues identified in the staff

[15:29] report is that the proposed

[15:30] ordinance changes the

[15:31] activities. The advisory

[15:33] committee, um, conducts from

[15:35] reviewing and reporting to the

[15:37] Executive and Council to review

[15:38] and provide guidance on

[15:39] behavioral health. Bridge

[15:42] annual reports. Executive staff

[15:43] state that this change is

[15:44] intended to better reflect the

[15:45] advisory committees current

[15:47] role and engagement. Regarding

[15:49] the annual report process. The

[15:51] proposed change in Advisory

[15:52] Committee duties reflects a

[15:54] policy choice. Um.

[15:56] Additionally, section one also

[15:57] replaces two positions for an

[15:58] individual representing

[16:00] behavioral health, consumer

[16:02] interests and an individual

[16:03] representing community

[16:04] interests from the mid

[16:06] consumers and communities. Ad

[16:08] Hoc workgroup with two

[16:10] positions that would represent

[16:11] behavioral health. Consumer

[16:12] interests who have lived

[16:14] experience with behavioral

[16:16] health conditions. Executive

[16:17] staff state that during the

[16:18] renewal process, the Mid

[16:20] Advisory Committee advised

[16:22] adding additional members with

[16:24] lived experience. This proposed

[16:26] change to the membership

[16:28] reflects a policy choice.

[16:30] Sections two, three and five in

[16:31] the proposed ordinance are all

[16:33] technical changes. Those are

[16:34] outlined in the staff report.

[16:37] But just to keep things moving,

[16:37] I

[16:38] ll move on to section four,

[16:40] which would update the name of

[16:41] the mid fund to the Behavioral

[16:44] Health Bridge Fund. This

[16:46] section also has a key issue

[16:48] identified that would remove

[16:50] the new strategy Reserve fund

[16:52] from King County Code.

[16:53] According to executive staff,

[16:56] the Mid to initiative 65, which

[16:57] is emerging issues and

[16:59] Behavioral health, was launched

[17:02] in the 2324 biennium through a

[17:03] partnership with the Mid

[17:05] Advisory Committee. This fund

[17:07] served the purpose of the new

[17:09] strategy Reserve Fund executive

[17:11] staff state that during the

[17:12] biennium, this strategy, funded

[17:14] for time limited projects

[17:17] including including Seattle

[17:18] Public Schools, creation of

[17:20] substance Use Reduction work

[17:22] Group and virtual parent

[17:24] education sessions, among other

[17:26] programs. The removal of this

[17:28] new strategy Reserve Fund is

[17:29] proposed by the executive

[17:31] because the strategy is no

[17:32] longer funded and executive

[17:34] staff states that it has

[17:36] historically been challenging

[17:38] to administer under short

[17:39] timelines and in response to

[17:41] new and emerging trends.

[17:43] Removing this new strategy

[17:44] Reserve Fund from King County

[17:47] Code is a policy choice. There

[17:48] is no fiscal impact of the

[17:50] proposed ordinance. According

[17:51] to the Fiscal Note, and

[17:51] council

[17:52] s legal counsel has

[17:54] reviewed the proposed

[17:56] ordinance. So I will move on to

[17:58] the implementation plan.

[18:00] Proposed ordinance, which is

[18:04] 2026 0177. I am on page 89 of

[18:06] the packet. This ordinance

[18:08] would adopt the implementation

[18:09] plan for the renamed Behavioral

[18:11] Health Bridge or Bridge Sales

[18:14] tax funded services from 2028

[18:17] through 2034, starting in 2028.

[18:19] This implementation plan would

[18:21] govern the administration and

[18:22] implementation plan of the

[18:23] Behavioral Health Bridge sales

[18:25] tax revenue. The existing mid

[18:27] to Service Improvement Plan,

[18:28] implementation plan and

[18:30] evaluation plan will continue

[18:32] to govern investments for this

[18:34] fund through 2027, in

[18:35] accordance with an expenditure

[18:36] restriction in the county

[18:37] s

[18:40] 2627 biennial budget. This

[18:42] legislation also is a mandatory

[18:44] dual referral to both rpc and

[18:47] three hs. The implementation

[18:49] plan is organized around a

[18:50] primary purpose and five

[18:52] updated strategy areas, which

[18:54] are identified in table two,

[18:57] which is on page 94 of your

[18:59] packet. Programs that receive

[19:01] bridge funding according to the

[19:02] plan will advance the primary

[19:04] strategy areas and will be tied

[19:07] to performance measures and

[19:09] outcomes that achieve the 13

[19:11] strategy areas as identified in

[19:15] table two. Table two the the

[19:16] primary. I

[19:17] ll just read the

[19:18] primary purpose. And then again

[19:21] that table two is on page 94.

[19:22] The primary purpose of the

[19:24] bridge is to invest in the long

[19:25] term availability,

[19:27] accessibility, effectiveness

[19:28] and equity of the county

[19:28] s

[19:29] behavioral health system,

[19:31] especially where people are

[19:32] falling through the cracks of

[19:36] existing systems. The strategy

[19:37] areas I

[19:38] ll just briefly read

[19:39] through those. The first one is

[19:41] care transitions and Diversion

[19:43] Services strategy. Area two is

[19:44] substance use disorder

[19:45] prevention, treatment and

[19:47] recovery. Strategy three is

[19:48] equitable access to behavioral

[19:50] health care. Strategy four is

[19:51] children, youth, and young

[19:53] adult mental well-being. And

[19:54] strategy five is behavioral

[19:57] health workforce development.

[19:58] Um. It is important to note

[20:03] that the transmitted 28 to 2034

[20:04] plan, unlike the Mid two

[20:06] implementation plan, does not

[20:07] identify specific programs that

[20:09] will receive bridge funding as

[20:11] allowed under state law. The

[20:12] plan further indicates that

[20:13] this structure allows the

[20:15] Behavioral Health and Recovery

[20:16] Division to make programmatic

[20:18] decisions through procurement.

[20:20] The phased competitive

[20:21] procurement and based Budget

[20:23] analysis section. Later in the

[20:24] staff report provides more

[20:28] detail. Um, on that process and

[20:30] attachment five to the staff

[20:32] report contains a crosswalk

[20:34] provided by executive staff

[20:35] that illustrates the Mid

[20:38] programs that currently are

[20:40] operating and the corresponding

[20:41] anticipated bridge activity

[20:42] under which programs MAY be

[20:46] eligible for funding. Um, I

[20:46] m

[20:47] going to move past the

[20:48] community engagement and

[20:49] subject matter expert

[20:50] components, as I believe

[20:51] executive staff are touching on

[20:53] that in their presentation. So

[20:56] I am now on page 96 of the

[20:58] packet. Um, the phased

[21:00] competitive Procurement and

[21:02] Based budget analysis. So the

[21:04] transmitted plan states that

[21:05] the executive intends to

[21:06] implement phased competitive

[21:08] procurements beginning in 2028

[21:10] for nearly all bridge funded

[21:12] programs administered by

[21:14] contracted providers. The plan

[21:15] states that the phase timeline

[21:17] will allow for careful design

[21:19] of the procurement process, and

[21:21] page 138, which is in the

[21:23] implementation plan, not in the

[21:24] staff report, shows the

[21:26] complete list of components

[21:27] that are expected to be

[21:29] included in the procurement

[21:32] process. Design. Executive

[21:33] staff indicate that the

[21:35] procurement process will follow

[21:37] standard departmental um

[21:38] procedures, including new

[21:40] safeguards that dhs is

[21:41] implementing to respond to the

[21:45] results of the 2025 um audit.

[21:46] Additionally, procurements will

[21:48] be guided by the anticipated

[21:49] activities that appear with the

[21:51] logic models that are described

[21:52] in more detail in the

[21:54] Performance Measurement section

[21:56] of the staff report. Those um

[21:58] logic models are also in the

[21:59] appendices to the

[22:02] implementation plan. The

[22:03] transmitted plan states that

[22:05] all bridge funded programs that

[22:06] are managed or administered by

[22:07] King County departments and

[22:10] agencies outside of dhs,

[22:11] including those operated by the

[22:13] courts and public health, will

[22:15] receive a base budget analysis

[22:17] instead of being procured.

[22:18] Because those programs are

[22:20] operated by King County.

[22:21] Details about what this base

[22:24] budget analysis, um, are not

[22:26] included in the plan, but the

[22:28] plan states that the executive

[22:29] anticipates that the initial

[22:30] analysis would be completed

[22:35] ahead of the 2829 budget. Um,

[22:36] due to the scale of planning

[22:38] and staffing, the plan states

[22:39] that the procurement and base

[22:41] budget analysis cannot occur

[22:42] all at once and will be done in

[22:44] a phased manner, as described

[22:46] in table three, which is on

[22:48] page 97 of today

[22:50] s packet. The

[22:52] plan states that the phased

[22:53] procurement approach will

[22:55] provide an opportunity to

[22:56] coordinate the children, youth

[22:58] and young adult mental

[22:59] well-being strategy with the

[23:00] Best starts for kids renewal,

[23:02] which is anticipated next year.

