King County Mental Health Plan (KCMHP)

FREQUENTLY   ASKED   QUESTIONS

Please Note: The following information is specific to the King County Mental Health system and the King County Mental Health Plan. The questions and answers may not apply to other county mental health systems around the state. If you reside outside of King County, you will need to contact your own County/Regional Support Network/Prepaid Inpatient Health Plan for information on the services available in your area.

Q: What is the King County Mental Health Plan?

The King County Mental Health Plan (KCMHP) provides community-based mental health services to Medicaid-eligible and, as resources permit, a portion of the King County resident low-income non-Medicaid population. It was created in response to changes at both the federal and state level that mandated a shift from a fee-for-service system to managed care. KCMHP services are provided through a credentialed provider network.

Q: Who manages the KCMHP?

King County Mental Health, Chemical Abuse and Dependency Services Division (MHCADSD) manages the KCMHP. King County retains responsibility for administration and direction of policy decisions and the financial management of the publicly funded mental health system. It also authorizes and manages client care, coordinates billing and reimbursement functions and manages the MHP provider network.

Q: How do I know if I am eligible for MHP services?

Because resources in the public sector are limited, services must be targeted to those persons most in need. Medical necessity criteria (see below) represent a clinically based designation of who should be served in the publicly funded mental health system. Individuals who are Medicaid eligible and who meet medical necessity criteria are eligible for KCMHP services. The assessment described below will determine if you are eligible and if so, what intensity of service you are eligible to receive. For non-Medicaid persons, priority for services is given to those who meet medical necessity criteria, have a family income of less than 200% of federal poverty guidelines for adult services or a family income of less than 300% of federal poverty guidelines for children's services, are in acute need of services, and meet specific at-risk criteria. An individual may meet non-Medicaid criteria for services but actual service provision is dependent upon the availability of KCMHP financial resources. Fewer spaces are available for non-Medicaid persons.

Q: What is "medical necessity" and how are tier assignments made?

Medical necessity criteria define the minimum requirements for service that a person must meet in order to be authorized to receive services under the MHP. The criteria specify the level of functioning, degree of psychiatric impairment, allowable diagnoses, treatment plan (including expected services and service intensity), and expected outcomes. Medical necessity is established for each client on an individual basis.  Clients and family members are encouraged to actively participate in treatment planning and designation of outcomes and goals.

Q: What services can I get as an outpatient?

Each client receives an individual treatment plan as part of the assessment process. Services for each client vary according to need and choice. A basic array of core services are provided by all vendors; specialized services (e.g. ethnic/cultural-specific services),  vary from provider to provider. Some agencies chose to specialize in certain service areas. KCMHP Client Services at (800) 790-8049 can provide assistance with locating specialized care.

The core services available are summarized as follows:

• For children: Crisis, stabilization, intake evaluation, cultural evaluation, interdisciplinary evaluation, psychological assessment, medication management, individual treatment services, group treatment services, child and adolescent day treatment, child and adolescent inpatient diversion, family treatment, psychiatric assessment, and interpreter services.
• For adults: Crisis, stabilization, intake evaluation, cultural evaluation, interdisciplinary evaluation, psychological assessment, medication management, individual treatment services, group treatment services, day treatment, inpatient diversion, family treatment, drop in clubs, vocational services, psychiatric assessment, and interpreter services.
• For older adults: Crisis, stabilization, intake evaluation, cultural evaluation, interdisciplinary evaluation, psychological assessment, medication management, individual treatment services, group treatment services, day treatment, inpatient diversion, family treatment, drop in clubs, psychiatric assessment, and interpreter services.

Q: Where can I get mental health care for my child, parent, spouse, or myself?

• If this is an emergency, call 911 or the Crisis Clinic at (206) 461-3222 or toll free at 1-866-427-4747.
• For non-emergency care, your private physician can give you information and referral to a qualified individual or community mental health center. A list of King County MHP community mental health providers is available on the web site. For information and referral to the King County mental health system call KCMHP Client Services at (800) 790-8049 during business hours, Monday-Friday, 8 a.m. - 5 p.m.

Q: How do I know if the provider I want to go to is a King County Mental Health Plan provider?

There are currently 17 community mental health centers under direct contract with King County to provide mental health services in the King County Mental Health Plan. In some cases, those mental health providers subcontract with other agencies to provide specialized kinds of care. Call KCMHP Client Services at (800) 790-8049 to request provider network information or a brochure.

Q: I have GAU coupons. Where do I go for mental health services?

Government Assistance – Unemployable (GAU) coupons do not have an outpatient mental health benefit provided by the KCMHP. You may wish to check with DSHS or your mental health provider to see if you are eligible to receive GAX (Government Assistance – Expedited Medicaid Disability) coverage that does cover mental health services. If you are only eligible for GAU, you are considered a "non-covered" or non-Medicaid client. See "How do I know if I am eligible for KCMHP services?"

Q: I don’t have any (much) money and I need mental health services. Where do I go?

The KCMHP provides ongoing mental health services for Medicaid recipients and a small portion of low-income persons who are not Medicaid eligible. The KCMHP has limited funding to provide services to non-covered individuals. If you do not have coupons and cannot afford the full fee, you can go to a community mental health center.  They may charge a small fee based upon your ability to pay. If they do not have capacity now, you may ask them to put you on their waitlist or to refer you to another agency.

