We have.
Welcome to the AUGUST 26th
meeting of the Regional Policy
Committee. To manage today
s
meeting, I
d like to ask the
only committee members and the
scheduled presenters join us on
the zoom platform. I asked the
other staff and interested
community members follow the
meeting on King County tv
channel 22 or stream online.
This time. I
d like to begin by
asking the clerk to call the
roll.
Thank you. Chair. Council
member Arnaud.
Here.
MAY your packets. MAY your
backs. You
re muted. Okay. MAY.
Council member. Robertson. MAY
your wrath. MAY your brethren.
Council member. Juarez. Council
member. Len. Council member.
Faster. Council member. Drink.
Councilmember Baron. Here.
Councilmember. Perry.
Sherburne.
Reichbauer here. Well, we
ll go
back and do a roll. Again, I
know that the Sound City
Association has had a meeting
going on, and that they are
concluding at this time, and
we
re trying to accommodate
their schedule. Uh, I want to
thank everyone for attending
today
s Regional Policy
Committee meeting. We have two
briefings on today
s agenda,
both related to the county
sales tax funded Mid initiative
that provides behavioral health
programs and services to King
County residents, which has
been renewed to continue
through 2034, 2030. For. The
first briefing will cover the
mid annual report for calendar
year 2025. The second briefing
will be the committee
s first
opportunity to hear about the
executive
s proposed 2028 2030
four implementation plans for
this initiative, which is
proposed through a companion
legislation to be renamed
Behavioral Health Bridge. At
this time, I would like to
bring forth, um, I believe
Isabel Jones, the acting
director, as well as Robin
Buren, the special project
manager, to talk about, um, our
item number four, 2026 0088.
MISTER Chair, this is Miranda.
Would you like for Sam Porter
to provide a brief introductory
remarks before our presenters
begin?
Sure.
Absolutely. Report.
Miranda. Thank you.
Thank you. Chair von Reichbauer
Sam Porter, Council central
staff. The documents for this
staff report begin in the
packet on page nine of the pdf.
I will just provide a very
brief overview of the
requirements of the mid annual
report before handing it over
to Robin Bowman. From dhs to to
present on the materials. So
the 2025 mid annual report does
appear to meet the requirements
of King County Code. Um, the
services and programs funded by
the Mid are evaluated by staff
in King County
s Department of
Community and Human Services,
based on data submitted by
providers. King County Code
requires that the Annual
Summary Evaluation report shall
include, at minimum, the
following performance
measurement statistics, program
utilization statistics.
Requests for proposals and
expenditure status updates.
Progress reports on evaluation.
Implementation. Geographic
distribution of the sales tax
expenditures across the county,
including collection of
residential zip code data for
individuals served by the
programs and strategies.
Updated performance measurement
targets for the the following
year of Mid initiatives,
programs and services.
Recommendations on either
program changes or process
changes, or both, and then
summary cumulative calendar
year data on page 11 of the
packet. There is a table one
that provides an overview of
the different sections of the
2025 mid Annual Report, and
includes the page numbers that
are associated, and I will
leave the rest of it to our
folks at dhs. That concludes my
remarks. Thank you.
Thank you very much. I want the
record to also recognize that
Mayor Backus, Mayor Pavone, and
mayor. Mayor Ralph Roll here
present as well. Um, at this
time, uh, we
ll go to our
friends at, um, Isabel or
Robin, who
s going to start off.
Hi. Thank you so much. Uh,
chair and, uh, committee
members. Um, thank you for
having us. Uh, I will start us
off, and I will go ahead and
share my screen with our
slides. Uh, one moment. Okay.
Um, are you seeing the screen
now?
We are. They just popped up.
Okay. I
m going to start the
slides from the beginning. Um,
okay. Um, thank you so much.
And I will introduce myself.
For the record, my name is
Isabel Jones. I
m the acting
director of the Behavioral
Health and Recovery Division
here at the Department of
Community and Human Services.
And I
ll pass it to my
colleague Robin to introduce
herself.
Sure. My name is Robin Forman.
I
m typically the mid
coordinator. You
ve seen me
here before for the last
several years. I
m serving in a
special duty role right now.
And the proviso report that you
will all receive later. Um, in
JANUARY of 2027. But here to
share the report this today.
Thank you. And I will kick us
off. I am just going to put the
2025 mid annual report in
context for our next
presentation on the renewal of
the Mid and the bridge
implementation plan. Um, as a
reminder in context, the Mid is
a one tenth of 1% sales tax
that generates just under about
$100 million per year in
revenue for the county. In
support of behavioral health
services in our community. Um,
in 2008, the Mid was launched
to counter chronic state and
federal underinvestment in
behavioral health programming,
providing a more stable local
resource that strengthens our
provider capacity and our
behavioral health delivery
system. The mid one and mid two
implementation plans, which
were the first two nine year
cycles of the mid uh, which has
stood for mental illness and
drug dependency. Um, those
investment and implementation
plans historically focused on
prevention, early intervention,
diversion, recovery and reentry
system improvement, crisis
services and therapeutic
courts. Um, in SEPTEMBER 2025,
the King County Council voted
to extend the mid sales tax.
The collection of the sales tax
for an additional nine years
through 2034. Um, and since
that time we have been working
on an implementation plan for,
uh, sort of the next iteration
of the mid, uh, which we are
now calling the bridge, which
we transmitted in JULY of 2026
and is under consideration by
the council at this time. Um,
so our following presentation,
uh, will provide additional,
uh, context related to the
bridge implementation plan. But
today
s presentation, um, with
Robin is focused on 2025 and
the mid investments of 2025 and
some of the accomplishments of
the mid, um, in the last year,
2025. Um, with that, I
m going
to turn it to Robin.
Great. Thank you for that
introduction. So. I will just
be starting on this slide. Um,
wanted to share the outcomes.
The 2025 mid accomplishments.
You can see on this. These are
signature measures um for Mid
initiatives for which jail
bookings, emergency department
admissions and inpatient
psychiatric hospital admissions
are assessed. Outcome data
demonstrated a consistent
impact in reducing the use of
these system among mid
participants over the long
term. Um, three years after
initiating initiating Mid
services, we can see that the
63% of participants had fewer
recorded crisis episodes, 29%
had fewer emergency department
admissions. Jail bookings were
down 33% in psychiatric
hospital admissions were down
41% over the long term, and 89%
of youth in related programs
had no new juvenile legal
system. Charges filed after
enrolling in mid services. Next
slide. Let
s go. In 2025. Mid
serve just over 30,000 people
across 52 initiatives. Um this
slide displays the demographic
information of people served by
Mid initiatives. Last year. And
we
ve included the percent of
the population living below the
federal poverty level, which we
use often as a proxy for need
to provide the additional
context. Next slide. These maps
show the geographic
distribution of individuals
served by Mid. Also, compared
to the federal poverty level.