[23:04] Um, to ensure that funding

[23:05] streams complement rather than

[23:07] duplicate one another,

[23:10] executive staff provided table

[23:12] four, which is on page 98 that

[23:14] shows an estimated timeline for

[23:16] the phased procurements and non

[23:18] funded program ramp down

[23:19] periods. That would be for

[23:20] programs that don

[23:20] t receive

[23:22] bridge funding but currently

[23:25] receive mid to funding. So that

[23:28] table is on page 98. The

[23:30] transmitted plan states that

[23:31] the process to develop and

[23:32] implement procurements is

[23:34] expected to include notifying

[23:36] the council. Um, additional

[23:37] details are not included in the

[23:39] plan, but in response to

[23:40] council staff questions,

[23:41] executive staff stated that the

[23:43] bridge will continue the

[23:46] standard practice that dhhs

[23:48] uses to notify Council of

[23:49] Procurements and invite council

[23:51] members and their staff to

[23:53] attend panel deliberations. Um.

[23:55] The members MAY wish to include

[23:56] additional detail in the plan

[23:58] to ensure that this practice

[24:00] occurs, and I will hand things

[24:02] over to my colleague, Miranda

[24:03] Leskinen, to go over the

[24:05] measurement and evaluation

[24:08] portion of the staff report.

[24:09] Okay.

[24:11] MR. Chair, would you like to

[24:15] pause or MAY I proceed?

[24:15] Why don

[24:16] t you proceed? Then

[24:16] we

[24:17] ll open up for questions

[24:18] afterwards. Thanks, Brenda.

[24:20] Thank you so much. So as Sam

[24:21] mentioned, I

[24:21] m going to pick up

[24:23] with measurement and

[24:24] evaluation. I

[24:24] m at the very

[24:26] bottom of page 98 of your

[24:29] packets. Um, so provisions for

[24:30] measurement and evaluation of

[24:31] bridge investments are

[24:33] addressed in the plan in its

[24:35] section seven, which starts on

[24:36] page 154 of your packets, if

[24:36] you

[24:38] re curious, um, the plan

[24:39] states that measurement and

[24:40] evaluation for the bridge,

[24:41] consistent with current

[24:44] practice under mid two, will

[24:46] utilize the results based

[24:48] accountability or rpa

[24:49] framework. Uh committee members

[24:50] will be familiar with this

[24:52] framework for evaluation, as it

[24:54] is also used for other human

[24:56] service initiatives like Best

[24:58] starts for kids and as a

[24:59] framework includes, uh,

[25:00] performance measures,

[25:02] population indicators, and

[25:04] in-depth evaluation regarding

[25:05] performance measures for the

[25:06] bridge. Per the transmitted

[25:08] plan, measures MAY be

[25:10] qualitative and or quantitative

[25:12] and will vary across programs

[25:14] and strategy areas depending on

[25:15] factors like the population

[25:17] served, types of services

[25:18] provided, and intended

[25:21] outcomes. Per the plan, request

[25:23] for proposals, RFPs for for

[25:26] competitive procurements will

[25:27] include that strategies,

[25:29] intended goals, and system wide

[25:31] outcomes and associated

[25:33] performance measures. Um, a

[25:34] couple of examples of

[25:35] performance measures are

[25:37] provided in the plan. In it

[25:37] s

[25:40] figure 22, which is located on

[25:43] page 157 of your packets. Um,

[25:45] also per the plan, uh, dhs

[25:47] staff will work with service

[25:48] providers during their

[25:50] contracting process to finalize

[25:52] a performance measurement plan,

[25:52] which I

[25:54] ll speak to a bit more

[25:55] shortly. Uh, for county

[25:57] administered programs, agencies

[25:59] will collaborate with dhs to

[26:00] develop their program

[26:02] performance measurement plan.

[26:02] I

[26:04] m going to pivot to logic

[26:05] models. I

[26:06] m on page 99 of your

[26:08] packets. As Sam noted. Um,

[26:10] appendices f through j of the

[26:13] transmitted plan. Identify a

[26:15] logic model for each of the

[26:17] five bridge strategy areas. Um,

[26:20] each strategy areas logic model

[26:21] highlights the types of

[26:23] programs or activities

[26:25] anticipated for funding, and

[26:27] illustrates the envisioned

[26:28] relationship between

[26:29] investments, measures, and

[26:31] outcomes. Tables five through

[26:32] nine of the staff report

[26:34] provide a very high level

[26:35] summary of those anticipated

[26:37] activities that are identified

[26:39] in each strategy. Areas. Logic

[26:41] model. Additionally, a Sam

[26:43] noted attachment five to the

[26:45] staff report on page 241 of

[26:46] your packets that was provided

[26:48] by executive staff provides

[26:49] that high level comparative

[26:53] crosswalk overview of Mid two

[26:55] programs and the anticipated

[26:57] bridge activities. Um, moving

[26:58] next to data collection. I

[26:59] m on

[27:01] page 102 of your packets. The

[27:04] transmitted plan indicates that

[27:05] data collection practices for

[27:07] the bridge will be outcomes

[27:09] driven and reflect system level

[27:10] objectives for each of those

[27:12] strategy areas, as described in

[27:14] the aforementioned logic

[27:16] models. Um, earlier in my

[27:17] remarks, I had referenced

[27:18] provider performance

[27:21] measurement plans. These plans

[27:22] will include key performance

[27:24] measures, types of data

[27:26] collection, reporting cycles,

[27:28] and activities to review data

[27:30] and use data to inform

[27:32] continuous improvements.

[27:33] Service providers will submit

[27:35] data and relevant information

[27:37] to the county as required by

[27:38] their contract and or

[27:40] documented in their performance

[27:42] measurement plans. The

[27:43] Transmitted Implementation Plan

[27:46] further notes that dhs intends

[27:47] to measure and assess long term

[27:49] data and outcomes at the

[27:50] participant level, as well as

[27:52] collect system level data as

[27:54] appropriate, and monitor key

[27:56] level behavioral health

[27:58] indicators. The last thing I

[27:58] ll

[27:59] touch on before handing things

[28:00] back over to Sam relates to

[28:02] in-depth evaluation. Uh, the

[28:04] transmitted implementation plan

[28:06] indicates that the ability to

[28:07] conduct in-depth evaluations

[28:09] will be different for each

[28:11] program and strategy, and

[28:14] identifies in the plan criteria

[28:16] to help guide the evaluation

[28:18] team in prioritizing projects

[28:19] for that more in-depth

[28:22] evaluation. Um, if if I MAY, I

[28:23] will hand things back over to

[28:25] Sam to continue with the staff

[28:27] report. Um, regarding

[28:28] reporting.

[28:30] Thank you. Miranda and I will

[28:32] go through these quickly so

[28:33] that members can begin

[28:35] discussing. But I am on page

[28:36] 102 of today

[28:38] s packet. Um,

[28:39] going into the reporting

[28:41] section. So the transmitted

[28:42] plan states that dhs will offer

[28:44] an annual briefing to council,

[28:46] coinciding with the release of

[28:50] the annual data dashboard. Um,

[28:53] and the the plan proposes that

[28:54] the executive transmit a

[28:56] biennial report to council

[28:58] instead of an annual report.

[28:59] Um, that would detail, continue

[29:01] to detail programs and services

[29:04] funded by the bridge. Um, this

[29:06] plan, uh, or the annual

[29:08] biennial report would be

[29:09] transmitted no later than

[29:11] AUGUST 31st every other year,

[29:14] beginning in 2030. This is a

[29:16] changed from the annual report

[29:18] cadence, a list of the contents

[29:20] of the proposed biennial report

[29:22] appears on page 103 of the

[29:24] packet today. Um, the

[29:26] transition to biennial reports

[29:26] and what

[29:27] s included in the

[29:29] report represent policy choices

[29:33] to the Council to to members.

[29:35] So moving on to the financial

[29:38] plan or financial policies, the

[29:40] transmitted plan includes a

[29:41] financial plan with estimated

[29:43] collections and expenditures.

[29:47] Table ten on page um 104. Uh,

[29:49] shows a summary of the

[29:52] estimated annual revenue from

[29:55] 2028 to 2034, based on the

[30:00] 2026, uh, for forecast. This,

[30:02] uh, has been updated from the

[30:05] the MARCH for forecast. Um,

[30:07] that was originally published

[30:09] in the 3/8 staff report, and it

[30:11] projects the JULY weather

[30:14] forecast. Uh shows a decrease

[30:18] in approximately $26 million

[30:20] less in overall revenue during

[30:21] the plan period from the MARCH

[30:24] forecast. Table 11 shows the

[30:25] estimated expenditures for each

[30:28] strategy, area, and staff

[30:29] analysis is ongoing regarding

[30:32] the impact of the JULY for

[30:33] forecast on the financial plan

[30:35] and estimated expenditures for

[30:39] the bridge. Moving on to the

[30:41] other financial policies before

[30:42] moving into the potential

[30:44] policy issues. So I

[30:44] m on page

[30:47] 105 of the packet. Uh, the

[30:49] transmitted plan indicates that

[30:50] the behavioral health bridge

[30:52] will set aside a half a percent

[30:53] of revenue for technical

[30:54] assistance and capacity

[30:56] building to support the

[30:57] implementation of the

[31:00] identified goals. Um, for

[31:01] administration and compliance.

