Community Health Plan, CHCs to pilot mental health services for GA-U recipients

In November, Community Health Plan launched a pilot program in King and Pierce Counties that integrates primary care and mental health treatment for people enrolled in the state's GA-U program—residents who, until now, have largely lacked access to affordable mental health services.

Health insurance has historically been scant or non-existent for people on GA-U—an acronym for "General Assistance-Unemployable," the state program that provides cash and medical benefits for people who are temporarily physically or mentally incapacitated. For many years, the state reimbursed providers who treated GA-U recipients on a fee-for-service basis. But care was expensive, and many providers chose not to treat GA-U recipients.

In 2004, as part of a pilot aimed at saving money and improving outcomes, the state began referring GA-U recipients in King and Pierce Counties to managed care administered by Community Health Plan.

"Pretty quickly, we heard that the CHCs were overwhelmed by the sheer numbers and by the challenge of treating a population in which so many people are struggling with mental illness," says Abie Castillo, Vice President of Network Development at Community Health Network of Washington. "Our mental health pilot gives providers the staff and training to better meet that challenge."

The two-year pilot will serve over 4,000 eligible clients. Patients receiving GA-U medical benefits will be screened for mental illness when they visit their primary care providers. Then they will be referred as appropriate to an on-site care coordinator for brief intervention or to specialized case management and treatment at a community mental health center.

"Access to mental health treatment is especially important for people who receive GA-U, because upwards of 50 percent of them have mental health conditions. Mental illness makes it harder to address substance abuse, housing issues, and any number of things that GA-U recipients typically wrestle with," Castillo says.

Patients in the program will be connected to a full range of social services, including substance abuse counseling, housing resources, and job services. DSHS will work with patients to ensure that they make full use of their GA-U benefits and, when necessary, enroll in GA-X (General Assistance—Expedited Medicaid) or SSI (Supplemental Security Income, the federal disability program).

"It's a two-track system," says Castillo. "The ultimate goal is help the client become healthy enough to become employed again or to recognize that they are permanently disabled and get them enrolled in SSI."

The pilot is being developed in cooperation with the providers who will administer the care.

"All the community providers—the CHCs, CMHCs, King County RSN, Harborview Medical Center, DASA substance abuse providers—are on the steering committee," says Castillo. "They're designing the process for themselves."

Community Health Plan is also partnering with psychiatrists at the University of Washington Medical Center, who will provide medication management and psychiatric consultation.

The pilot is being funded with $3.4 million allocated by the state legislature after Community Health Plan and a coalition of community advocates and stakeholders developed a proposal for how mental health services could be integrated with primary care. Among other things, the funding will be used to increase mental health staff and training at CHCs.

"This pilot is a perfect example of the community coming together to provide health care access to people everybody else is ignoring or forgetting about," says Castillo. "This program demonstrates exactly why the CHCs, and Community Health Plan, are here."

For more information about the pilot, contact Abie Castillo at (206) 613-8929 or abie.castillo@chpw.org.