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Evergreen Ledger

E2SHB 1813

Signed

House

Medical assist reprocurement

Concerning the reprocurement of medical assistance services, including the realignment of behavioral health crisis services for medicaid enrollees.

How does a bill become law?
  1. Introduced: The bill is filed and assigned a number.
  2. Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
  3. Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
  4. Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
  5. Governor: The Governor reviews the bill and decides whether to sign or veto it.
  6. Signed: The bill has been signed into law.
Introduced: February 27, 2025
Last Action: May 12, 2025
Status: C 216 L 25
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AI Analysis

This analysis was generated by AI and may contain errors. It is not legal advice. Always refer to the official bill text for authoritative information.
People & CommunitiesPeople-leaningCorporate & Wealthy Interests

This bill shifts responsibility for behavioral health crisis services for Medicaid enrollees from private insurance plans to regional Behavioral Health Administrative Services Organizations (BHASOs), beginning January 1, 2027. It also launches a full reprocurement of most medical assistance services by July 31, 2026, and requires new funding and operational standards to ensure crisis services are available 24/7 to all residents in need, regardless of insurance.

  • Initiates a competitive bidding process for reprocurement of most medical assistance services by July 31, 2026, with full implementation by January 1, 2027.
  • Excludes behavioral health crisis services (e.g., mobile crisis response, crisis stabilization, 23-hour observation facilities) from the reprocurement and transfers their administration to Behavioral Health Administrative Services Organizations (BHASOs) by January 1, 2027.
  • Requires BHASOs to operate 24/7 crisis hotlines, crisis response teams, and coordination systems—including for involuntary commitments—and to serve all individuals in crisis regardless of insurance status.
  • Mandates a funding analysis by January 1, 2026, to determine regional needs for crisis services, including support for non-Medicaid populations, and requires adjustments to Medicaid rates when new services open or expand.
  • Requires a transition plan to be submitted to the governor and legislature by December 31, 2025, outlining how crisis services will shift from managed care organizations to BHASOs, with coordination strategies and timelines.

Who is affected

  • Medicaid enrollees who experience behavioral health crises — Behavioral health crisis services (e.g., mobile crisis teams, crisis stabilization, 23-hour observation facilities) will shift from being managed by private insurance plans (managed care organizations) to being directly administered by regional behavioral health administrative services organizations (BHASOs), starting January 1, 2027.
  • Behavioral health administrative services organizations (BHASOs) — Will take over administration of all behavioral health crisis services for Medicaid enrollees, conduct regional funding analyses, expand crisis networks, and coordinate with tribes and providers. Must ensure services are available 24/7 regardless of insurance status.
  • Managed care organizations (MCOs) that serve Medicaid enrollees — Will no longer directly manage or pay for behavioral health crisis services for their enrollees after January 1, 2027, but must transition those responsibilities to BHASOs and continue coordinating care for other services.
  • State Department of Health (the 'authority' in the bill) — Will receive annual reports on crisis service performance and outcomes, and must submit a transition plan to the legislature by December 31, 2025. Will also conduct a funding analysis to ensure adequate resources for both Medicaid and non-Medicaid populations.
  • People experiencing behavioral health crises who are unhoused, justice-involved, or from underserved communities — May benefit from expanded crisis services and improved access, especially during transitions from incarceration or state hospitals, and through increased coordination with tribal and community providers.
Effective: January 1, 2027Fiscal impact: The bill requires a comprehensive funding analysis by January 1, 2026, to determine regional needs for behavioral health crisis services, including funding for non-Medicaid populations. It mandates adjustments to Medicaid rates when new crisis programs or facilities open or expand, and requires BHASOs to maintain adequate reserves or bonds. The state may need to allocate additional general fund or federal grant money to cover gaps not covered by Medicaid reimbursements.
Model: Intel/Qwen3-Coder-Next-int4-AutoRoundGenerated: Mar 19, 2026 at 7:19 PM

Pro/Con Analysis

Stronger case for benefits

Potential Benefits (5)

  • Mandating 24/7 crisis services—including mobile response, stabilization, and coordination for involuntary commitments—regardless of insurance status significantly expands access for Medicaid enrollees, unhoused individuals, and those without coverage, reducing barriers to timely care and preventing avoidable hospitalizations or incarceration.