[31:03] In response to the 2025 audit,

[31:05] the transmitted plan states

[31:06] that the bridge will increase

[31:08] the proportion of funds

[31:09] supporting administrative

[31:13] functions in 2028 to 2034 to

[31:15] enhance fiscal controls and

[31:17] contract management. Um

[31:18] executive staff indicate that

[31:20] additional staff will be needed

[31:21] to support procurement

[31:22] evaluation, program management,

[31:24] compliance, financial

[31:26] management and reporting. Um

[31:28] for the reserves consistent

[31:29] with the county

[31:30] s comprehensive

[31:32] financial management policies,

[31:34] the bridge will maintain a fund

[31:35] reserve equivalent to 60 days

[31:37] of budgeted spending in the

[31:39] current, adopted or projected

[31:40] biennial budget. Under this

[31:42] plan. Additionally, the fund

[31:44] will maintain a sustainability

[31:46] reserve starting in 2028 to

[31:48] maintain program commitments

[31:50] despite the projected decrease

[31:51] in sales tax revenue

[31:53] anticipated in 2029 due to

[31:56] 2026. Changes in state law

[31:58] pertaining to products and

[31:59] services that will be exempt

[32:01] from sales tax beginning in

[32:03] 2029. The sustainability

[32:05] Reserve is anticipated to be

[32:07] spent down by 2031. The

[32:08] transmitted plan also would

[32:10] formalize the continuation of a

[32:12] transfer of mid revenue to the

[32:13] Behavioral Health Fund that has

[32:16] occurred since 2021, and

[32:17] consistent with the health

[32:19] through housing Crisis Care

[32:22] centers and bsk levy. If a

[32:23] substantial adjustment to the

[32:25] financial plan were planned by

[32:26] the executive, then the

[32:28] executive would transmit a

[32:29] notification letter to Council

[32:30] explaining the rationale and

[32:32] scope of the plan change upon

[32:33] which time the council would

[32:35] have 30 days to pass a motion

[32:37] rejecting the change. Otherwise

[32:38] the change would proceed after

[32:42] 30 days. Uh, I am now on page

[32:44] 106 of the packet. The

[32:47] priorities for allocating the

[32:49] undesignated fund balance, the

[32:50] transmitted plan would

[32:52] establish priorities for

[32:53] allocating any undesignated

[32:55] fund balance, which is new for

[32:57] this revenue stream. The plan

[32:58] states that the executive

[32:59] intends to apply the following

[33:01] three priorities to allocate

[33:03] any undesignated fund balance.

[33:04] When the executive determines

[33:05] that it represents an

[33:07] opportunity for long term or

[33:10] sustainable investment. In any

[33:12] year where inflation rates have

[33:13] been reduced due to limited

[33:15] funding availability, the

[33:17] undesignated fund balance would

[33:18] provide inflationary

[33:20] adjustments to contracted

[33:22] providers up to the amount of

[33:24] cpu. Seattle inflation rates.

[33:27] The second, um, type of use for

[33:29] undesignated fund balance under

[33:30] a long term investment would be

[33:33] to augment existing investments

[33:35] to mitigate losses of Medicaid

[33:36] coverage to the degree

[33:38] necessary and feasible within

[33:40] allowable funds. And the third

[33:42] use of undesignated fund

[33:43] balance. If it

[33:44] s determined to

[33:46] be a long term investment, is

[33:48] to scale high performing or

[33:49] innovative behavioral health

[33:51] bridge investments to address a

[33:54] net unmet need. The plan states

[33:55] that when the executive

[33:56] determines that fund

[33:58] availability is one time in

[33:59] nature and cannot reasonably

[34:01] support sustained programming,

[34:03] the executive intends to

[34:04] consider using these funds for

[34:06] one time investments, including

[34:07] capital projects such as

[34:09] behavioral health facilities or

[34:10] housing for people with

[34:11] behavioral health conditions,

[34:13] or in pilot programs that can

[34:14] later transition to other

[34:16] funding sources, such as

[34:18] Medicaid. The transmitted plan

[34:20] also includes a proviso

[34:24] response, um, that uh responds

[34:27] to an analysis requested for

[34:29] about the dhs inflation rate

[34:31] adjustment policy that is in.

[34:32] There

[34:33] s an overview of that in

[34:34] the staff report. I won

[34:34] t go

[34:36] into it now. Um, but just

[34:37] flagging that for you that

[34:38] that

[34:39] s present in the

[34:41] transmitted plan, um, moving on

[34:43] to the potential policy issues.

[34:45] So staff have identified nine

[34:47] potential policy issues that

[34:50] are summarized on pages 109 to

[34:53] 110 of your packet. Um, I will

[34:54] only highlight a few here

[34:56] before handing things over to

[34:58] executive staff. Um, but the

[35:00] the first that I will highlight

[35:01] is that the priorities for

[35:02] allocating the undesignated

[35:03] fund balance that I just spoke

[35:05] about, those are policy

[35:06] choices, since that is a new

[35:08] policy. Um, members could

[35:10] consider changing those or

[35:12] amending those in some way.

[35:14] Another policy issue is that

[35:16] the transmitted plan uses

[35:17] permissive language throughout,

[35:20] such as intends, plans and

[35:21] anticipates with respect to

[35:23] various components of the plan

[35:24] that the executive MAY

[35:26] implement. Using these terms

[35:28] allows the executive the option

[35:29] to not implement components,

[35:31] whereas terms such as shell or

[35:32] will would require the

[35:34] executive to follow through.

[35:36] Um. The transmitted plan, as

[35:38] mentioned, changes the

[35:39] recording cadence from an

[35:41] annual report to a biennial

[35:43] report. Um, that is a policy

[35:46] choice to make that change. Um,

[35:49] the implementation plan also is

[35:51] drafted, uh, from the

[35:52] perspective of the executive.

[35:52] So that

[35:54] s a language choice.

[35:56] That is a policy choice. Um, it

[35:58] refers to things, uh, as in

[35:59] keeping with the executive

[36:00] s

[36:03] priorities, instead of, uh,

[36:05] having it be a from the county

[36:07] as a perspective of the plan.

[36:07] So it

[36:08] s a policy choice whether

[36:10] or not to edit these statements

[36:13] so that the implementation plan

[36:14] reflects that it is a King

[36:15] County plan, and not just that

[36:16] of the executive. Um, and then

[36:18] the last policy flag that I

[36:19] will make is that there

[36:20] s just

[36:22] a lack of specificity in the

[36:24] plan around what specific

[36:26] programs will receive funding

[36:28] based on communication with the

[36:30] executive staff. It appears

[36:30] that they MAY not have

[36:32] additional detail to share

[36:33] about this. Regarding

[36:36] programmatic investments. Um,

[36:38] at this time. So if members

[36:39] wanted additional information

[36:41] about these topics prior to

[36:44] 2028, uh, the council would uh,

[36:46] could add a new section to the

[36:47] proposed ordinance and amend

[36:49] the implementation plan to

[36:51] reflect that as well. So the,

[36:54] um, last two things that I will

[36:56] note are the updated, um,

[36:59] schedule for the the plan that

[37:03] is on page 111 of the packet.

[37:06] Um, this update was, uh,

[37:08] distributed to rpc members. So

[37:10] you should have that updated

[37:12] schedule in your inbox. The

[37:14] main changes are that it

[37:16] anticipates three, uh,

[37:17] contemplates three touches for

[37:18] each committee

[37:19] s, uh, with

[37:20] amendments being considered in

[37:22] three hours in OCTOBER. Now,

[37:24] instead of in SEPTEMBER. Um and

[37:26] an option for amendments to

[37:27] also be taken up in rpc during

[37:29] a special meeting that is to be

[37:32] scheduled the week of NOVEMBER

[37:34] 2nd. Um, lastly, before handing

[37:35] things over, I will orient

[37:36] members to the attachment of

[37:37] the staff report. We have

[37:38] mentioned the Behavioral Health

[37:40] Bridge and Mid strategy

[37:41] crosswalk. That is attachment

[37:44] five that provides the overview

[37:47] of existing uh programs and

[37:49] what bridge, uh, they MAY be

[37:50] eligible for, what bridge

[37:52] strategy they MAY be eligible

[37:53] for under um and then

[37:55] attachment six is the question

[37:57] and response question and

[37:59] answer um document. That was in

[38:02] response to the JULY 23rd, uh,

[38:04] three hours committee meeting.

[38:05] Attachment seven is the

[38:06] behavioral health bridge and

[38:08] mid strategy financial

[38:10] crosswalk, which shows, uh, the

[38:14] Mid strategies, uh, and what uh

[38:16] amount those programs were

[38:19] funded, sort of rolled up into

[38:21] the bridge strategies. Um,

[38:22] attachment eight is sort of a

[38:24] reference document for that.

[38:26] Attachment seven that gives the

[38:29] um the actual names of the

[38:30] strategies that attachment

[38:32] seven only shows the sort of

[38:34] Sio five, the abbreviation. So

[38:36] attachment eight helps provide

[38:37] a little bit more information

[38:39] about that. And then the last

[38:40] attachment is the executive

[38:43] staff PowerPoint presentation.

[38:44] Um, Councilmember von

[38:45] Reichbauer, would you like me

[38:46] to hand things over to

[38:48] executive staff now for for

[38:49] their presentation?

[38:50] Let me see if there

[38:50] s any

[38:52] questions today. Thank you. I

[38:53] m

[38:55] just checking for hands and

[38:57] feel free colleagues to speak

[38:59] out if I MISS You.

[39:00] Okay.

[39:01] So let

[39:02] s go ahead now to the

[39:04] executive staff.

[39:05] Sounds good. So we have

[39:08] Isabelle Jones. Um, also Laura

[39:10] Smith, Susan McLaughlin and Liz

[39:13] Arjun. Um, to present on this

[39:16] item.

[39:18] Thank you so much, Sam, and

[39:20] good afternoon, everybody. MR.

