Health care expanded for state's poor

A year ago, as Washington faced a $9 billion revenue shortfall, Gov. Chris Gregoire proposed eliminating the state's last social safety net for people whose physical or mental disabilities prevent them from holding a job.

Instead, the Legislature not only spared General Assistance for the Unemployable, it made it better, say those in the business of providing health care to the state's poorest residents.

"It's miraculous for us," said Peg Hopkins, director of the Community Health Association of Spokane. "We are so grateful we were able to pull this program through the last legislative session."

This month, the nonprofit Community Health Plan of Washington expands statewide a pilot program that began in Pierce and King counties in 2004. The GA-U Integration program will provide managed health care, including mental-health treatment, to 18,000 people who cannot work.

Nowhere will this change be felt more dramatically than at the Community Health Association (CHAS) clinics in the Spokane area, which have the highest percentage of GA-U patients of any system in the state, Hopkins said.

Time will tell whether providing these patients with coordinated health care will save the state money or even whether it will be allowed to continue.

Once again, state-funded programs like GA-U are at risk of being eliminated as lawmakers struggle to make up an additional $2.5 billion revenue shortfall.

"We are in a position that most of what is left is protected by law," said state Sen. Lisa Brown, D-Spokane.

"When you have a program like GA-U that is state only, it is clearly on the line."

Advocates say the new plan, if it survives the budget ax, has the potential to save health-care costs.

Pierce and King counties saw savings of $3.5 million, primarily in hospital and pharmaceutical costs, said David Kinard, of Community Health Plan. The nonprofit corporation is the state's largest care provider for people insured through the Basic Health Plan and the only provider for those under the GA-U plan.

"It manages costs while providing continuity of care," Kinard said.

Washington has been one of just a few states to offer a program like GA-U, which was intended to help people get back on their feet by providing health care and a monthly stipend of as much as $339. Recipients must prove they have assets of less than $1,000 and be physically or mentally unable to work for three months.

Although 40 percent of GA-U recipients have a mental condition as a primary diagnosis, the program did not provide for mental health or substance-abuse treatment.

But the GA-U Integrated system provides for both and assigns a care coordinator to make sure clients get access to physical and mental-health care, as well as social and vocational services.

"What that means is you've got someone in a primary-care role working as air traffic controller for all their health needs," Hopkins said, adding that GA-U clients typically have complicated medical and psychological conditions.

Under the past fee-for-service model, these patients could be expensive because there was no controlling their encounters with medical providers as they cycled on and off GA-U for years.

Additional savings are expected under the new plan by recognizing those patients who are permanently disabled and moving them off GA-U and onto federal Social Security disability income.

Hopkins said there are an estimated 1,600 people on GA-U in Spokane County, 1,100 of whom already are patients of CHAS, which has a vested interest in the success of the new plan.

The alternative the Legislature again will consider in the 2010 session is shifting the financial burden onto the local community and its nonprofit clinics.

"What we were facing was these persons who are extremely needy would lose their coverage but still be our patients," Hopkins said.