[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.