[39:21] Chair, members of the

[39:22] committee, thanks for having us

[39:24] this afternoon. My name is

[39:25] Susan McLaughlin. I am the

[39:27] director of the Department of

[39:29] Community and Human Services

[39:31] over here at King County. And I

[39:33] am going to kick us off. So,

[39:35] um, uh, just to say, I

[39:35] m sure

[39:35] you

[39:36] re aware at this moment

[39:36] that we

[39:37] re here to brief you on

[39:39] the behavioral health Bridge

[39:42] implementation plan. Um, the

[39:43] county council passed the

[39:44] continuation of the collection

[39:46] of the one tenth of 1% sales

[39:50] tax at the end of 2025. And

[39:51] with the promise of an

[39:52] implementation plan being

[39:54] transmitted mid-year. So, um,

[39:56] this updated implementation

[39:58] plan has been noted, covers

[39:59] behavioral health sales tax

[40:03] investments from 2028 to 20 20

[40:05] or sorry, 2034. Um, the

[40:07] implementation plan and

[40:09] financial plan for the bridge

[40:10] just is a little background

[40:11] context. Take into

[40:13] consideration three things.

[40:16] First is that we want to ensure

[40:18] that the the bridge and the use

[40:20] of this precious sales tax is

[40:22] more focused on investments in

[40:23] areas within the behavioral

[40:25] health system that have the

[40:27] greatest need, and also

[40:27] ensuring that there

[40:28] s greater

[40:30] accountability to achieve the

[40:31] goals that are laid out in the

[40:33] plan. The second is to mitigate

[40:35] current and projected financial

[40:38] pressures that are plaguing the

[40:40] sales tax and the bridge. And

[40:41] so one of the things that we

[40:43] need to do is bring bridge

[40:45] expenditures into alignment

[40:48] with the projected revenue. And

[40:49] then finally, we want to make

[40:51] sure that we support a smooth

[40:53] transition to new investment

[40:55] areas and new outcome. Um, and

[40:57] goal expectations while

[41:00] mitigating any disruption in

[41:01] services wherever possible for

[41:03] providers. So at the end of the

[41:03] day, we

[41:05] re looking to make sure

[41:06] that we are using these

[41:08] precious and shrinking dollars

[41:11] in the most strategic way. Um,

[41:14] next slide. Our agenda for

[41:15] today, um, we

[41:16] re gonna cover

[41:18] how the implementation plan was

[41:21] developed, including the, um,

[41:22] the depth of community

[41:24] engagement that was done. Uh,

[41:24] we

[41:25] ll also talk about what

[41:25] s

[41:27] different with regard to the

[41:29] bridge implementation plan and

[41:30] how we plan to implement the

[41:31] transition through our

[41:33] procurement process. And then,

[41:34] as Sam noted, there

[41:35] s an

[41:37] analysis that will, um, talk

[41:40] about about the impact of dcs

[41:42] inflationary adjustment policy

[41:43] on the behavioral health bridge

[41:44] and its implementation and

[41:47] financial planning. So kicking

[41:49] us off is just, uh, gives the

[41:50] highest level, um, all that

[41:52] went into the development of

[41:54] this implementation plan, it

[41:58] started in late 2023 and 2024,

[41:59] when we were doing an

[42:01] assessment of the behavioral

[42:03] health landscape. Um, you know,

[42:05] the last mid renewal was back

[42:10] in 20 2016, 2017. And a lot has

[42:11] changed with regard to

[42:12] behavioral health services,

[42:15] including both all of state.

[42:15] There

[42:16] s been federal changes

[42:18] and also local changes to both

[42:21] policy and funding. Um,

[42:23] including the introduction of

[42:25] new local resources like the

[42:26] crisis care center levy that

[42:26] didn

[42:29] t exist when the last uh,

[42:31] mid version was implemented. We

[42:34] then combined that landscape

[42:36] analysis data with our

[42:38] community engagement feedback.

[42:38] And I

[42:38] m going to talk a little

[42:40] bit about what that looked

[42:42] like. Um, in a minute and who

[42:43] we talked to. But to develop

[42:45] the five new strategy areas

[42:47] that are part of this renewal

[42:51] implementation plan, um, we

[42:54] engaged over 2200 diverse

[42:56] county residents to understand

[42:57] from their perspective, the

[42:58] behavioral health system needs

[43:01] gaps and opportunities. Um,

[43:03] once we had all of that data

[43:05] collected and brought together,

[43:08] we engaged a cross-sector, um,

[43:10] table of subject matter

[43:11] experts, and this was done

[43:14] between APRIL and JULY of 2025.

[43:16] We convened five different

[43:19] tables, one around each of the

[43:21] prioritized strategy areas that

[43:23] are in the implementation plan.

[43:25] Those work groups of subject

[43:27] matter experts included um

[43:29] providers and included

[43:30] researchers in that particular

[43:33] area. Advocates, peers, county

[43:34] staff, people with lived

[43:36] experience. And through that

[43:37] process, that group really

[43:39] developed a set of ideas and

[43:42] recommendations, um, that could

[43:43] be used to leverage the

[43:45] foundation of what Mid had been

[43:47] doing and to and to build

[43:49] forward in the best future.

[43:51] Invest um investment of these

[43:53] funds. We then did an internal

[43:56] analysis of that information in

[43:57] AUGUST through DECEMBER,

[43:59] leveraging the data and

[44:01] knowledge and looking at some

[44:03] of those ideas through the lens

[44:03] of what

[44:05] s feasible, equitable,

[44:07] how does it align with existing

[44:10] programs and services, and also

[44:12] prioritizing what the greatest

[44:13] need was. And then, of course,

[44:15] we had our executive

[44:18] transition. Um, uh, late at the

[44:21] end of 2025 into 2026. And so,

[44:23] um, we were able to then work

[44:24] with our new executive, Zahilay

[44:27] to understand priorities of

[44:29] this administration and how we

[44:30] fit that together into this mid

[44:32] implementation plan. So, um,

[44:33] quite a process that

[44:33] s been

[44:35] going on for a while, but it

[44:36] really helped to shape and

[44:37] inform where we think the

[44:39] behavioral health system needs

[44:40] to go. So now I

[44:40] m going to talk

[44:42] a little bit about the ways

[44:44] that we engage community

[44:47] members, providers and others

[44:49] in this process. As I

[44:52] mentioned, over 2200 people

[44:53] were engaged over an 18 month

[44:55] period. Uh, we used a

[44:57] combination of listening

[44:59] sessions, both virtual and

[45:01] in-person sessions across King

[45:03] County, including at least one

[45:05] in every council district. We

[45:08] held community events and we

[45:11] can, um, conducted an online

[45:13] survey that was translated into

[45:15] 21 different languages and had

[45:17] our teams out in a variety of

[45:19] different community settings

[45:21] and events with qr codes where

[45:22] people could just, like, log on

[45:24] with their phone and answer

[45:25] that survey right then and

[45:27] there. Um, we had a very

[45:29] diverse set of respondents to

[45:31] all of that participated, and

[45:33] all of those different, um,

[45:35] venues and avenues, including

[45:37] half of the people engaged, um,

[45:40] were self-identified as being

[45:41] black, indigenous or other

[45:42] people. People of color,

[45:46] including our Latinx, uh, Asian

[45:47] American, Pacific Islander,

[45:49] Middle Eastern, and so forth.

[45:52] Um, and then there was quite a

[45:55] variety also of different, um,

[45:57] lived experience and ages. So

[46:00] we did hear, um, specifically

[46:02] from youth, uh, between the

[46:06] ages of 2025, about 209 were

[46:08] engaged, um, seniors. We had a

[46:11] sample of folks from the lgbtq

[46:15] ia plus population, individuals

[46:16] that I self-identify as having

[46:17] lived experience with, mental

[46:19] health and substance use needs,

[46:21] um, about 356 people there. We

[46:24] also did some, um, focused, um,

[46:26] listening sessions in our King

[46:28] County jail to hear directly

[46:29] from people who have behavioral

[46:32] health conditions, who are were

[46:33] incarcerated. So, again, a

[46:35] very, um, very wide range of

[46:37] people that we heard from and

[46:39] the nature of those

[46:41] conversations were really about

[46:43] what, um, what are the gaps in

[46:44] the behavioral health system?

[46:45] What are your highest

[46:46] priorities? Where do you think

[46:48] we need to make changes or need

[46:49] more investment and so forth?

[46:50] So that

[46:51] s what helped inform

[46:52] this. Um, I also mentioned our

[46:55] subject matter expert groups.

[46:57] Uh, you can see here we had

[46:58] again one work group for each

[47:01] of the five strategy areas. Um,

[47:03] they it was a very diverse

[47:05] group of people. Um,

[47:06] participants included clinical

[47:09] providers, licensed peers, um,

[47:10] individuals from the criminal

[47:13] legal system, researchers,

[47:15] educators, outreach workers,

[47:17] nonprofit leaders. We also had,

[47:19] um, substantial engagement with

[47:21] our mid advisory committee

[47:24] throughout this process as well.