And while Mid serve residents
across all of King County,
service recipients were more
often rated in zip codes with a
higher percentage of families
living below the poverty line
aligning with Mid School to
serve those most in need. Next
slide. And last year
s
financial report reflects a
single year budget. You are
very well aware of that. We
adjusted to a new biennium um,
in 2025 mid expended 115.8
million of its budgeted $128.2
million, or 90% of our planned
expenditures. And as you are
also likely where mid to
funding obligations are
starting to outpace projected
revenues. The behavioral health
Bridge Implementation Plan
presents the opportunity to
realign programming and planned
expenditures to anticipated
revenue beginning in 2028, and
lastly, I just encourage you
all to visit the data
dashboard. It
s truly worth
diving into if you want to
learn more about mid to
programming. The hyperlink is
included on the slide and is
embedded throughout the online
version of the report. And now
I
ll turn it back to Isbell for
some concluding remarks. Thank
you.
Thank you. Um, so the
behavioral Health Bridge is
very much building on the
learnings, the investments, the
community engagement, um, that
has occurred over the life of
really both mid one and mid
two. Um, there are a couple,
uh, kind of key points that we
are bringing from mid over to
the bridge, which is to
strengthen our data reporting
and accountability. Um, by
having performance expectations
within each of the five new
strategy areas, including
performance measurement and
accountability that we apply to
some of the programming. About
25% of the mid programming that
is actually administered by
county agencies. Um, we
re also
emphasizing alignment and
integration across service
areas and increasing
coordination and cross system
connectivity. Um, one of the
ways that we intend to do that
is by managing the mid, um, the
goal level rather than a more
narrow individual initiative
level as we did in mid one and
two, which we found kind of
created, um, more silos and
challenged our ability to have
integration across programming.
Um, and then continuing to
invest where needs are
greatest. According to data,
community engagement and
subject matter input. Um, and
with that, that actually
concludes our mid 2025 annual
report presentation. Uh,
however, our next presentation
will continue on this topic as
we transition to the bridge
implementation plan.
All right.
And I think I will turn it back
to you, chair, perhaps to Sam.
Thank you. I thought you were
going to continue. Although my
colleagues. Any questions? I
know. Um, this has been a
beginning process for many of
us. I
m checking any raised
hands. I feel free to speak up
if I MISS You on the zoom
outline. You know, it looks
like we have no questions for
my colleagues. Isabelle, where
do you want to go from here?
Um, I believe I will pass it to
Sam Porter, who is going to do
a staff briefing on the bridge
implementation plan.
Excellent. Sam, can you proceed
with the, um, executive
transmitted behavioral health
Bridge implementation program
and companion legislation?
Yes, certainly. Thank you.
Chair. Von Reichbauer Sam
Porter, Council central staff.
Um, so if you don
t mind, I
m
going to begin with the mid
renaming ordinance and then go
into the implementation plan.
The mid renaming ordinance is
fairly brief and leads into the
implementation plan because
it
s renaming the Mid. So the
materials for this ordinance
begin on page 65 of the packet.
Proposed ordinance 2026 0174
would rename and revise the
mental illness and drug
dependency for Mid Fund and
Advisory Committee to the
Behavioral Health Bridge Fund
and Advisory Committee, and
make additional changes to the
Advisory Committee. This
legislation is a mandatory dual
referral to this committee and
the health, Housing and Human
Services Committee. The term
behavioral health encompasses
both mental illness and drug
dependency, also referred to as
substance use disorders. The
transmittal states that the
proposed name change is because
the terms mental illness and
drug dependency no longer
reflect the values and
priorities that guide
behavioral health work today,
and that the terms contribute
to stigma. Executive staff
indicate that the new name is
responsive to community
feedback. Section one of the
proposed ordinance makes
changes to the advisory
committee and updates reference
to expired portions of King
County Code and references to
groups that no longer exist,
including all home and regional
Human Services Levy, Citizen
Oversight board. The proposed
ordinance. Um, one of the key
issues identified in the staff
report is that the proposed
ordinance changes the
activities. The advisory
committee, um, conducts from
reviewing and reporting to the
Executive and Council to review
and provide guidance on
behavioral health. Bridge
annual reports. Executive staff
state that this change is
intended to better reflect the
advisory committees current
role and engagement. Regarding
the annual report process. The
proposed change in Advisory
Committee duties reflects a
policy choice. Um.
Additionally, section one also
replaces two positions for an
individual representing
behavioral health, consumer
interests and an individual
representing community
interests from the mid
consumers and communities. Ad
Hoc workgroup with two
positions that would represent
behavioral health. Consumer
interests who have lived
experience with behavioral
health conditions. Executive
staff state that during the
renewal process, the Mid
Advisory Committee advised
adding additional members with
lived experience. This proposed
change to the membership
reflects a policy choice.
Sections two, three and five in
the proposed ordinance are all
technical changes. Those are
outlined in the staff report.
But just to keep things moving,
I
ll move on to section four,
which would update the name of
the mid fund to the Behavioral
Health Bridge Fund. This
section also has a key issue
identified that would remove
the new strategy Reserve fund
from King County Code.
According to executive staff,
the Mid to initiative 65, which
is emerging issues and
Behavioral health, was launched
in the 2324 biennium through a
partnership with the Mid
Advisory Committee. This fund
served the purpose of the new
strategy Reserve Fund executive
staff state that during the
biennium, this strategy, funded
for time limited projects
including including Seattle
Public Schools, creation of
substance Use Reduction work
Group and virtual parent
education sessions, among other
programs. The removal of this
new strategy Reserve Fund is
proposed by the executive
because the strategy is no
longer funded and executive
staff states that it has
historically been challenging
to administer under short
timelines and in response to
new and emerging trends.
Removing this new strategy
Reserve Fund from King County
Code is a policy choice. There
is no fiscal impact of the
proposed ordinance. According
to the Fiscal Note, and
council
s legal counsel has
reviewed the proposed
ordinance. So I will move on to
the implementation plan.
Proposed ordinance, which is
2026 0177. I am on page 89 of
the packet. This ordinance
would adopt the implementation
plan for the renamed Behavioral
Health Bridge or Bridge Sales
tax funded services from 2028
through 2034, starting in 2028.
This implementation plan would
govern the administration and
implementation plan of the
Behavioral Health Bridge sales
tax revenue. The existing mid
to Service Improvement Plan,
implementation plan and
evaluation plan will continue
to govern investments for this
fund through 2027, in
accordance with an expenditure
restriction in the county
s
2627 biennial budget. This
legislation also is a mandatory
dual referral to both rpc and
three hs. The implementation
plan is organized around a
primary purpose and five
updated strategy areas, which
are identified in table two,
which is on page 94 of your
packet. Programs that receive
bridge funding according to the
plan will advance the primary
strategy areas and will be tied
to performance measures and
outcomes that achieve the 13
strategy areas as identified in
table two. Table two the the
primary. I
ll just read the
primary purpose. And then again
that table two is on page 94.
The primary purpose of the
bridge is to invest in the long
term availability,
accessibility, effectiveness
and equity of the county
s
behavioral health system,
especially where people are
falling through the cracks of
existing systems. The strategy
areas I
ll just briefly read
through those. The first one is
care transitions and Diversion
Services strategy. Area two is
substance use disorder
prevention, treatment and
recovery. Strategy three is
equitable access to behavioral
health care. Strategy four is
children, youth, and young
adult mental well-being. And
strategy five is behavioral
health workforce development.
