Washington providing leading example for other states in implementing crisis response services


Shane Ersland


Washington is providing a leading example for other states in its work on several health initiatives, including crisis response services and healthcare affordability efforts.

Health policy leaders discussed federal and state initiatives at the 2024 Washington State of Reform Health Policy Conference on Jan. 4th. Priya Helweg, deputy regional director and executive officer for Region 10 of the U.S. Department of Health and Human Services (HHS)—which covers Washington, Oregon, Alaska, and Idaho—said behavioral health, lowering healthcare costs, and increasing accessibility are priorities for the department this year. 

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“We reinforced our certified community behavioral health clinics, ensuring around-the-clock care for those in dire need,” Helweg said. “HHS has taken a full-department approach to delivering integrated and equitable behavioral healthcare when the secretary started his Behavioral Health Coordinating Council. Those priorities are overdose prevention, crisis and suicide prevention, and behavioral health integration. And since that time, we’ve seen the most progressive overdose prevention strategy to date that prioritizes harm reduction and long-term recovery.”

The recent rollout of the 988 crisis line has provided an important tool for HHS in studying the impact crisis services have on people, Helweg said. Since it was launched, the line has received 5.5 million calls and texts, she said. The line provides options for specific cultural groups as well.

“There’s the Maternal Mental Health line, Veterans Crisis line, LBGTQI+ line, and a real focus on youth,” Helweg said. “And Washington, as usual, is front and center. There is a Native American-specific line called Native and Strong, and I’m hearing that it’s used as a model for other states to address an important population that needs specific interaction around this issue. They’re just proportionally impacted.”

Liz Arjun, associate principal at Health Management Associates, assisted Washington’s Crisis Response Improvement Strategy Committee in implementing the 988 line. 

“That work has been so informative to other states. It has really helped other states think about how they want to take on implementing 988. And (think) about it as an opportunity to not only implement the line, but redesign their crisis system.”

— Arjun

Arjun said she spent about five years working in Washington, D.C., as a liaison between state advocates and a federal policy think tank, where she became familiar with the impact states have on shaping federal policy. 

“I really saw firsthand how much it was states leading the way,” Arjun said. “And that what happens in the states informs federal initiatives and efforts.”

Those efforts can be seen in federal health initiatives like the $35-a-month cap on insulin for Medicare members, Medicare’s new option to negotiate prescription drug prices, and the extension of coverage for postpartum care for 12 months for those on Medicaid and the Children’s Health Insurance Program. 

Helweg also noted that the National Health Service Corps Loan Repayment Program will help supplement the healthcare workforce. 

“Providers can go into underserved communities—rural and tribal communities—and receive scholarships and loan repayment to serve those communities. There’s about 20,000 of those folks out there right now. There’s also workforce diversity programs which are created to assist students with disadvantaged backgrounds throughout the educational pipeline.”

— Helweg

Arjun noted that Washington is also working on several healthcare affordability initiatives. Those include the Washington State Health Care Authority’s new Prescription Drug Affordability Board (PDAB)—which held its first meeting on Oct. 20th, 2023—and the Health Care Cost Transparency Board.

“Washington is one of eight or nine states that has cost boards promoting transparency to look at what is driving the increase in healthcare costs,” Arjun said.

Arjun also works with Washington’s Universal Health Care Commission, which is very unique, she said. 

“There are a few other states that have been looking at efforts to implement universal healthcare,” Arjun said. “But what’s unique about Washington’s commission is that it’s uniquely charged with looking at transitional solutions to advance coverage, access, and equity. That commission has really taken that on, and we’ll be doing more of that work over the next year.” 

Some of the things the commission will study this year include administrative supplementation and options to increase the number of providers that accept Medicaid, Arjun said.

“At the same time, how can we do more to align what’s happening across the different markets so that we don’t have different adequacy network standards per exchange plan for Medicaid?” she asked. “That’s something the commission will likely be looking at because if there is a universal system at some point—with a unified single-payer system, which is the long-term goal of that commission—there’s so much work that needs to be done now to actually pave the way for that. 

And that commission has really embraced that. And that’s very unique because other commissions have just been focusing on, ‘OK, we’re trying to do single-payer, and here’s our plan,’ and then nothing happens. So I think this commission is really trying to see what it can do to lift up efforts that can improve things for folks right now.”

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