Suquamish, state ink agreement for mental health care

SUQUAMISH — Until now, Suquamish tribal members seeking Medicaid-eligible mental health services from the state encountered frustrating, timely barriers in system operations.

After negotiating for more than two years, Suquamish Tribal Chairman Leonard Forsman and State Medicaid Director Doug Porter, who also serves as DSHS’ assistant secretary of health and recovery services, signed an agreement Aug. 25 enabling smoother access for tribal youth needing mental health services.

“This agreement is the first in Washington state and removes an approximate 20-year legislative barrier that prevented the tribe from directly accessing Medicaid-eligible state mental health services for tribal youth,” said Melody Allen, attorney for the Suquamish Tribe.

The agreement especially highlighted the Medicaid-funded Children’s Long-Term Inpatient Program (CLIP).

The CLIP program is a long-term placement for children with extreme cases of mental illness, said Jim Stevenson, communications director for Washington’s Department for Social and Health Services Medicaid program.

Currently, there are only 100 CLIP beds available in Washington.

Prior to the agreement, Allen said there was a gap in the delivery of mental health services to the Suquamish Tribe and other tribes in Washington because of legislation passed in 1989.

The 1989 legislation created a Regional Support Network (RSN), which placed control on the county level, she said.

“This legislation did not recognize tribal sovereignty, tribal law or government-to-government relationships between the tribes and the state as set forth in the 1989 Centennial Accord,” she said.

Trying to get tribal members the services needed “wasn’t efficient or easy to handle,” Stevenson said.

In the past, to gain admission into CLIP, tribal members had to go through RSN structure, which operated on a managed-care funding arrangement, not the fee-for-service basis the tribal health care system operated on, Stevenson said.

“Tribal sovereignty, tribal law and the government-to-government relationship between the tribe and the state serve as the platform for the agreement,” Allen said.

Under the new agreement, DSHS and the Suquamish Tribe created a direct relationship that enables tribal members to access mental health services without going through a separate process with the RSN. This streamlines the process, creating more timely treatment to necessary services.

According to a press release by DSHS, the landmark agreement paves the way for access to Medicaid health coverage for tribal members without sacrificing treaty rights.

“These are sensitive issues for the tribes,” Porter stated in the press release. “We have not found them to be unsolvable problems, but they need to be approached with care and honest, open dialogue.”

Allen said she hopes the agreement sets a precedent for other tribes throughout Washington.

“The parties believe that the agreement will serve as a model for other tribes to gain direct access for Medicaid-eligible state mental health services.”

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