Um. It is important to note
that the transmitted 28 to 2034
plan, unlike the Mid two
implementation plan, does not
identify specific programs that
will receive bridge funding as
allowed under state law. The
plan further indicates that
this structure allows the
Behavioral Health and Recovery
Division to make programmatic
decisions through procurement.
The phased competitive
procurement and based Budget
analysis section. Later in the
staff report provides more
detail. Um, on that process and
attachment five to the staff
report contains a crosswalk
provided by executive staff
that illustrates the Mid
programs that currently are
operating and the corresponding
anticipated bridge activity
under which programs MAY be
eligible for funding. Um, I
m
going to move past the
community engagement and
subject matter expert
components, as I believe
executive staff are touching on
that in their presentation. So
I am now on page 96 of the
packet. Um, the phased
competitive Procurement and
Based budget analysis. So the
transmitted plan states that
the executive intends to
implement phased competitive
procurements beginning in 2028
for nearly all bridge funded
programs administered by
contracted providers. The plan
states that the phase timeline
will allow for careful design
of the procurement process, and
page 138, which is in the
implementation plan, not in the
staff report, shows the
complete list of components
that are expected to be
included in the procurement
process. Design. Executive
staff indicate that the
procurement process will follow
standard departmental um
procedures, including new
safeguards that dhs is
implementing to respond to the
results of the 2025 um audit.
Additionally, procurements will
be guided by the anticipated
activities that appear with the
logic models that are described
in more detail in the
Performance Measurement section
of the staff report. Those um
logic models are also in the
appendices to the
implementation plan. The
transmitted plan states that
all bridge funded programs that
are managed or administered by
King County departments and
agencies outside of dhs,
including those operated by the
courts and public health, will
receive a base budget analysis
instead of being procured.
Because those programs are
operated by King County.
Details about what this base
budget analysis, um, are not
included in the plan, but the
plan states that the executive
anticipates that the initial
analysis would be completed
ahead of the 2829 budget. Um,
due to the scale of planning
and staffing, the plan states
that the procurement and base
budget analysis cannot occur
all at once and will be done in
a phased manner, as described
in table three, which is on
page 97 of today
s packet. The
plan states that the phased
procurement approach will
provide an opportunity to
coordinate the children, youth
and young adult mental
well-being strategy with the
Best starts for kids renewal,
which is anticipated next year.
Um, to ensure that funding
streams complement rather than
duplicate one another,
executive staff provided table
four, which is on page 98 that
shows an estimated timeline for
the phased procurements and non
funded program ramp down
periods. That would be for
programs that don
t receive
bridge funding but currently
receive mid to funding. So that
table is on page 98. The
transmitted plan states that
the process to develop and
implement procurements is
expected to include notifying
the council. Um, additional
details are not included in the
plan, but in response to
council staff questions,
executive staff stated that the
bridge will continue the
standard practice that dhhs
uses to notify Council of
Procurements and invite council
members and their staff to
attend panel deliberations. Um.
The members MAY wish to include
additional detail in the plan
to ensure that this practice
occurs, and I will hand things
over to my colleague, Miranda
Leskinen, to go over the
measurement and evaluation
portion of the staff report.
Okay.
MR. Chair, would you like to
pause or MAY I proceed?
Why don
t you proceed? Then
we
ll open up for questions
afterwards. Thanks, Brenda.
Thank you so much. So as Sam
mentioned, I
m going to pick up
with measurement and
evaluation. I
m at the very
bottom of page 98 of your
packets. Um, so provisions for
measurement and evaluation of
bridge investments are
addressed in the plan in its
section seven, which starts on
page 154 of your packets, if
you
re curious, um, the plan
states that measurement and
evaluation for the bridge,
consistent with current
practice under mid two, will
utilize the results based
accountability or rpa
framework. Uh committee members
will be familiar with this
framework for evaluation, as it
is also used for other human
service initiatives like Best
starts for kids and as a
framework includes, uh,
performance measures,
population indicators, and
in-depth evaluation regarding
performance measures for the
bridge. Per the transmitted
plan, measures MAY be
qualitative and or quantitative
and will vary across programs
and strategy areas depending on
factors like the population
served, types of services
provided, and intended
outcomes. Per the plan, request
for proposals, RFPs for for
competitive procurements will
include that strategies,
intended goals, and system wide
outcomes and associated
performance measures. Um, a
couple of examples of
performance measures are
provided in the plan. In it
s
figure 22, which is located on
page 157 of your packets. Um,
also per the plan, uh, dhs
staff will work with service
providers during their
contracting process to finalize
a performance measurement plan,
which I
ll speak to a bit more
shortly. Uh, for county
administered programs, agencies
will collaborate with dhs to
develop their program
performance measurement plan.
I
m going to pivot to logic
models. I
m on page 99 of your
packets. As Sam noted. Um,
appendices f through j of the
transmitted plan. Identify a
logic model for each of the
five bridge strategy areas. Um,
each strategy areas logic model
highlights the types of
programs or activities
anticipated for funding, and
illustrates the envisioned
relationship between
investments, measures, and
outcomes. Tables five through
nine of the staff report
provide a very high level
summary of those anticipated
activities that are identified
in each strategy. Areas. Logic
model. Additionally, a Sam
noted attachment five to the
staff report on page 241 of
your packets that was provided
by executive staff provides
that high level comparative
crosswalk overview of Mid two
programs and the anticipated
bridge activities. Um, moving
next to data collection. I
m on
page 102 of your packets. The
transmitted plan indicates that
data collection practices for
the bridge will be outcomes
driven and reflect system level
objectives for each of those
strategy areas, as described in
the aforementioned logic
models. Um, earlier in my
remarks, I had referenced
provider performance
measurement plans. These plans
will include key performance
measures, types of data
collection, reporting cycles,
and activities to review data
and use data to inform
continuous improvements.
Service providers will submit
data and relevant information
to the county as required by
their contract and or
documented in their performance
measurement plans. The
Transmitted Implementation Plan
further notes that dhs intends
to measure and assess long term
data and outcomes at the
participant level, as well as
collect system level data as
appropriate, and monitor key
level behavioral health
indicators. The last thing I
ll
touch on before handing things
back over to Sam relates to
in-depth evaluation. Uh, the
transmitted implementation plan
indicates that the ability to
conduct in-depth evaluations
will be different for each
program and strategy, and
identifies in the plan criteria
to help guide the evaluation
team in prioritizing projects
for that more in-depth
evaluation. Um, if if I MAY, I
will hand things back over to
Sam to continue with the staff
report. Um, regarding
reporting.
Thank you. Miranda and I will
go through these quickly so
that members can begin
discussing. But I am on page
102 of today
s packet. Um,
going into the reporting
section. So the transmitted
plan states that dhs will offer
an annual briefing to council,
coinciding with the release of
the annual data dashboard. Um,
and the the plan proposes that
the executive transmit a
biennial report to council
instead of an annual report.
Um, that would detail, continue
to detail programs and services
funded by the bridge. Um, this
plan, uh, or the annual
biennial report would be
transmitted no later than
AUGUST 31st every other year,
beginning in 2030. This is a
changed from the annual report
cadence, a list of the contents
of the proposed biennial report
appears on page 103 of the
packet today. Um, the
transition to biennial reports
and what
s included in the
report represent policy choices
to the Council to to members.