[47:26] Um, the goals again of the and

[47:27] from the same work group formed

[47:30] the basis of the goals that are

[47:31] identified. So each there

[47:31] s the

[47:34] five strategy areas. And um

[47:36] specific goals within each. And

[47:36] that

[47:37] s what you

[47:37] ll hear in a

[47:39] minute from Liz about um, one

[47:41] of the big changes is getting

[47:42] much more focused on impact and

[47:44] outcomes and detailing out what

[47:46] when we do procurements, what

[47:46] we

[47:47] re trying to achieve to

[47:49] ensure that the strategies that

[47:49] we

[47:50] re investing in are

[47:51] achieving the goals that we

[47:51] re

[47:53] trying to accomplish. So with

[47:53] that, I

[47:54] m going to turn it over

[47:55] to Liz, who will introduce

[47:57] herself and, um, sort of put

[47:59] the frame of the executive new

[48:01] executive administration on,

[48:04] um, priorities. Liz.

[48:06] Thanks, Susan. Good afternoon

[48:07] everyone. For the record, my

[48:08] name is Liz Arjun. I

[48:08] m the

[48:09] behavioral health and public

[48:10] health policy advisor for

[48:12] Executive Zahilay. I

[48:12] m pleased

[48:14] to be here in partnership with

[48:16] colleagues from dhs, be heard.

[48:18] And for those whom I don

[48:18] t

[48:20] know, just a little bit, a bit

[48:22] about my background, um, I

[48:23] return to the county and public

[48:26] service in, uh, MARCH this

[48:29] year. Um, after working, um,

[48:32] here at King County from 2014

[48:35] to 2017, when I was here at the

[48:36] county before I was a joint

[48:38] employee of dhs and Public

[48:39] Health, where I had the

[48:41] opportunity to work on project

[48:43] projects that were focused on

[48:44] bringing our departments

[48:45] together and working together

[48:47] on behalf of the shared

[48:49] populations that are so often

[48:50] the focus of the two agencies.

[48:52] But where coordination and

[48:53] alignment were not the standard

[48:55] approach, and these projects

[48:56] were a catalyst to start

[48:57] working that way. When I came

[48:59] back to the county earlier this

[49:01] year, I was really pleased to

[49:03] see the path that the bird team

[49:04] and the executive team were

[49:06] already on with regard to how

[49:07] we were, how we were

[49:09] approaching the mid renewal and

[49:11] the implementation plan. And

[49:14] just to say that this really is

[49:17] a one one county approach where

[49:17] we

[49:18] re looking to funding

[49:19] activities that will support a

[49:22] system of robust behavioral

[49:23] health continuum from

[49:25] prevention activities that

[49:26] could be happening in public

[49:28] health to the therapeutic court

[49:30] interventions, um, to, you

[49:32] know, the the crisis system

[49:32] that

[49:34] s being established. And,

[49:36] um, this is something that I,

[49:38] Susan, is going to share more

[49:40] about, but was very strongly

[49:41] heard in the community. But

[49:41] it

[49:44] s also what makes sense, um,

[49:46] the people that we serve are

[49:47] not uh, they don

[49:47] t they don

[49:48] t

[49:50] care what what agency is

[49:51] serving them. They just want to

[49:52] have their needs met. And so I

[49:54] was really pleased to see that

[49:56] approach. We really viewed this

[50:00] happening in an approach that

[50:01] promotes overall accountability

[50:03] across the county, investments

[50:04] that the Mid brings to the

[50:06] table or that the bridge brings

[50:08] to the table. Um, we envision

[50:10] doing this through establishing

[50:13] with our partners at dhs and

[50:15] other relevant agencies,

[50:17] establishing a shared framework

[50:20] about metrics for metrics and

[50:23] accountability. Um, again, just

[50:24] to reiterate, it doesn

[50:25] t matter

[50:26] which department is

[50:28] administering the services. We

[50:31] want to have a an overarching

[50:32] framework for accountability

[50:34] that crosses those agencies.

[50:36] Um, we want to be able to look

[50:38] and see over time as we

[50:39] re

[50:40] making an investment in one

[50:41] part of the continuum, how it

[50:43] MAY or MAY not be showing up in

[50:46] other parts. Um, and we

[50:48] anticipate that this approach

[50:50] will give us the opportunity to

[50:52] make stronger, data driven

[50:54] decisions in real time that

[50:55] have performance goals that we

[50:57] can see and make adjustments

[50:59] along the way. So I

[50:59] m really

[51:01] pleased to be here with my

[51:04] colleagues from dhs and be back

[51:05] with many of you who whom I

[51:06] ve

[51:06] had the chance to meet in the

[51:08] past and look forward to

[51:09] talking with you more in the

[51:10] future. I

[51:10] m going to pass it

[51:16] back over to Susan.

[51:17] Um, I think this is about is

[51:18] this going to you or do you

[51:20] want me to take these? Okay.

[51:21] Yeah, I can take this. Um,

[51:23] thank you so much. Uh, thank

[51:25] you. And for the record, I

[51:25] d

[51:27] like to introduce myself. My

[51:28] name is Isabel Jones. She her

[51:30] pronouns. And I am the acting

[51:32] director for the Division of

[51:33] Behavioral Health and Recovery

[51:35] here in dc. Hs. Um, and I am

[51:37] going to talk us through some

[51:39] of what is new in the bridge

[51:41] implementation plan as compared

[51:43] to the prior Mid implementation

[51:46] plan. Um, so first start the

[51:48] bridge investment

[51:50] considerations. Um, the

[51:52] investments as outlined in the

[51:53] Mid implementation plan

[51:55] financial model are designed to

[51:57] respond to changing financial

[51:58] projections throughout the

[52:00] implementation plan 2028

[52:03] through 2034. Um, for context,

[52:06] the mid as of 2026 is actually

[52:08] currently in a minor reserve

[52:11] shortfall of approximately $4

[52:14] million. Um, and should

[52:16] expenditures and economic

[52:18] adjustments for all existing

[52:20] programs within the current Mid

[52:23] continue. Um, you know, sort of

[52:24] as status quo and giving

[52:26] inflationary adjustments each

[52:28] year. Um, the revenue source

[52:30] would be in a significant

[52:31] reserve shortfall of

[52:34] approximately 29. Yeah, 29

[52:38] million by 2029. Um, so the

[52:41] bridge implementation plan, uh,

[52:43] is designed to address that

[52:46] over, um, the first several

[52:47] years of the implementation

[52:49] plan, in particular, um,

[52:51] primarily by conducting

[52:53] procurements for new

[52:56] programming or to select, uh,

[52:59] new providers to do similar

[53:01] programming to the current mid,

[53:04] um, and to assure that as we

[53:05] proceed into the mid, the

[53:08] bridge implementation plan, um,

[53:11] that the programming is, uh,

[53:13] sort of operating within the

[53:15] revenue that is available from

[53:17] the funding source. Um,

[53:19] additionally, we have

[53:21] introduced through learnings

[53:23] during the last prior mid

[53:24] implementation plan, um, we

[53:25] ve

[53:26] introduced a reserve that

[53:29] creates more flexibility during

[53:31] anticipated periods of sales

[53:33] tax volatility. For example, we

[53:36] know that in 2029 there will be

[53:37] a kind of a revenue, uh,

[53:40] reduction in terms of sales tax

[53:41] due to some of the state

[53:43] changes to the, um, related to

[53:44] the millionaire

[53:45] s tax. Um, and

[53:48] so the implementation plan

[53:49] already contemplates that that

[53:50] would be a year where there

[53:52] would be a lower inflationary

[53:55] adjustment proposed. Um, but it

[53:58] also creates a reserve, as Sam

[54:02] mentioned, through 2031, so

[54:03] that we are sort of smoothing

[54:05] out the known sales tax

[54:07] volatility, um, and planning

[54:09] for it so that we can plan

[54:10] ahead to provide economic

[54:12] adjustments for existing

[54:15] contractors. Um, uh, when

[54:17] revenue is available. Um, and

[54:18] this is something that is part

[54:19] of the bridge implementation

[54:21] plan as a learning from the

[54:23] prior mid period. Um, and then

[54:25] we are also proposing to

[54:26] strengthen our monitoring and

[54:28] compliance work by rightsizing

[54:29] staffing to support the

[54:33] investment of $100 million per

[54:36] year. We do have over 312

[54:37] contracts currently within the

[54:40] mid. Um, and so we are seeking

[54:42] a modest increase in staffing

[54:43] to support our ability to do

[54:45] compliance work, do monitoring

[54:48] work, and to implement the

[54:50] various levels up policies and

[54:52] procedures that the department,

[54:55] um, uh, has been, um,

[54:57] implementing. And next slide,

[55:04] please. Um, so another primary,

[55:06] uh, change in the bridge as

[55:09] compared to Mid. Is that the

[55:12] bridge is organized into five

[55:15] primary strategy areas, um,

[55:19] with 2 to 3 concrete goals. Uh,

[55:21] in each of these five strategy

[55:26] areas for a total of 13 goals

[55:27] and funding in the financial

[55:30] plan is at that goal level. Um,

[55:33] and this is a shift from mid

[55:35] where the Mid implementation

[55:37] plan was organized under about

[55:41] 55 distinct initiatives. Um,

[55:43] those 55 initiatives did roll

[55:45] up to five goals. Also in the

[55:47] Mid implementation plan. Um,

[55:50] but we are seeking to move away

[55:52] from uh 55 distinct

[55:54] initiatives, which in some

[55:56] cases were quite narrowly

[55:59] defined and kind of, uh,

[56:00] resulted in somewhat

[56:03] constraining how, uh, programs

[56:05] could be implemented within a

[56:07] given initiative if it was

[56:09] narrowly defined to moving

[56:11] towards kind of a little bit of

[56:14] a higher level investment and,

[56:15] um, having more flexibility

[56:17] within the bridge to be able to

[56:20] make broader, deeper

[56:21] investments, meaningful,

[56:24] impactful investments. Um,

[56:25] investments that are scalable

[56:27] across our community and

[56:29] operating at that goal level

[56:32] rather than at the, um, the

[56:34] initiative level. Um, so the

[56:36] five strategy areas are care,

[56:38] transitions and diversion

[56:40] services, substance use

[56:41] disorder, treatment and

[56:43] recovery, equitable access to

[56:44] behavioral health care, child

[56:46] youth and young adult mental

[56:47] well-being and behavioral

[56:49] health. Workforce development.

