2021 Spotlight Award for Innovation: Washington

This Fall marks NAMD’s third annual Spotlight Award recognizing the spectacular work Medicaid agencies have done in service to the 80 million people covered by program. As the COVID-19 pandemic continued to disrupt healthcare for millions of Americans, Medicaid leaders used their creativity, fearlessness, and tenacity to use this disruption to address long-standing challenges in Medicaid. This year we highlight Washington’s leadership in leveraging this disruption to improve behavioral healthcare for their most vulnerable populations.

Challenge

Like many states across the country, Washington faced systemic challenges with meeting the unique needs of high-risk children with complex emotional, behavioral, and social issues. This vulnerable population receives services from many state agencies, including Medicaid, which makes coordinated care incredibly important, but also challenging.

Catalyst

In response to a 2009 lawsuit, where the plaintiffs argued that children and youth living in Washington were not getting the intensive mental health services they needed, Washington State developed the Wraparound with Intensive Services (WISe) program. WISe is a family driven, youth guided, and community based comprehensive group of services that support children, youth, and their families with intensive treatment needs. It serves youth 0-20 and their families by meeting individuals where they are and allowing them to drive their treatment. When the pandemic hit Washington in March 2020, access to these intensive mental health services were put in jeopardy.

Meeting the Moment

To increase access to these vital services during the pandemic, WISe adapted to allow for hybrid and virtual care options using telehealth to support the state’s youth and families, including developing platforms for family and youth engagement. Youth and family organizations came together and swiftly established platforms to support youth and families providing direct support, like the Family, Youth, and System Partner Round Tables, which allows community partners to have a voice in the behavioral health system. Despite increasing workforce challenges, providers continued to offer services and increase intensity through telehealth and virtual session options.

During the pandemic, mental health care decreased nationally, but in WISe, Washington State maintained service hours and, in some regions, increased service hours.

• CMS data released on May 14, 2021, showed a 34% decline in the number of mental health services utilized by children under age 19 (February 2020 to October 2020), compared to the same period in 2019.
• In the same period (February 2020 – October 2020), the 3-month moving average WISe Service Intensity for the state dipped slightly in March 2020 to 9.3 hours, then quickly increased. By August 2020, Washington State had reached 10.5 hours as their 3-month moving average for the state, then increased that to 11.8 in February 2021.

Not only did WISe adapt in a way which mitigated disruption to care, it also increased service intensity and supports that resulted in the dismissal of the lawsuit in September 2021.

Spotlight Award

For these innovations, the state of Washington is a recipient of NAMD’s 2021 Spotlight Award.