So moving on to the financial
plan or financial policies, the
transmitted plan includes a
financial plan with estimated
collections and expenditures.
Table ten on page um 104. Uh,
shows a summary of the
estimated annual revenue from
2028 to 2034, based on the
2026, uh, for forecast. This,
uh, has been updated from the
the MARCH for forecast. Um,
that was originally published
in the 3/8 staff report, and it
projects the JULY weather
forecast. Uh shows a decrease
in approximately $26 million
less in overall revenue during
the plan period from the MARCH
forecast. Table 11 shows the
estimated expenditures for each
strategy, area, and staff
analysis is ongoing regarding
the impact of the JULY for
forecast on the financial plan
and estimated expenditures for
the bridge. Moving on to the
other financial policies before
moving into the potential
policy issues. So I
m on page
105 of the packet. Uh, the
transmitted plan indicates that
the behavioral health bridge
will set aside a half a percent
of revenue for technical
assistance and capacity
building to support the
implementation of the
identified goals. Um, for
administration and compliance.
In response to the 2025 audit,
the transmitted plan states
that the bridge will increase
the proportion of funds
supporting administrative
functions in 2028 to 2034 to
enhance fiscal controls and
contract management. Um
executive staff indicate that
additional staff will be needed
to support procurement
evaluation, program management,
compliance, financial
management and reporting. Um
for the reserves consistent
with the county
s comprehensive
financial management policies,
the bridge will maintain a fund
reserve equivalent to 60 days
of budgeted spending in the
current, adopted or projected
biennial budget. Under this
plan. Additionally, the fund
will maintain a sustainability
reserve starting in 2028 to
maintain program commitments
despite the projected decrease
in sales tax revenue
anticipated in 2029 due to
2026. Changes in state law
pertaining to products and
services that will be exempt
from sales tax beginning in
2029. The sustainability
Reserve is anticipated to be
spent down by 2031. The
transmitted plan also would
formalize the continuation of a
transfer of mid revenue to the
Behavioral Health Fund that has
occurred since 2021, and
consistent with the health
through housing Crisis Care
centers and bsk levy. If a
substantial adjustment to the
financial plan were planned by
the executive, then the
executive would transmit a
notification letter to Council
explaining the rationale and
scope of the plan change upon
which time the council would
have 30 days to pass a motion
rejecting the change. Otherwise
the change would proceed after
30 days. Uh, I am now on page
106 of the packet. The
priorities for allocating the
undesignated fund balance, the
transmitted plan would
establish priorities for
allocating any undesignated
fund balance, which is new for
this revenue stream. The plan
states that the executive
intends to apply the following
three priorities to allocate
any undesignated fund balance.
When the executive determines
that it represents an
opportunity for long term or
sustainable investment. In any
year where inflation rates have
been reduced due to limited
funding availability, the
undesignated fund balance would
provide inflationary
adjustments to contracted
providers up to the amount of
cpu. Seattle inflation rates.
The second, um, type of use for
undesignated fund balance under
a long term investment would be
to augment existing investments
to mitigate losses of Medicaid
coverage to the degree
necessary and feasible within
allowable funds. And the third
use of undesignated fund
balance. If it
s determined to
be a long term investment, is
to scale high performing or
innovative behavioral health
bridge investments to address a
net unmet need. The plan states
that when the executive
determines that fund
availability is one time in
nature and cannot reasonably
support sustained programming,
the executive intends to
consider using these funds for
one time investments, including
capital projects such as
behavioral health facilities or
housing for people with
behavioral health conditions,
or in pilot programs that can
later transition to other
funding sources, such as
Medicaid. The transmitted plan
also includes a proviso
response, um, that uh responds
to an analysis requested for
about the dhs inflation rate
adjustment policy that is in.
There
s an overview of that in
the staff report. I won
t go
into it now. Um, but just
flagging that for you that
that
s present in the
transmitted plan, um, moving on
to the potential policy issues.
So staff have identified nine
potential policy issues that
are summarized on pages 109 to
110 of your packet. Um, I will
only highlight a few here
before handing things over to
executive staff. Um, but the
the first that I will highlight
is that the priorities for
allocating the undesignated
fund balance that I just spoke
about, those are policy
choices, since that is a new
policy. Um, members could
consider changing those or
amending those in some way.
Another policy issue is that
the transmitted plan uses
permissive language throughout,
such as intends, plans and
anticipates with respect to
various components of the plan
that the executive MAY
implement. Using these terms
allows the executive the option
to not implement components,
whereas terms such as shell or
will would require the
executive to follow through.
Um. The transmitted plan, as
mentioned, changes the
recording cadence from an
annual report to a biennial
report. Um, that is a policy
choice to make that change. Um,
the implementation plan also is
drafted, uh, from the
perspective of the executive.
So that
s a language choice.
That is a policy choice. Um, it
refers to things, uh, as in
keeping with the executive
s
priorities, instead of, uh,
having it be a from the county
as a perspective of the plan.
So it
s a policy choice whether
or not to edit these statements
so that the implementation plan
reflects that it is a King
County plan, and not just that
of the executive. Um, and then
the last policy flag that I
will make is that there
s just
a lack of specificity in the
plan around what specific
programs will receive funding
based on communication with the
executive staff. It appears
that they MAY not have
additional detail to share
about this. Regarding
programmatic investments. Um,
at this time. So if members
wanted additional information
about these topics prior to
2028, uh, the council would uh,
could add a new section to the
proposed ordinance and amend
the implementation plan to
reflect that as well. So the,
um, last two things that I will
note are the updated, um,
schedule for the the plan that
is on page 111 of the packet.
Um, this update was, uh,
distributed to rpc members. So
you should have that updated
schedule in your inbox. The
main changes are that it
anticipates three, uh,
contemplates three touches for
each committee
s, uh, with
amendments being considered in
three hours in OCTOBER. Now,
instead of in SEPTEMBER. Um and
an option for amendments to
also be taken up in rpc during
a special meeting that is to be
scheduled the week of NOVEMBER
2nd. Um, lastly, before handing
things over, I will orient
members to the attachment of
the staff report. We have
mentioned the Behavioral Health
Bridge and Mid strategy
crosswalk. That is attachment
five that provides the overview
of existing uh programs and
what bridge, uh, they MAY be
eligible for, what bridge
strategy they MAY be eligible
for under um and then
attachment six is the question
and response question and
answer um document. That was in
response to the JULY 23rd, uh,
three hours committee meeting.
Attachment seven is the
behavioral health bridge and
mid strategy financial
crosswalk, which shows, uh, the
Mid strategies, uh, and what uh
amount those programs were
funded, sort of rolled up into
the bridge strategies. Um,
attachment eight is sort of a
reference document for that.
Attachment seven that gives the
um the actual names of the
strategies that attachment
seven only shows the sort of
Sio five, the abbreviation. So
attachment eight helps provide
a little bit more information
about that. And then the last
attachment is the executive
staff PowerPoint presentation.
Um, Councilmember von
Reichbauer, would you like me
to hand things over to
executive staff now for for
their presentation?
Let me see if there
s any
questions today. Thank you. I
m
just checking for hands and
feel free colleagues to speak
out if I MISS You.