    HealthcarePeopleRef: Sec. 1(2)(a)

  • Removing crisis services from managed care organizations and placing them under BHASOs—centralized regional entities with cross-system coordination authority—reduces fragmentation and improves continuity of care for high-risk individuals, especially those transitioning from jails, state hospitals, or emergency departments.

    Public SafetyPeopleRef: Sec. 1(1)(b)(ii)

  • The requirement to expedite reenrollment for eligible individuals leaving correctional facilities and institutions for mental diseases directly benefits justice-involved and clinically vulnerable populations by reducing gaps in care and supporting reintegration, which can lower recidivism and improve long-term outcomes.

    HealthcarePeopleRef: Sec. 2(3)(c)

  • By requiring BHASOs to evaluate service delivery models—including mobile crisis response and peer-run services—the bill supports evidence-based, community-integrated care that can reduce school-based crises and improve student mental health outcomes, especially for youth in underserved districts.

    EducationPeopleRef: Sec. 1(2)(b)(i)

  • Mandating discharge planning and care coordination for individuals transitioning from state hospitals or inpatient settings helps reduce rehospitalization and promotes community integration—particularly for those with complex needs—though success depends on adequate funding and provider capacity.

    HealthcarePeopleRef: Sec. 2(1)(vi)
Potential Concerns (5)

  • Expanding 24/7 crisis response and involuntary commitment coordination to all individuals in crisis—regardless of insurance—may increase demand on law enforcement and emergency services during transitions, especially in regions where BHASOs lack sufficient staffing or infrastructure to handle high-volume crisis calls or high-risk cases (e.g., armed individuals, acute psychosis with aggression), potentially straining local resources before new facilities open.

    Public SafetyPeopleRef: Sec. 1(2)(b)(ii)

  • The requirement to adjust Medicaid rates for new or expanded crisis services may create financial instability for BHASOs in regions where federal or state funding lags behind projected need, leading to delays in service rollout or provider network contraction—particularly in rural or high-need areas—potentially worsening access for vulnerable populations.

    HealthcarePeopleRef: Sec. 1(2)(b)(iii)

  • While the bill mandates coordination with tribes and local governments, it does not provide dedicated funding for local government participation in crisis response or data sharing, placing administrative and operational burden on counties—especially those without existing behavioral health infrastructure—to fill gaps in service delivery.

    Local GovernmentPeopleRef: Sec. 2(2)

  • The requirement to contract with “sufficient” crisis providers—without specifying minimum staffing thresholds or wage standards—may incentivize BHASOs to rely on underpaid or contract-based staff to meet budget constraints, potentially compromising service quality and increasing turnover in an already strained workforce.

    Business & EmploymentLean peopleRef: Sec. 2(1)(e)

  • The bill does not explicitly tie crisis service expansion to housing or shelter capacity, so individuals discharged from crisis stabilization may face homelessness if supportive housing is unavailable—potentially increasing recidivism to crisis care and emergency rooms, undermining the goal of system-wide stabilization.

    HousingLean peopleRef: Sec. 1(2)(b)(ii)

Who Is Most Affected

Medicaid enrollees who experience behavioral health crisesPositive Impact

Medicaid enrollees in crisis—especially those unhoused, justice-involved, or with co-occurring disorders—will benefit from guaranteed 24/7 access to crisis services without insurance barriers, reducing reliance on ER visits, jails, or state hospitals.

Behavioral health administrative services organizations (BHASOs)Mixed Impact

BHASOs gain expanded authority and funding responsibility, but face operational risks if state/federal funding falls short of regional needs—especially in rural or high-need areas—potentially leading to service gaps or provider network instability.

Managed care organizations (MCOs) that serve Medicaid enrolleesMixed Impact

MCOs lose direct responsibility for crisis services but avoid associated liability and administrative burden; however, they must still coordinate care and may face reduced leverage in negotiations with BHASOs, potentially weakening their role in integrated care.

State Department of Health (the 'authority' in the bill)Mixed Impact

The Department of Health gains oversight and reporting authority, strengthening its role in system coordination, but also assumes responsibility for ensuring adequate funding and performance monitoring—adding regulatory burden without new resources.

People experiencing behavioral health crises who are unhoused, justice-involved, or from underserved communitiesPositive Impact

Underserved groups—including unhoused, justice-involved, tribal, and rural populations—are explicitly prioritized in coordination and outreach mandates, but actual benefit depends on whether BHASOs receive sufficient funding to reach them.