[56:51] I will note that, um, well,

[56:53] this is a change in structure

[56:55] and sort of organization of

[56:58] work in the bridge. The

[56:59] existing programs and

[57:02] initiatives and contracts, um,

[57:04] do crosswalk to these five

[57:06] strategy areas and 13 goals.

[57:08] And in many ways, you know,

[57:10] align with the direction that

[57:10] we

[57:12] re moving in the bridge. So

[57:12] it

[57:13] s not a, um, it

[57:14] s not a

[57:16] dramatic departure from, uh,

[57:18] much of which much of what the

[57:20] Mid has been investing in over

[57:23] the last few years. Um, but in

[57:24] particular, I think a different

[57:27] way of organizing the work.

[57:30] And, you know, uh, highlighting

[57:32] these really as the five

[57:34] strategy areas in particular

[57:36] that we see as being priorities

[57:37] for the community Behavioral

[57:39] Health System based on, as

[57:40] Susan mentioned, uh,

[57:41] significant community

[57:43] engagement as well as data

[57:45] analysis and a lot of work with

[57:47] subject matter experts in our

[57:55] system. Uh, next slide. Um, the

[57:56] bridge implementation plan is

[57:57] also bringing a county wide

[57:59] approach to accountable

[58:01] accountability and outcomes.

[58:02] Um, uh, as the executive

[58:03] s

[58:05] office has mentioned, um, there

[58:06] is an intent to measure,

[58:08] monitor and support

[58:09] accountability across county

[58:11] administered programming in

[58:13] addition to our programming

[58:15] that we contract out to

[58:17] providers. Um, currently under

[58:18] the Mid right now, there

[58:19] s

[58:22] about 75% of the funds that are

[58:23] administered through contracts

[58:24] with provider organizations in

[58:27] the community. And then about

[58:29] 25% of the programming is

[58:31] actually administered by the

[58:33] county itself, whether that be

[58:34] through public health or, um,

[58:36] jail health or even some

[58:37] programming that

[58:38] s administered

[58:38] in the sheriff

[58:39] s office. For

[58:42] example. Um, uh, we will also

[58:43] be doing competitive

[58:46] procurement for dhs programs.

[58:47] Uh, this is something that we

[58:50] are proposing to do. Uh, in all

[58:52] five strategy areas and under

[58:55] all of the sort of 13 goals,

[58:55] um, that doesn

[58:57] t necessarily

[58:59] mean that some or much of the

[59:01] current programming that

[59:03] happens now in the mid, um,

[59:05] might not be something that,

[59:06] uh, either something that is

[59:07] procured in the future or

[59:09] something very similar could be

[59:11] procured in the future. But we

[59:13] are proposing to do procurement

[59:16] processes for, uh, contracted

[59:18] programming. We think this is

[59:20] very important. Um, just to,

[59:22] uh, give, for example, new

[59:24] organizations and entrants in

[59:26] our community an opportunity to

[59:27] compete, an opportunity to

[59:29] bring forward the best possible

[59:31] proposals for how they can

[59:33] serve our community. Um, so

[59:35] that is, um, a change that

[59:35] we

[59:37] re proposing in this bridge

[59:39] implementation plan. Um, that

[59:41] is something that we seek to do

[59:43] and we think is very important

[59:44] to do at this point for the

[59:46] funding source. Um, because in

[59:49] many cases, it has been many

[59:51] years, uh, since some of our

[59:52] programming through this

[59:53] funding source has actually

[59:55] been open up for a competitive

[59:58] process in the community. Uh,

[1:00:03] next slide, please. Um, in

[1:00:05] terms of the anticipated steps

[1:00:08] to the procurement, uh, so, um,

[1:00:08] I

[1:00:09] ll just kind of walk us

[1:00:12] through how we at the division.

[1:00:14] Um, uh, do our procurements and

[1:00:16] what those various steps are,

[1:00:17] as well as my next slide. We

[1:00:17] ll

[1:00:19] talk about the timeline. Um,

[1:00:21] but we start by analyzing the

[1:00:23] current financial projections,

[1:00:25] how much revenue is going to be

[1:00:27] available to, you know, put out

[1:00:29] for a given procurement, the

[1:00:30] behavioral health landscape,

[1:00:32] performance data and potential

[1:00:34] funding sources for each

[1:00:35] strategy area? Um, what we

[1:00:36] re

[1:00:38] referencing with that is, um,

[1:00:41] uh, continuing to evaluate, uh,

[1:00:42] if there is a funding source

[1:00:44] that has perhaps become

[1:00:47] available to the county, um, in

[1:00:48] recent years, such as the

[1:00:49] crisis care center levy, that

[1:00:51] might have a stronger alignment

[1:00:52] with something that we were

[1:00:54] previously doing under the mid.

[1:00:57] Um, we would seek to evaluate

[1:00:59] whether that programming might

[1:01:00] actually be more appropriate

[1:01:02] for a different funding source

[1:01:05] and evaluate the programs

[1:01:06] Where we have braided multiple

[1:01:08] funding sources together to

[1:01:09] determine if there might be an

[1:01:10] opportunity to kind of

[1:01:12] streamline and fund something

[1:01:14] through 1 or 2 funding sources,

[1:01:17] as opposed to at times, 4 to 5

[1:01:19] funding sources. Um, the

[1:01:19] executive

[1:01:21] s office intends to

[1:01:22] conduct a base budget analysis

[1:01:24] of programs that are directly

[1:01:26] operated by county agencies as

[1:01:29] part of the 2829 budget

[1:01:31] process. Um, then we would

[1:01:33] crosswalk existing programs to

[1:01:35] strategy areas, identify

[1:01:37] alternative funding sources

[1:01:38] where applicable, and right

[1:01:41] size rfp budgets to align

[1:01:43] procurements with other county

[1:01:45] funding streams. Again, as

[1:01:46] available, um, draft our

[1:01:48] procurement materials for the

[1:01:51] anticipated activities, goals,

[1:01:53] preliminary outcome measures in

[1:01:54] partnership with the

[1:01:54] executive

[1:01:56] s office. Also likely

[1:01:57] doing more community engagement

[1:01:59] in that process. More subject

[1:02:01] matter expert engagement and

[1:02:03] using the logic models that are

[1:02:05] in the implementation plan as a

[1:02:07] starting point. Um, the

[1:02:09] implementation plan itself does

[1:02:10] include for each of the 13

[1:02:13] goals, a list of what we refer

[1:02:16] to as anticipated activities.

[1:02:19] Um, so this is a strong kind of

[1:02:22] roadmap or example that, uh,

[1:02:24] you and stakeholders could look

[1:02:26] at to have a sense of what are

[1:02:27] some of the things that we

[1:02:29] think would be applicable or

[1:02:30] would be kind of appropriate

[1:02:33] under each goal to be the focus

[1:02:36] point for a future procurement?

[1:02:37] Um, then we would launch

[1:02:38] competitive procurements with

[1:02:40] community outreach information

[1:02:42] sessions and technical

[1:02:44] assistance, recruit and train

[1:02:46] panelists, conduct equitable

[1:02:49] applications, scoring select

[1:02:50] awardees, and complete all of

[1:02:53] our due diligence processes.

[1:02:55] Um, this is also where we would

[1:02:57] notify Council and we, as part

[1:02:59] of our standard procurement

[1:03:00] process. For example, we invite

[1:03:03] council, um, to participate in

[1:03:07] the scoring panels. Uh, next

[1:03:12] slide. Um, in terms of the

[1:03:14] estimated timeline for the

[1:03:16] phased procurement, uh, the

[1:03:19] implementation plan proposes to

[1:03:21] phase the procurements over

[1:03:24] approximately two years. Um,

[1:03:25] this is for a number of

[1:03:28] reasons. Uh, for one thing, um,

[1:03:30] just capacity and resources,

[1:03:31] both at the department level

[1:03:34] and in the community to develop

[1:03:36] procurements. Um, and to for

[1:03:38] community members to respond to

[1:03:39] procurements is something that

[1:03:42] we think necessitates a phased

[1:03:44] approach. Um, we want to be

[1:03:46] able to, uh, certainly take

[1:03:48] time and again, do additional

[1:03:49] stakeholder engagement as we

[1:03:51] are developing these

[1:03:52] procurements. Um, from the time

[1:03:54] when our procurement would be

[1:03:56] announced to when a new program

[1:03:57] would launch would actually be

[1:04:00] a little bit over a year. Um,

[1:04:02] because of just the time it

[1:04:03] takes to put out the

[1:04:04] procurements, allow the

[1:04:06] provider community to respond

[1:04:08] to procurements, and then go

[1:04:09] through the selection process,

[1:04:11] and then also do readiness

[1:04:13] review due notification to any

[1:04:16] existing programs that you know,

[1:04:17] might need a transition period

[1:04:19] and kind of a ramp down period.