Okay.
So let
s go ahead now to the
executive staff.
Sounds good. So we have
Isabelle Jones. Um, also Laura
Smith, Susan McLaughlin and Liz
Arjun. Um, to present on this
item.
Thank you so much, Sam, and
good afternoon, everybody. MR.
Chair, members of the
committee, thanks for having us
this afternoon. My name is
Susan McLaughlin. I am the
director of the Department of
Community and Human Services
over here at King County. And I
am going to kick us off. So,
um, uh, just to say, I
m sure
you
re aware at this moment
that we
re here to brief you on
the behavioral health Bridge
implementation plan. Um, the
county council passed the
continuation of the collection
of the one tenth of 1% sales
tax at the end of 2025. And
with the promise of an
implementation plan being
transmitted mid-year. So, um,
this updated implementation
plan has been noted, covers
behavioral health sales tax
investments from 2028 to 20 20
or sorry, 2034. Um, the
implementation plan and
financial plan for the bridge
just is a little background
context. Take into
consideration three things.
First is that we want to ensure
that the the bridge and the use
of this precious sales tax is
more focused on investments in
areas within the behavioral
health system that have the
greatest need, and also
ensuring that there
s greater
accountability to achieve the
goals that are laid out in the
plan. The second is to mitigate
current and projected financial
pressures that are plaguing the
sales tax and the bridge. And
so one of the things that we
need to do is bring bridge
expenditures into alignment
with the projected revenue. And
then finally, we want to make
sure that we support a smooth
transition to new investment
areas and new outcome. Um, and
goal expectations while
mitigating any disruption in
services wherever possible for
providers. So at the end of the
day, we
re looking to make sure
that we are using these
precious and shrinking dollars
in the most strategic way. Um,
next slide. Our agenda for
today, um, we
re gonna cover
how the implementation plan was
developed, including the, um,
the depth of community
engagement that was done. Uh,
we
ll also talk about what
s
different with regard to the
bridge implementation plan and
how we plan to implement the
transition through our
procurement process. And then,
as Sam noted, there
s an
analysis that will, um, talk
about about the impact of dcs
inflationary adjustment policy
on the behavioral health bridge
and its implementation and
financial planning. So kicking
us off is just, uh, gives the
highest level, um, all that
went into the development of
this implementation plan, it
started in late 2023 and 2024,
when we were doing an
assessment of the behavioral
health landscape. Um, you know,
the last mid renewal was back
in 20 2016, 2017. And a lot has
changed with regard to
behavioral health services,
including both all of state.
There
s been federal changes
and also local changes to both
policy and funding. Um,
including the introduction of
new local resources like the
crisis care center levy that
didn
t exist when the last uh,
mid version was implemented. We
then combined that landscape
analysis data with our
community engagement feedback.
And I
m going to talk a little
bit about what that looked
like. Um, in a minute and who
we talked to. But to develop
the five new strategy areas
that are part of this renewal
implementation plan, um, we
engaged over 2200 diverse
county residents to understand
from their perspective, the
behavioral health system needs
gaps and opportunities. Um,
once we had all of that data
collected and brought together,
we engaged a cross-sector, um,
table of subject matter
experts, and this was done
between APRIL and JULY of 2025.
We convened five different
tables, one around each of the
prioritized strategy areas that
are in the implementation plan.
Those work groups of subject
matter experts included um
providers and included
researchers in that particular
area. Advocates, peers, county
staff, people with lived
experience. And through that
process, that group really
developed a set of ideas and
recommendations, um, that could
be used to leverage the
foundation of what Mid had been
doing and to and to build
forward in the best future.
Invest um investment of these
funds. We then did an internal
analysis of that information in
AUGUST through DECEMBER,
leveraging the data and
knowledge and looking at some
of those ideas through the lens
of what
s feasible, equitable,
how does it align with existing
programs and services, and also
prioritizing what the greatest
need was. And then, of course,
we had our executive
transition. Um, uh, late at the
end of 2025 into 2026. And so,
um, we were able to then work
with our new executive, Zahilay
to understand priorities of
this administration and how we
fit that together into this mid
implementation plan. So, um,
quite a process that
s been
going on for a while, but it
really helped to shape and
inform where we think the
behavioral health system needs
to go. So now I
m going to talk
a little bit about the ways
that we engage community
members, providers and others
in this process. As I
mentioned, over 2200 people
were engaged over an 18 month
period. Uh, we used a
combination of listening
sessions, both virtual and
in-person sessions across King
County, including at least one
in every council district. We
held community events and we
can, um, conducted an online
survey that was translated into
21 different languages and had
our teams out in a variety of
different community settings
and events with qr codes where
people could just, like, log on
with their phone and answer
that survey right then and
there. Um, we had a very
diverse set of respondents to
all of that participated, and
all of those different, um,
venues and avenues, including
half of the people engaged, um,
were self-identified as being
black, indigenous or other
people. People of color,
including our Latinx, uh, Asian
American, Pacific Islander,
Middle Eastern, and so forth.
Um, and then there was quite a
variety also of different, um,
lived experience and ages. So
we did hear, um, specifically
from youth, uh, between the
ages of 2025, about 209 were
engaged, um, seniors. We had a
sample of folks from the lgbtq
ia plus population, individuals
that I self-identify as having
lived experience with, mental
health and substance use needs,
um, about 356 people there. We
also did some, um, focused, um,
listening sessions in our King
County jail to hear directly
from people who have behavioral
health conditions, who are were
incarcerated. So, again, a
very, um, very wide range of
people that we heard from and
the nature of those
conversations were really about
what, um, what are the gaps in
the behavioral health system?
What are your highest
priorities? Where do you think
we need to make changes or need
more investment and so forth?
So that
s what helped inform
this. Um, I also mentioned our
subject matter expert groups.
Uh, you can see here we had
again one work group for each
of the five strategy areas. Um,
they it was a very diverse
group of people. Um,
participants included clinical
providers, licensed peers, um,
individuals from the criminal
legal system, researchers,
educators, outreach workers,
nonprofit leaders. We also had,
um, substantial engagement with
our mid advisory committee
throughout this process as well.
Um, the goals again of the and
from the same work group formed
the basis of the goals that are
identified. So each there
s the
five strategy areas. And um
specific goals within each. And
that
s what you
ll hear in a
minute from Liz about um, one
of the big changes is getting
much more focused on impact and
outcomes and detailing out what
when we do procurements, what
we
re trying to achieve to
ensure that the strategies that
we
re investing in are
achieving the goals that we
re
trying to accomplish. So with
that, I
m going to turn it over
to Liz, who will introduce
herself and, um, sort of put
the frame of the executive new
executive administration on,
um, priorities. Liz.
Thanks, Susan. Good afternoon
everyone. For the record, my
name is Liz Arjun. I
m the
behavioral health and public
health policy advisor for
Executive Zahilay. I
m pleased
to be here in partnership with
colleagues from dhs, be heard.
And for those whom I don
t
know, just a little bit, a bit
about my background, um, I
return to the county and public
service in, uh, MARCH this
year. Um, after working, um,
here at King County from 2014
to 2017, when I was here at the
county before I was a joint
employee of dhs and Public
Health, where I had the
opportunity to work on project
projects that were focused on
bringing our departments
together and working together
on behalf of the shared
populations that are so often
the focus of the two agencies.
