Always a Crisis, Never a Solution

Again, state cuts threaten King County services for indigent mentally ill people.

The State of Washington might have a $1.4 billion budget surplus this year, but you'd be hard-pressed to prove that by low-income mentally ill people in King County. For the fifth consecutive year, the county faces the prospect of kicking hundreds of patients off mental-health-care rolls unless the Legislature and Gov. Christine Gregoire act quickly.

"We are already in a crisis situation," says Sandeep Kaushik, a spokesperson for County Executive Ron Sims. The county, he says, is not accepting new non-Medicaid patients, owing to moves by the state Department of Social and Health Services to cut allocations of state money to King County and other population centers. "We simply don't have the money to fund them."

"Non-Medicaids," as the patients are known, don't qualify for state and federal Medicaid money, despite being low-income and, often, desperately ill. Traditionally, the county has managed to treat these patients by engineering savings in its system and using the savings to cover these patients. But last year, the feds and the state changed the rules so that savings could not be spent on non-Medicaid patients. The county has already asked the Legislature for $7.4 million in additional funding for this year, which would backfill previous cuts.

Amnon Shoenfeld, director of mental health, chemical abuse, and dependency services for the county, says the county is also struggling with potential loss of several million dollars more due to changes in reimbursement rates for patients on Medicaid that favor smaller counties—and that cut money paid to larger counties like King. King County serves about 22,000 Medicaid patients with mental illness. About 260 patients would be without health care if the Legislature doesn't fund the $7.4 million backfill. Coupled with the rate change, Shoenfeld says, he might have to cut the county's $77 million mental-health budget by at least 12 percent.

Previous cuts to more than 1,000 non- Medicaid patients have resulted in many of these people ending up in jail or at Western State Hospital in Steilacoom. Lars Erickson, a spokesperson for the governor, says Gregoire understands "that King County feels it has been shorted" and is working with legislators "trying to find a solution." The solution is simple: more money.

Calls seeking comment from several legislators went unreturned.

Kaushik says that Sims has made the issue the county's top priority during this year's legislative session. If the county is left short, he says, it might have to file a lawsuit against the state.

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