[1:04:21] Um, so there would be a, a

[1:04:24] pretty significant timeline of

[1:04:25] about a year. Um, in

[1:04:27] particular, for any program

[1:04:29] that was not proposing to be

[1:04:30] renewed or really is not going

[1:04:31] to be the focus of a

[1:04:33] procurement in the future. That

[1:04:35] program would have over a year

[1:04:38] notice. Um, on that timeline.

[1:04:39] Um, and then, you know, we also

[1:04:41] have some, uh, things that we

[1:04:43] would just note in terms of the

[1:04:45] child, youth and young adult,

[1:04:47] uh, mental wellbeing strategy

[1:04:50] being the last strategy on the

[1:04:51] phased procurement timeline.

[1:04:53] That is intentional. Um, so

[1:04:56] that, uh, there is more clarity

[1:04:57] and uncertainty around best

[1:04:59] starts for kids and we would be

[1:05:00] able to sort of align that

[1:05:03] procurement with, uh, with Best

[1:05:06] starts for kids at that time.

[1:05:09] Next slide please. Um, I wanted

[1:05:11] to touch on, uh, just upcoming

[1:05:14] reports and briefings. Um, so

[1:05:18] the 2025 mid retrospective, uh,

[1:05:19] we just did prior to this

[1:05:22] presentation, then we have two

[1:05:24] progress reports. Um, well, we

[1:05:25] have a progress report and then

[1:05:26] a transmittal that will go to

[1:05:28] county Council related to our

[1:05:30] strategic planning work. This

[1:05:32] was a proviso that was in the

[1:05:34] prior budget that has, um,

[1:05:37] required us to bring forward a

[1:05:39] very comprehensive report

[1:05:40] around our programming and our

[1:05:42] strategic planning. So we have

[1:05:45] an upcoming SEPTEMBER briefing

[1:05:46] on that. And then we will

[1:05:47] transmitting the report in

[1:05:49] JANUARY. Um, and then following

[1:05:52] that at both our pc as well as

[1:05:54] council each summer, we would

[1:05:55] be coming back with bridge

[1:05:58] transition updates. Um, and we

[1:06:01] will also have the data

[1:06:03] dashboard. Um, that, you know,

[1:06:05] is available and has data

[1:06:06] related to all of the

[1:06:07] programming. And then the first

[1:06:09] biennial report would actually

[1:06:12] be in AUGUST 2030. Um, that

[1:06:14] would look back on the first

[1:06:16] two full years of the bridge

[1:06:19] implementation plan. Next slide

[1:06:20] please. Um, I

[1:06:21] m gonna also

[1:06:22] touch on the inflation

[1:06:26] analysis. Um, uh, which was a

[1:06:28] budget proviso. That is part of

[1:06:31] the implementation plan. Um,

[1:06:33] the budget proviso, uh, sought

[1:06:35] for the department to talk

[1:06:37] about how inflation rate

[1:06:39] adjustments are made and

[1:06:42] determined to be, um, sort of

[1:06:44] viable and something that can

[1:06:45] happen within a given revenue

[1:06:47] source. Um, we do seek to

[1:06:48] integrate provider inflation

[1:06:50] rate adjustments into

[1:06:52] implementation plans and budget

[1:06:54] proposals for our local funding

[1:06:57] sources whenever the revenue

[1:06:59] support source supports our

[1:07:01] ability to do that. That is so

[1:07:02] that we can support human

[1:07:04] service providers to maintain

[1:07:05] their service levels and retain

[1:07:07] their workers in the face of

[1:07:09] inflationary costs that they

[1:07:11] experience at the provider

[1:07:13] level. Um, however, there are

[1:07:15] times when expenditure growth

[1:07:18] is predicted to outpace revenue

[1:07:20] growth. Um, and so, you know,

[1:07:21] therefore and we see this

[1:07:22] happening in the mid and the

[1:07:23] bridge. Um, there are times

[1:07:26] when we know that the economic

[1:07:27] adjustment that we would seek

[1:07:29] to give to contracted providers

[1:07:31] is actually larger than the

[1:07:32] additional revenue that will

[1:07:34] come in during that time

[1:07:36] period. Um, and so again, in

[1:07:39] the implementation plan, we did

[1:07:40] build in that kind of

[1:07:42] volatility reserve to account

[1:07:44] for that. And uh, inflationary

[1:07:46] adjustments are always subject

[1:07:48] to council approval and go

[1:07:50] through that, uh, budget

[1:07:52] process. Um, and at times we

[1:07:54] have to propose a lower

[1:07:56] inflationary adjustment or

[1:07:57] perhaps even know inflationary

[1:07:59] inflationary adjustment if the

[1:08:00] revenue source can

[1:08:01] t support

[1:08:05] it. Um, we can go to the next

[1:08:07] slide. Um, I

[1:08:08] m just going to

[1:08:09] touch on some a couple of

[1:08:11] frequently asked questions that

[1:08:12] we have gotten over the last

[1:08:14] couple of weeks, and then we

[1:08:15] can open it up for additional

[1:08:17] questions. Um, one of the

[1:08:19] questions has been whether the

[1:08:20] bridge will invest equitably

[1:08:22] across the county. Um, and we

[1:08:23] do expect to maintain or

[1:08:25] improve our behavioral health

[1:08:27] service availability across the

[1:08:29] full county through countywide

[1:08:30] services and targeted

[1:08:32] investments in both rural and

[1:08:34] urban areas. Um, another

[1:08:36] question we have got is why

[1:08:37] there is a proposed shift from

[1:08:39] annual to bi annual narrative

[1:08:41] reports. Um, the proposed

[1:08:43] implementation plan does

[1:08:44] continue. An annual dashboard

[1:08:46] update accompanied by council

[1:08:48] briefings. Each year. The

[1:08:50] proposed transition to bi

[1:08:52] annual narrative reports is

[1:08:53] intended to redirect executive

[1:08:56] branch resources to continuous

[1:08:59] improvement. Um, and with that,

[1:09:01] that brings me to the end of

[1:09:03] the slides. And I think we can

[1:09:05] open for questions. Um, or I

[1:09:09] can turn it back to you. Chair.

[1:09:09] I

[1:09:11] m going to open up for

[1:09:12] questions at this time. Thank

[1:09:13] you very much. I

[1:09:13] m looking at

[1:09:15] my colleagues. I know we

[1:09:15] re

[1:09:16] kind of overwhelmed with all

[1:09:18] the data that we have received.

[1:09:21] Not only today, but in advance.

[1:09:22] But I want to make sure my

[1:09:23] colleagues, if they had any

[1:09:25] questions, this would be a good

[1:09:27] time. If not, we have a

[1:09:28] scheduled process that I

[1:09:29] ve

[1:09:30] worked out with, uh, vice

[1:09:33] chair, Mayor of Backus to

[1:09:35] hopefully accommodate the

[1:09:37] Scelsi Association, the city of

[1:09:38] Seattle, and my colleagues on

[1:09:42] the county council. Um, chair,

[1:09:45] mayor, mayor. Baca. Okay.

[1:09:47] Councilmember Baron.

[1:09:48] Thank you. Chair. Uh, you know,

[1:09:49] and I definitely want to defer

[1:09:50] if other colleagues have

[1:09:52] questions because I have I have

[1:09:53] the, uh, the the good fortune

[1:09:56] of serving both on hhs, on the

[1:09:58] council side. And so I get to

[1:10:00] hear these presentations twice.

[1:10:03] Um, uh, I first want to say

[1:10:04] share that. I really appreciate

[1:10:07] your, um, uh, working with

[1:10:08] Councilmember Mosqueda to

[1:10:09] adjust the schedule, to give us

[1:10:11] a little bit more time to this

[1:10:12] is a very important decision

[1:10:14] involving, you know, hundreds

[1:10:15] of millions of dollars of

[1:10:16] investments over the next

[1:10:17] several years. And so I

[1:10:19] appreciate the, um, allowing us

[1:10:21] a little bit more opportunity

[1:10:22] to to consider this because I

[1:10:23] think there are some

[1:10:24] significant questions, policy

[1:10:26] questions here. Uh, one thing I

[1:10:28] wanted to highlight for, um,

[1:10:30] our colleagues, uh, on the, on

[1:10:32] the committee, uh, I would

[1:10:35] encourage you to, as Sam

[1:10:37] mentioned, attachment seven,

[1:10:39] which is on page 259 of the

[1:10:41] packet. As the chair mentioned,

[1:10:42] we have a lot of information

[1:10:44] here, but I think the reason

[1:10:45] that I point to 59 is because

[1:10:47] there are some significant

[1:10:49] shifts in funding allocations

[1:10:50] that are being proposed among

[1:10:53] the different strategy areas.