But where coordination and
alignment were not the standard
approach, and these projects
were a catalyst to start
working that way. When I came
back to the county earlier this
year, I was really pleased to
see the path that the bird team
and the executive team were
already on with regard to how
we were, how we were
approaching the mid renewal and
the implementation plan. And
just to say that this really is
a one one county approach where
we
re looking to funding
activities that will support a
system of robust behavioral
health continuum from
prevention activities that
could be happening in public
health to the therapeutic court
interventions, um, to, you
know, the the crisis system
that
s being established. And,
um, this is something that I,
Susan, is going to share more
about, but was very strongly
heard in the community. But
it
s also what makes sense, um,
the people that we serve are
not uh, they don
t they don
t
care what what agency is
serving them. They just want to
have their needs met. And so I
was really pleased to see that
approach. We really viewed this
happening in an approach that
promotes overall accountability
across the county, investments
that the Mid brings to the
table or that the bridge brings
to the table. Um, we envision
doing this through establishing
with our partners at dhs and
other relevant agencies,
establishing a shared framework
about metrics for metrics and
accountability. Um, again, just
to reiterate, it doesn
t matter
which department is
administering the services. We
want to have a an overarching
framework for accountability
that crosses those agencies.
Um, we want to be able to look
and see over time as we
re
making an investment in one
part of the continuum, how it
MAY or MAY not be showing up in
other parts. Um, and we
anticipate that this approach
will give us the opportunity to
make stronger, data driven
decisions in real time that
have performance goals that we
can see and make adjustments
along the way. So I
m really
pleased to be here with my
colleagues from dhs and be back
with many of you who whom I
ve
had the chance to meet in the
past and look forward to
talking with you more in the
future. I
m going to pass it
back over to Susan.
Um, I think this is about is
this going to you or do you
want me to take these? Okay.
Yeah, I can take this. Um,
thank you so much. Uh, thank
you. And for the record, I
d
like to introduce myself. My
name is Isabel Jones. She her
pronouns. And I am the acting
director for the Division of
Behavioral Health and Recovery
here in dc. Hs. Um, and I am
going to talk us through some
of what is new in the bridge
implementation plan as compared
to the prior Mid implementation
plan. Um, so first start the
bridge investment
considerations. Um, the
investments as outlined in the
Mid implementation plan
financial model are designed to
respond to changing financial
projections throughout the
implementation plan 2028
through 2034. Um, for context,
the mid as of 2026 is actually
currently in a minor reserve
shortfall of approximately $4
million. Um, and should
expenditures and economic
adjustments for all existing
programs within the current Mid
continue. Um, you know, sort of
as status quo and giving
inflationary adjustments each
year. Um, the revenue source
would be in a significant
reserve shortfall of
approximately 29. Yeah, 29
million by 2029. Um, so the
bridge implementation plan, uh,
is designed to address that
over, um, the first several
years of the implementation
plan, in particular, um,
primarily by conducting
procurements for new
programming or to select, uh,
new providers to do similar
programming to the current mid,
um, and to assure that as we
proceed into the mid, the
bridge implementation plan, um,
that the programming is, uh,
sort of operating within the
revenue that is available from
the funding source. Um,
additionally, we have
introduced through learnings
during the last prior mid
implementation plan, um, we
ve
introduced a reserve that
creates more flexibility during
anticipated periods of sales
tax volatility. For example, we
know that in 2029 there will be
a kind of a revenue, uh,
reduction in terms of sales tax
due to some of the state
changes to the, um, related to
the millionaire
s tax. Um, and
so the implementation plan
already contemplates that that
would be a year where there
would be a lower inflationary
adjustment proposed. Um, but it
also creates a reserve, as Sam
mentioned, through 2031, so
that we are sort of smoothing
out the known sales tax
volatility, um, and planning
for it so that we can plan
ahead to provide economic
adjustments for existing
contractors. Um, uh, when
revenue is available. Um, and
this is something that is part
of the bridge implementation
plan as a learning from the
prior mid period. Um, and then
we are also proposing to
strengthen our monitoring and
compliance work by rightsizing
staffing to support the
investment of $100 million per
year. We do have over 312
contracts currently within the
mid. Um, and so we are seeking
a modest increase in staffing
to support our ability to do
compliance work, do monitoring
work, and to implement the
various levels up policies and
procedures that the department,
um, uh, has been, um,
implementing. And next slide,
please. Um, so another primary,
uh, change in the bridge as
compared to Mid. Is that the
bridge is organized into five
primary strategy areas, um,
with 2 to 3 concrete goals. Uh,
in each of these five strategy
areas for a total of 13 goals
and funding in the financial
plan is at that goal level. Um,
and this is a shift from mid
where the Mid implementation
plan was organized under about
55 distinct initiatives. Um,
those 55 initiatives did roll
up to five goals. Also in the
Mid implementation plan. Um,
but we are seeking to move away
from uh 55 distinct
initiatives, which in some
cases were quite narrowly
defined and kind of, uh,
resulted in somewhat
constraining how, uh, programs
could be implemented within a
given initiative if it was
narrowly defined to moving
towards kind of a little bit of
a higher level investment and,
um, having more flexibility
within the bridge to be able to
make broader, deeper
investments, meaningful,
impactful investments. Um,
investments that are scalable
across our community and
operating at that goal level
rather than at the, um, the
initiative level. Um, so the
five strategy areas are care,
transitions and diversion
services, substance use
disorder, treatment and
recovery, equitable access to
behavioral health care, child
youth and young adult mental
well-being and behavioral
health. Workforce development.
I will note that, um, well,
this is a change in structure
and sort of organization of
work in the bridge. The
existing programs and
initiatives and contracts, um,
do crosswalk to these five
strategy areas and 13 goals.
And in many ways, you know,
align with the direction that
we
re moving in the bridge. So
it
s not a, um, it
s not a
dramatic departure from, uh,
much of which much of what the
Mid has been investing in over
the last few years. Um, but in
particular, I think a different
way of organizing the work.
And, you know, uh, highlighting
these really as the five
strategy areas in particular
that we see as being priorities
for the community Behavioral
Health System based on, as
Susan mentioned, uh,
significant community
engagement as well as data
analysis and a lot of work with
subject matter experts in our
system. Uh, next slide. Um, the
bridge implementation plan is
also bringing a county wide
approach to accountable
accountability and outcomes.
Um, uh, as the executive
s
office has mentioned, um, there
is an intent to measure,
monitor and support
accountability across county
administered programming in
addition to our programming
that we contract out to
providers. Um, currently under
the Mid right now, there
s
about 75% of the funds that are
administered through contracts
with provider organizations in
the community. And then about
25% of the programming is
actually administered by the
county itself, whether that be
through public health or, um,
jail health or even some
programming that
s administered
in the sheriff
s office. For
example. Um, uh, we will also
be doing competitive
procurement for dhs programs.
