Funding & Payment Models
About Us
Reliable care requires reliable funding. Washington will align dollars with outcomes, equity, and continuity so programs can deliver timely help in every region.
Purpose
Move money toward what works, make mid-acuity services billable, and reward closed-loop coordination and family experience. Cut administrative burden so providers spend more time on care.
What success looks like
Navigation, stabilization, and step-down are funded and available statewide.
Contracts reward access, continuity after transitions, and measured equity gains.
Fewer unfunded handoffs and less cost shifting to families and schools.
Providers have predictable cash flow and simpler reporting.
Today’s financing gaps
Navigation and care coordination often unfunded or time-limited.
Hospital-to-community transitions lack a paid bridge.
Fragmented payers and documentation create dead ends and delays.
Community and Tribal partners carry work without stable support.
Six-month targets
Interim billing codes or braided funds live for navigation & stabilization
Short-stay step-down financed in pilot regions
Outcome clauses added to ≥3 major contracts per region
Small flexible funds available for community & Tribal partners
Public dashboard links spend to results by pathway & region
Core strategies
Pay for what works across the continuum, reduce admin load, braid funds, and reward outcomes and equity—without burying providers in paperwork.
Pay for the middle of the continuum
Fund closed-loop navigation as a covered service with 48-hour handoff confirmation.
Finance community stabilization teams to keep youth at home.
Pay for short-stay step-down that bridges hospital to ongoing care.
Start brief treatment within days using simple, time-based payments.
Outcome-based purchasing
Tie a portion of payment to improvements in access, continuity, and family experience.
Set equity targets with gap closing as the outcome, not just averages rising.
Use small, simple incentives first, then scale as data quality strengthens.
Braided & blended funding
Align Medicaid, commercial, education, and local funds for shared pathways.
Create regional improvement pools that follow the youth across settings.
Use standard MOUs to describe who pays for what, when, and for how long.
Reduce administrative load
Standard documentation for navigation, handoffs, and shared care plans.
One cross-payer referral form per pathway with minimum data elements.
Quarterly “stop doing” reviews to remove reports no one uses.
Pay community & Tribal partners
Multi-year contracts with living-wage budgets and training support.
Flexible funds for culturally specific services and outreach.
Prompt payment clauses to protect smaller providers.
Payment models we will use
Time-based service codes
Navigation, stabilization, and brief treatment.
Episode payments
Short-stay step-down with defined start/end.
Outcome add-ons
Confirmed handoffs & 7-day follow-up after transitions.
Capacity retainers
Hold evening/weekend access at high-demand sites.
Performance pools
Return savings to regions that improve access & equity.
Measures we will publish
Time to first kept appointment
Closed-loop rate within 48 hours
Follow-up within 7 days after transitions
Share of spend on mid-acuity services
Family experience on ease of getting help
Equity gap movement for each measure
All measures are disaggregated by race, language, disability, geography, and payer. Small-n cells are suppressed.
Equity commitments
Direct new dollars to communities with the longest waits and highest drop-off.
Fund language access, accessibility, and trauma-informed practice in every contract.
Compensate lived and living expertise for design, testing, and review.
Publish spending by region and provider type with plain-language summaries.
30–60–90 day plan
A fast, focused rollout that moves dollars to what works, simplifies contracts, and publishes results.
Days 1–30
Map current spend by pathway and region.
Select interim codes or braided payment methods for navigation and stabilization.
Draft model contract clauses for outcomes, equity targets, and prompt payment.
Days 31–60
Execute pilot contracts with payment for navigation, stabilization, and step-down.
Stand up a regional improvement pool with simple application and rapid awards.
Launch the first public finance-to-results dashboard.
Days 61–90
Expand pilots to additional regions and providers.
Adjust rates and documentation based on real use and staff feedback.
Publish a 90-day report on spend shifts, outcomes, and lessons.
Roles and accountability
Finance Lead aligns codes, rates, and contracts across payers.
Program Leads define service standards and confirm delivery.
Equity Lead reviews investment patterns and gap-closing targets.
Regional Coalitions localize MOUs and choose community partners.
Data Lead connects claims, encounters, and outcomes for public reporting.
Risk management
Fragmentation solved with standard forms, shared definitions, and common APIs.
Cash flow strain reduced with advances, retainers, and prompt payment.
Perverse incentives prevented with balanced measures and public review.
Equity drift countered by gap-focused targets and funded community oversight.
What we will not do
Fund pilots without a path to scale.
Add reporting that does not change decisions.
Shift costs to families, schools, or small providers.
Tie payment to measures that are not visible to the public.
Phase gate to reliability
We advance when regions show:
Stable payment for navigation, stabilization, and step-down.
Improved access and continuity for two consecutive quarters.
Documented spend shift toward mid-acuity services.
Community and Tribal partners confirm the model is working and worth scaling.
The commitment
We will put money where families feel the difference. Funding will reward timely access, safe transitions, and equity gains. Contracts will be simpler. Providers will have the resources to deliver. Communities will see results.