[1:10:53] And I think it

[1:10:54] s important for

[1:10:55] us to understand those

[1:10:57] decisions as we as we consider

[1:10:59] this. Um, and it kind of leads

[1:11:00] me to one of the questions that

[1:11:02] I had, and I appreciate that

[1:11:03] this team is, uh, we

[1:11:04] re going

[1:11:05] to have a separate meeting to

[1:11:06] kind of focus a little bit on

[1:11:07] this, but I wanted to highlight

[1:11:09] this issue for everybody here

[1:11:10] and to allow them an

[1:11:11] opportunity to share a little

[1:11:12] bit of a perspective on, on on

[1:11:15] the proposal, because one of

[1:11:16] the areas that I

[1:11:17] m concerned

[1:11:19] about is, um, the there

[1:11:20] s some

[1:11:21] aspect of the current program

[1:11:23] that supports behavioral health

[1:11:25] for low income people who are

[1:11:27] ineligible for Medicaid. Um,

[1:11:30] and that program is, uh, you

[1:11:31] know, as was mentioned, we

[1:11:31] re

[1:11:33] going to continue funding these

[1:11:34] services. But what I noted, if

[1:11:36] you look at that, that chart in

[1:11:38] 259, there

[1:11:38] s a significant

[1:11:40] decrease in the amount of

[1:11:41] funding that is going to that

[1:11:42] is going to be cut by about a

[1:11:44] quarter, uh, of funding as

[1:11:46] proposed currently in future

[1:11:49] years. Um, and that strikes me

[1:11:50] as a little bit concerning,

[1:11:53] given that we have a, you know,

[1:11:53] uh, we

[1:11:56] re expecting, uh, a drop

[1:11:57] in the number of people who are

[1:11:58] eligible for Medicaid who are

[1:12:00] about to lose coverage for

[1:12:02] about 4000 residents, uh,

[1:12:04] because of immigration status

[1:12:05] issues. These are folks who are

[1:12:07] here on legal status, but who

[1:12:09] are being made ineligible

[1:12:10] because of the of the bill last

[1:12:12] year from Congress. And then,

[1:12:13] of course, the work

[1:12:14] requirements that are going to

[1:12:16] be imposed next year. Um, the

[1:12:17] estimates I think that we heard

[1:12:18] from public health recently

[1:12:21] were about 72,000 residents are

[1:12:23] expected to potentially lose

[1:12:25] Medicaid next year. And so I, I

[1:12:27] would love to hear from dhs

[1:12:29] staff on how we

[1:12:30] re accounting

[1:12:31] for that at a time when we

[1:12:32] re

[1:12:34] expecting the population that

[1:12:35] is not eligible for Medicaid to

[1:12:38] increase over the next several

[1:12:41] years. Um, why the decision was

[1:12:42] made to actually reduce the

[1:12:43] amount of funding to that

[1:12:45] program. That is ensuring that,

[1:12:46] uh, or, you know, attempting to

[1:12:49] at least mitigate, uh, and

[1:12:50] provide coverage for people who

[1:12:52] are not eligible for Medicaid,

[1:12:53] uh, to, to have access to

[1:12:58] behavioral health.

[1:13:04] Who wants to take that on?

[1:13:04] Don

[1:13:07] t you? Yeah. Go ahead.

[1:13:10] Um, yeah. So we are we, as you

[1:13:13] know, have, um, a program now

[1:13:16] that provides, uh, services to

[1:13:17] individuals who are not

[1:13:18] eligible to Medicaid and who

[1:13:21] are otherwise uninsured. Um,

[1:13:22] this is actually the single

[1:13:24] largest, uh, initiative in the

[1:13:27] current mid. Um, we have been

[1:13:28] working with the provider

[1:13:31] community this year due to some

[1:13:32] challenges that we identified

[1:13:35] with that program in 2025. Um,

[1:13:37] the program actually ended up

[1:13:39] being overspent by its budget

[1:13:42] in 2025 by about $1.5 million.

[1:13:45] And so we did a very broad

[1:13:46] listening session with all of

[1:13:47] the providers who participate

[1:13:49] in that program and have been

[1:13:51] doing quite a bit of evaluation

[1:13:53] as to how, at the provider

[1:13:54] level, they determine

[1:13:55] eligibility, for example, and

[1:13:57] screening for individuals who

[1:13:58] are able to access that

[1:14:00] benefit. Um, and then also

[1:14:01] around our payment methodology

[1:14:04] of how we pay for the services.

[1:14:06] Um, right now, the program

[1:14:08] serves a little under 4000

[1:14:10] people per year. Um, you know,

[1:14:12] some of the analysis that we

[1:14:15] have done has, um, uh, led us

[1:14:16] to implement process

[1:14:18] improvements in the program in

[1:14:20] terms of more clear eligibility

[1:14:23] and screening processes so that

[1:14:24] we can validate that

[1:14:26] individuals who are on the

[1:14:28] benefit absolutely do not have

[1:14:30] any eligibility for Medicaid

[1:14:31] that could be leveraged for

[1:14:34] their services. Um, and we are

[1:14:36] also implementing some, uh,

[1:14:38] changes so that we are going to

[1:14:41] be reporting spend down when we

[1:14:42] at the county use local funds

[1:14:44] to pay for these services.

[1:14:46] Previously that was not being

[1:14:47] reported in the state

[1:14:47] s spend

[1:14:49] down process. Um, which we have

[1:14:52] learned could allow individuals

[1:14:53] to probably within a matter of

[1:14:56] months, qualify for Medicaid by

[1:14:58] meeting their spend down. Um,

[1:14:59] and then transition over to

[1:15:01] Medicaid as their funding

[1:15:04] source. Um, additionally, we

[1:15:08] also have done a kind of, um, a

[1:15:11] cost modeling, I guess I would

[1:15:12] say in terms of looking at how

[1:15:14] we pay for services, which

[1:15:15] right now when someone comes

[1:15:18] on, we pay for about 12 months

[1:15:20] of benefits. If we transitioned

[1:15:23] to, um, kind of a fee based

[1:15:25] payment methodology. Um, which

[1:15:27] would be a significant change

[1:15:29] in this program, but it would

[1:15:31] be a fee based methodology

[1:15:33] where the county was paying for

[1:15:35] each service that is provided

[1:15:38] to an individual. Um, our

[1:15:39] modeling shows that we would be

[1:15:42] able we would, um, uh, expend

[1:15:45] about one quarter of the funds

[1:15:47] on the same amount of people

[1:15:49] and services being provided as

[1:15:51] they are now. So there are a

[1:15:52] number of process improvements

[1:15:55] that we already have under way

[1:15:57] on this program that we think

[1:15:58] will allow the program to

[1:15:59] actually serve additional

[1:16:02] clients within the same budget.

[1:16:05] Um, and other opportunities for

[1:16:08] kind of optimization and

[1:16:09] potentially changing the

[1:16:11] payment model in such a way

[1:16:12] that we could serve additional

[1:16:15] individuals. Um, so that is

[1:16:18] some of the, um, the work that

[1:16:18] we

[1:16:19] ve been doing related to

[1:16:22] that question. Um, oh, the

[1:16:23] other thing that I would note

[1:16:24] is there is a section of the

[1:16:26] implementation plan that also

[1:16:28] outlines the priorities for

[1:16:30] investment. Should, um, revenue

[1:16:32] be available and revenue can

[1:16:34] become available both through

[1:16:36] just, you know, additional

[1:16:37] revenue, more revenue coming in

[1:16:39] than expected or also through

[1:16:42] underspend of initiatives. If

[1:16:43] it takes longer for something

[1:16:45] to get off the ground. Or

[1:16:46] there

[1:16:47] s a variety of reasons

[1:16:48] why underspend occurs. Um, and

[1:16:50] after providing full and

[1:16:52] economic adjustments to

[1:16:54] existing program, the very next

[1:16:56] priority that we are proposing

[1:16:59] is to add additional funding

[1:17:02] to, um, uh, this program or

[1:17:03] potentially other programs, if

[1:17:05] they primarily serve non

[1:17:08] Medicaid people. Um, to

[1:17:10] mitigate the harm of H.R. One,

[1:17:12] so, um, that is another thing

[1:17:14] that I would sort of direct you

[1:17:16] to is something we have, um,

[1:17:19] put in as really the next

[1:17:21] priority for funding. If we

[1:17:24] identify that there is more

[1:17:26] needed in order to mitigate

[1:17:28] harms of H.R. One.

[1:17:29] Thank you.

[1:17:31] Uh, any other follow up

[1:17:32] questions?

[1:17:34] No, chair. I appreciate it. I

[1:17:35] appreciate the response. Look

[1:17:36] forward to digging in more with

[1:17:39] the the on this. But I think

[1:17:40] this continues to be an area of

[1:17:41] concern for me. But I

[1:17:42] appreciate the response and

[1:17:44] look forward to continuing

[1:17:44] conversations.

[1:17:46] Thank you to any other

[1:17:47] colleagues at this time. Have a

[1:17:50] question? If not, I want you to

[1:17:52] feel free to, um, send

[1:17:54] questions to Sam, who will then

[1:17:57] work with the, um executive

[1:17:59] staff on answering them. Uh,

[1:18:01] Sam, thank you very much for

[1:18:02] you and your staff. Susan,

[1:18:04] thank you for your staff work

[1:18:06] as well. And your team. And

[1:18:07] again, it

[1:18:07] s going to be a team

[1:18:09] effort to resolve some of the

[1:18:11] issues that have come up and

[1:18:13] hopefully resolve some of the,

[1:18:14] um, concerns that have been

[1:18:16] raised. If there

[1:18:16] s no other

[1:18:17] issue to come before it.

[1:18:19] Would you like to do the the

[1:18:19] minutes?

[1:18:20] No, no.

[1:18:21] No, I think we

[1:18:22] ll do that

[1:18:23] another time.

[1:18:26] Thank you. Thank you.

[1:18:26] If there

[1:18:27] s no other issues,

[1:18:30] come before us. We are

[1:18:30] adjourned.

Regional Policy Committee_20260826

Agenda

Transcript