Uh, this is something that we
are proposing to do. Uh, in all
five strategy areas and under
all of the sort of 13 goals,
um, that doesn
t necessarily
mean that some or much of the
current programming that
happens now in the mid, um,
might not be something that,
uh, either something that is
procured in the future or
something very similar could be
procured in the future. But we
are proposing to do procurement
processes for, uh, contracted
programming. We think this is
very important. Um, just to,
uh, give, for example, new
organizations and entrants in
our community an opportunity to
compete, an opportunity to
bring forward the best possible
proposals for how they can
serve our community. Um, so
that is, um, a change that
we
re proposing in this bridge
implementation plan. Um, that
is something that we seek to do
and we think is very important
to do at this point for the
funding source. Um, because in
many cases, it has been many
years, uh, since some of our
programming through this
funding source has actually
been open up for a competitive
process in the community. Uh,
next slide, please. Um, in
terms of the anticipated steps
to the procurement, uh, so, um,
I
ll just kind of walk us
through how we at the division.
Um, uh, do our procurements and
what those various steps are,
as well as my next slide. We
ll
talk about the timeline. Um,
but we start by analyzing the
current financial projections,
how much revenue is going to be
available to, you know, put out
for a given procurement, the
behavioral health landscape,
performance data and potential
funding sources for each
strategy area? Um, what we
re
referencing with that is, um,
uh, continuing to evaluate, uh,
if there is a funding source
that has perhaps become
available to the county, um, in
recent years, such as the
crisis care center levy, that
might have a stronger alignment
with something that we were
previously doing under the mid.
Um, we would seek to evaluate
whether that programming might
actually be more appropriate
for a different funding source
and evaluate the programs
Where we have braided multiple
funding sources together to
determine if there might be an
opportunity to kind of
streamline and fund something
through 1 or 2 funding sources,
as opposed to at times, 4 to 5
funding sources. Um, the
executive
s office intends to
conduct a base budget analysis
of programs that are directly
operated by county agencies as
part of the 2829 budget
process. Um, then we would
crosswalk existing programs to
strategy areas, identify
alternative funding sources
where applicable, and right
size rfp budgets to align
procurements with other county
funding streams. Again, as
available, um, draft our
procurement materials for the
anticipated activities, goals,
preliminary outcome measures in
partnership with the
executive
s office. Also likely
doing more community engagement
in that process. More subject
matter expert engagement and
using the logic models that are
in the implementation plan as a
starting point. Um, the
implementation plan itself does
include for each of the 13
goals, a list of what we refer
to as anticipated activities.
Um, so this is a strong kind of
roadmap or example that, uh,
you and stakeholders could look
at to have a sense of what are
some of the things that we
think would be applicable or
would be kind of appropriate
under each goal to be the focus
point for a future procurement?
Um, then we would launch
competitive procurements with
community outreach information
sessions and technical
assistance, recruit and train
panelists, conduct equitable
applications, scoring select
awardees, and complete all of
our due diligence processes.
Um, this is also where we would
notify Council and we, as part
of our standard procurement
process. For example, we invite
council, um, to participate in
the scoring panels. Uh, next
slide. Um, in terms of the
estimated timeline for the
phased procurement, uh, the
implementation plan proposes to
phase the procurements over
approximately two years. Um,
this is for a number of
reasons. Uh, for one thing, um,
just capacity and resources,
both at the department level
and in the community to develop
procurements. Um, and to for
community members to respond to
procurements is something that
we think necessitates a phased
approach. Um, we want to be
able to, uh, certainly take
time and again, do additional
stakeholder engagement as we
are developing these
procurements. Um, from the time
when our procurement would be
announced to when a new program
would launch would actually be
a little bit over a year. Um,
because of just the time it
takes to put out the
procurements, allow the
provider community to respond
to procurements, and then go
through the selection process,
and then also do readiness
review due notification to any
existing programs that you know,
might need a transition period
and kind of a ramp down period.
Um, so there would be a, a
pretty significant timeline of
about a year. Um, in
particular, for any program
that was not proposing to be
renewed or really is not going
to be the focus of a
procurement in the future. That
program would have over a year
notice. Um, on that timeline.
Um, and then, you know, we also
have some, uh, things that we
would just note in terms of the
child, youth and young adult,
uh, mental wellbeing strategy
being the last strategy on the
phased procurement timeline.
That is intentional. Um, so
that, uh, there is more clarity
and uncertainty around best
starts for kids and we would be
able to sort of align that
procurement with, uh, with Best
starts for kids at that time.
Next slide please. Um, I wanted
to touch on, uh, just upcoming
reports and briefings. Um, so
the 2025 mid retrospective, uh,
we just did prior to this
presentation, then we have two
progress reports. Um, well, we
have a progress report and then
a transmittal that will go to
county Council related to our
strategic planning work. This
was a proviso that was in the
prior budget that has, um,
required us to bring forward a
very comprehensive report
around our programming and our
strategic planning. So we have
an upcoming SEPTEMBER briefing
on that. And then we will
transmitting the report in
JANUARY. Um, and then following
that at both our pc as well as
council each summer, we would
be coming back with bridge
transition updates. Um, and we
will also have the data
dashboard. Um, that, you know,
is available and has data
related to all of the
programming. And then the first
biennial report would actually
be in AUGUST 2030. Um, that
would look back on the first
two full years of the bridge
implementation plan. Next slide
please. Um, I
m gonna also
touch on the inflation
analysis. Um, uh, which was a
budget proviso. That is part of
the implementation plan. Um,
the budget proviso, uh, sought
for the department to talk
about how inflation rate
adjustments are made and
determined to be, um, sort of
viable and something that can
happen within a given revenue
source. Um, we do seek to
integrate provider inflation
rate adjustments into
implementation plans and budget
proposals for our local funding
sources whenever the revenue
support source supports our
ability to do that. That is so
that we can support human
service providers to maintain
their service levels and retain
their workers in the face of
inflationary costs that they
experience at the provider
level. Um, however, there are
times when expenditure growth
is predicted to outpace revenue
growth. Um, and so, you know,
therefore and we see this
happening in the mid and the
bridge. Um, there are times
when we know that the economic
adjustment that we would seek
to give to contracted providers
is actually larger than the
additional revenue that will
come in during that time
period. Um, and so again, in
the implementation plan, we did
build in that kind of
volatility reserve to account
for that. And uh, inflationary
adjustments are always subject
to council approval and go
through that, uh, budget
process. Um, and at times we
have to propose a lower
inflationary adjustment or
perhaps even know inflationary
inflationary adjustment if the
revenue source can
t support
it. Um, we can go to the next
slide. Um, I
m just going to
touch on some a couple of
frequently asked questions that
we have gotten over the last
couple of weeks, and then we
can open it up for additional
questions. Um, one of the
questions has been whether the
bridge will invest equitably
across the county. Um, and we
do expect to maintain or
improve our behavioral health
service availability across the
full county through countywide
services and targeted
investments in both rural and
urban areas. Um, another
question we have got is why
there is a proposed shift from
annual to bi annual narrative
reports. Um, the proposed
implementation plan does
continue. An annual dashboard
update accompanied by council
briefings. Each year. The
proposed transition to bi
annual narrative reports is
intended to redirect executive
branch resources to continuous
improvement. Um, and with that,
that brings me to the end of
the slides. And I think we can
open for questions. Um, or I
can turn it back to you. Chair.
