[0:00] 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.

[0:19] 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.

[1:11] 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.

[1:31] 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.

[1:53] 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.

[2:27] 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.

[2:48] 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.

[3:10] 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.

[3:33] 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.

[3:57] 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.

[4:16] 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.

[4:40] 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.

[5:23] 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.

[5:42] 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.

[6:02] 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.

[6:23] 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.

[6:46] 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.

[7:14] 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

[7:34] 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,

[7:58] 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.

[8:22] 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.

[8:49] 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.

[9:25] 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.

[9:53] 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.

[10:22] 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.

[10:55] 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.

[11:17] 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.

[11:40] 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.

[12:06] 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

[12:26] 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.

[13:04] 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.

[13:28] 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.

[13:54] 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.

[14:14] 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.

[14:34] 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.

[14:56] 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.

[15:15] 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.

[15:38] 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.

[16:01] 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.

[16:26] 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.

[16:47] 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.

[17:09] 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.

[17:34] 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.

[17:53] 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.

[18:18] 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.

[18:42] 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

[19:06] 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

[19:27] 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.

[19:52] 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.

[20:13] 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.

[20:41] 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.

[21:03] 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

[21:24] 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.

[21:49] 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.

[22:11] 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.

[22:34] 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.

[22:55] 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.

[23:15] 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.

[23:36] 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.

[23:58] 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.

[24:19] 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

[24:38] 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.

[25:01] 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.

[25:28] 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.

[25:50] 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.

[26:14] 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.

[26:37] 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.

[27:02] 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.

[27:27] 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

[27:47] 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

[28:08] 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.

[28:30] 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.

[28:53] 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.

[29:13] 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.

[29:37] 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.

[30:06] 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.

[30:33] 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.

[30:56] 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.

[31:20] 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.

[31:45] 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.

[32:08] 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.

[32:28] 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.

[32:52] 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.

[33:15] 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.

[33:39] 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

[33:59] 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.

[34:22] 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.

[34:42] 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.

[34:59] 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.

[35:21] 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.

[35:41] 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.

[36:02] 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.

[36:19] 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.

[36:40] 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.

[37:06] 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.

[37:29] 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.

[37:48] 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.

[38:11] 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.

[38:34] 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.

[38:55] 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.

[39:20] 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.

[39:38] 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.

[40:01] 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

[40:23] 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.

[40:42] 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.

[41:01] 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.

[41:25] 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.

[41:47] 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.

[42:13] 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.

[42:35] 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.

[42:59] 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.

[43:25] 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.

[43:48] 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.

[44:13] 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.

[44:31] 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.

[44:54] 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

[45:16] 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.

[45:37] 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.

[46:06] 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.

[46:30] 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.

[46:47] 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.

[47:13] 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.

[47:34] 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.

[47:49] 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.

[48:07] 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.

[48:30] 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.

[48:48] 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

[49:04] 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

[49:26] 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.

[49:46] 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.

[50:05] 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.

[50:29] 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.

[50:49] 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.

[51:05] 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.

[51:25] 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.

[51:48] 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.

[52:15] 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.

[52:42] 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

[53:09] 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.

[53:34] 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.

[53:57] 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.

[54:18] 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.

[54:43] 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.

[55:14] 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.

[55:40] 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

[56:06] 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.

[56:34] 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.

[56:56] 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.

[57:18] 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

[57:40] 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

[58:09] 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

[58:32] 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.

[58:54] 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.

[59:17] 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.

[59:36] 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.

[59:57] 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.

[1:00:18] 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

[1:00:42] 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

[1:01:01] 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.

[1:01:24] 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.

[1:01:50] 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.

[1:02:11] 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?

[1:02:31] 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.

[1:02:55] 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.

[1:03:26] 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.

[1:03:48] 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,

[1:04:11] 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.

[1:04:28] 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.

[1:04:50] 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.

[1:05:12] 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.

[1:05:32] 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.

[1:05:56] 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.

[1:06:16] 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.

[1:06:42] 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.

[1:07:04] 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.

[1:07:22] 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.

[1:07:44] 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.

[1:08:06] 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.

[1:08:25] 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.

[1:08:46] 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.

[1:09:07] 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.

[1:09:22] 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.

[1:09:46] 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.

[1:10:05] 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.

[1:10:23] 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.

[1:10:42] 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.

[1:10:57] 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

[1:11:11] 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.

[1:11:31] 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.

[1:11:50] 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.

[1:12:07] 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.

[1:12:25] 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.

[1:12:43] 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.

[1:13:12] 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.

[1:13:31] 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

[1:13:50] 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.

[1:14:11] 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.

[1:14:31] 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.

[1:14:51] 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.

[1:15:12] 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.

[1:15:34] 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.

[1:15:57] 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.

[1:16:18] 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.

[1:16:40] 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.

[1:17:05] 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.

[1:17:26] 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.

[1:17:42] 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.

[1:18:02] 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.

[1:18:20] If there’s no other issues, come before us. We are adjourned.

Regional Policy Committee 8-26-26

Transcript