I
m going to open up for
questions at this time. Thank
you very much. I
m looking at
my colleagues. I know we
re
kind of overwhelmed with all
the data that we have received.
Not only today, but in advance.
But I want to make sure my
colleagues, if they had any
questions, this would be a good
time. If not, we have a
scheduled process that I
ve
worked out with, uh, vice
chair, Mayor of Backus to
hopefully accommodate the
Scelsi Association, the city of
Seattle, and my colleagues on
the county council. Um, chair,
mayor, mayor. Baca. Okay.
Councilmember Baron.
Thank you. Chair. Uh, you know,
and I definitely want to defer
if other colleagues have
questions because I have I have
the, uh, the the good fortune
of serving both on hhs, on the
council side. And so I get to
hear these presentations twice.
Um, uh, I first want to say
share that. I really appreciate
your, um, uh, working with
Councilmember Mosqueda to
adjust the schedule, to give us
a little bit more time to this
is a very important decision
involving, you know, hundreds
of millions of dollars of
investments over the next
several years. And so I
appreciate the, um, allowing us
a little bit more opportunity
to to consider this because I
think there are some
significant questions, policy
questions here. Uh, one thing I
wanted to highlight for, um,
our colleagues, uh, on the, on
the committee, uh, I would
encourage you to, as Sam
mentioned, attachment seven,
which is on page 259 of the
packet. As the chair mentioned,
we have a lot of information
here, but I think the reason
that I point to 59 is because
there are some significant
shifts in funding allocations
that are being proposed among
the different strategy areas.
And I think it
s important for
us to understand those
decisions as we as we consider
this. Um, and it kind of leads
me to one of the questions that
I had, and I appreciate that
this team is, uh, we
re going
to have a separate meeting to
kind of focus a little bit on
this, but I wanted to highlight
this issue for everybody here
and to allow them an
opportunity to share a little
bit of a perspective on, on on
the proposal, because one of
the areas that I
m concerned
about is, um, the there
s some
aspect of the current program
that supports behavioral health
for low income people who are
ineligible for Medicaid. Um,
and that program is, uh, you
know, as was mentioned, we
re
going to continue funding these
services. But what I noted, if
you look at that, that chart in
259, there
s a significant
decrease in the amount of
funding that is going to that
is going to be cut by about a
quarter, uh, of funding as
proposed currently in future
years. Um, and that strikes me
as a little bit concerning,
given that we have a, you know,
uh, we
re expecting, uh, a drop
in the number of people who are
eligible for Medicaid who are
about to lose coverage for
about 4000 residents, uh,
because of immigration status
issues. These are folks who are
here on legal status, but who
are being made ineligible
because of the of the bill last
year from Congress. And then,
of course, the work
requirements that are going to
be imposed next year. Um, the
estimates I think that we heard
from public health recently
were about 72,000 residents are
expected to potentially lose
Medicaid next year. And so I, I
would love to hear from dhs
staff on how we
re accounting
for that at a time when we
re
expecting the population that
is not eligible for Medicaid to
increase over the next several
years. Um, why the decision was
made to actually reduce the
amount of funding to that
program. That is ensuring that,
uh, or, you know, attempting to
at least mitigate, uh, and
provide coverage for people who
are not eligible for Medicaid,
uh, to, to have access to
behavioral health.
Who wants to take that on?
Don
t you? Yeah. Go ahead.
Um, yeah. So we are we, as you
know, have, um, a program now
that provides, uh, services to
individuals who are not
eligible to Medicaid and who
are otherwise uninsured. Um,
this is actually the single
largest, uh, initiative in the
current mid. Um, we have been
working with the provider
community this year due to some
challenges that we identified
with that program in 2025. Um,
the program actually ended up
being overspent by its budget
in 2025 by about $1.5 million.
And so we did a very broad
listening session with all of
the providers who participate
in that program and have been
doing quite a bit of evaluation
as to how, at the provider
level, they determine
eligibility, for example, and
screening for individuals who
are able to access that
benefit. Um, and then also
around our payment methodology
of how we pay for the services.
Um, right now, the program
serves a little under 4000
people per year. Um, you know,
some of the analysis that we
have done has, um, uh, led us
to implement process
improvements in the program in
terms of more clear eligibility
and screening processes so that
we can validate that
individuals who are on the
benefit absolutely do not have
any eligibility for Medicaid
that could be leveraged for
their services. Um, and we are
also implementing some, uh,
changes so that we are going to
be reporting spend down when we
at the county use local funds
to pay for these services.
Previously that was not being
reported in the state
s spend
down process. Um, which we have
learned could allow individuals
to probably within a matter of
months, qualify for Medicaid by
meeting their spend down. Um,
and then transition over to
Medicaid as their funding
source. Um, additionally, we
also have done a kind of, um, a
cost modeling, I guess I would
say in terms of looking at how
we pay for services, which
right now when someone comes
on, we pay for about 12 months
of benefits. If we transitioned
to, um, kind of a fee based
payment methodology. Um, which
would be a significant change
in this program, but it would
be a fee based methodology
where the county was paying for
each service that is provided
to an individual. Um, our
modeling shows that we would be
able we would, um, uh, expend
about one quarter of the funds
on the same amount of people
and services being provided as
they are now. So there are a
number of process improvements
that we already have under way
on this program that we think
will allow the program to
actually serve additional
clients within the same budget.
Um, and other opportunities for
kind of optimization and
potentially changing the
payment model in such a way
that we could serve additional
individuals. Um, so that is
some of the, um, the work that
we
ve been doing related to
that question. Um, oh, the
other thing that I would note
is there is a section of the
implementation plan that also
outlines the priorities for
investment. Should, um, revenue
be available and revenue can
become available both through
just, you know, additional
revenue, more revenue coming in
than expected or also through
underspend of initiatives. If
it takes longer for something
to get off the ground. Or
there
s a variety of reasons
why underspend occurs. Um, and
after providing full and
economic adjustments to
existing program, the very next
priority that we are proposing
is to add additional funding
to, um, uh, this program or
potentially other programs, if
they primarily serve non
Medicaid people. Um, to
mitigate the harm of H.R. One,
so, um, that is another thing
that I would sort of direct you
to is something we have, um,
put in as really the next
priority for funding. If we
identify that there is more
needed in order to mitigate
harms of H.R. One.
Thank you.
Uh, any other follow up
questions?
No, chair. I appreciate it. I
appreciate the response. Look
forward to digging in more with
the the on this. But I think
this continues to be an area of
concern for me. But I
appreciate the response and
look forward to continuing
conversations.
Thank you to any other
colleagues at this time. Have a
question? If not, I want you to
feel free to, um, send
questions to Sam, who will then
work with the, um executive
staff on answering them. Uh,
Sam, thank you very much for
you and your staff. Susan,
thank you for your staff work
as well. And your team. And
again, it
s going to be a team
effort to resolve some of the
issues that have come up and
hopefully resolve some of the,
um, concerns that have been
raised. If there
s no other
issue to come before it.
Would you like to do the the
minutes?
No, no.
No, I think we
ll do that
another time.
Thank you. Thank you.
If there
s no other issues,
come before us. We are
adjourned.