KCMHP Client Services can assist with questions and referrals (800) 790-8049.

While you may not be eligible for Medicaid coupons, your children might be. The Washington State Department of Social and Health Services (DSHS) has different income standards for eligibility for children than for adults. The Community Information Line (206) 461-3200 can give you the phone number for the Community Service Office in your area for application information.

You may wish to apply for the Washington Basic Health Plan (800) 826-2444. This is a state-subsidized group insurance plan available at low cost to eligible persons/families. There is a limited mental health benefit included in the plan.

For information on other community resources and assistance, call the DSHS Community Service Office in your area or the Community Information Line (206) 461-3200.

Q: I have (my kids have) Washington Basic Health Plan. What do I do?

The Washington Basic Health Plan (BHP) provides limited mental health benefits – ten inpatient days, 12 outpatient visits, and medication management (no limit). There are a number of BHP provider plans in King County to choose from. Your primary care physician must refer you to mental health services within the provider plan you are enrolled in, e.g. Group Health, Virginia Mason, etc. Some health services require a small fee (co-pay) to be paid at the time of service, typically approximately $8-10 per doctor office visit. For more information regarding mental health benefits and other coverage, call the Washington Basic Health Plan at (800) 826-2444 to request a brochure and enrollment packet.

Some children have Washington Basic Health Plan PLUS. These children are given a Medicaid coupon to cover mental health, vision and dental. These Medicaid coupons entitle them to KCMHP mental health services. When you call a KCMHP provider to make your appointment, tell the intake worker that your child/ren have Medicaid coupons through Washington Basic Health Plan PLUS.

Q: I only want medication. What can I do?

1) Any physician can prescribe psychiatric medications. However, the medications prescribed to treat mental illness are powerful drugs and require expertise and a level of monitoring to ensure that you are safely stable. Ask your doctor if s/he can provide this service for you; if your doctor says no, ask for a referral.

2) If you don’t have a doctor, don’t have much money, have been on medication successfully before and especially if you are on a waiting list for counseling services, the community medical clinics will sometimes prescribe medication on a sliding fee scale. The Community Information Line (206) 461-3200 can give you information including phone numbers in your area.

3) If you are entirely out of medication and especially if you feel badly, call the Crisis Clinic (206) 461-3222. They may be able to make an appointment for you or give you another referral.

Q: I have a complaint about my case manager/provider agency. What can I do?

Providers in the publicly funded mental health system are required to post their internal complaint and grievance procedures. If you are not able to resolve a complaint with a provider, you have two immediate options for assistance. You may call the Mental Health Ombuds-Service of King County for assistance (206) 205-5329 AND/OR you may call KCMHP Client Services at (800) 790-8049. Both are available to listen, inform you of your rights, and attempt to facilitate a resolution. Both will attempt to resolve complaints at the lowest possible level. Some complaints will turn into formal grievances if they cannot be resolved. The Ombuds Service will assist you with the grievance procedure including, if necessary, preparation for the State of Washington Fair Hearing process.

Q: What is the Mental Health Ombuds Service of King County?

The Mental Health Ombuds Service of King County serves clients receiving publicly funded mental health services and parents or guardians of minors receiving publicly funded mental health services by providing research, investigation, negotiation and advocacy assistance on behalf of the client. The Ombuds Service will always attempt to find resolution of the complaint or concern at the lowest possible level. The Ombuds Service is an independent agency under contract with the King County Mental Health, Chemical Abuse and Dependency Services Division. They can be reached at (206) 205-5329.

Q: I want to change case managers/agencies. How do I do that?

You have the right to change case managers or to transfer to another agency once in a year without having to specify any reason. You have the right to a "choice of available case managers" and your provider will let you know who is available. If you want to change agencies, call the agency you would like to switch to and confirm that they have all the services you require and that they have space available in their case load. When you have that confirmation, ask your case manager to transfer your benefit to your new provider. Be aware that this may take several days. If you wish to change case manager or agency more than once in a year you must demonstrate "just cause" such as a move, a poor relationship with your case manager, etc. The Ombuds Office can help advocate if you believe you have just cause.

Q: Someone I know is having a very difficult time and I think they need help, maybe even hospitalization, but they are refusing any assistance. What can I do?

Talk to the person and try to convince him/her to talk to their physician, clergy, a mental health counselor or the Crisis Clinic (206) 461-3222 or toll free at 1-866-427-4747. The Crisis Clinic is the centralized telephone number for all crisis services in the County. Specially trained volunteers and Crisis Clinic staff triage every call. They can refer the individual to immediate crisis outreach services or give the individual a referral to a mental health provider for a "Next-Day Appointment" for mental health services (reserved for someone in an acute mental health crisis).

If the person refuses to talk to anyone and you remain concerned for his/her health and safety, you may call the Crisis Clinic to voice your concerns and ask for help. If the Crisis Clinic feels the situation needs immediate crisis intervention, they will contact King County Crisis and Commitment Services, a division of MHCADSD. An outreach team of County Designated Mental Health Professionals will meet with the individual and attempt to arrange for outpatient treatment or voluntary hospitalization. If that is not successful and the team assesses an imminent risk per the Involuntary Treatment Act, they may take steps to detain the individual. There are strict laws and procedures to determine if a person can be involuntarily detained. See Crisis and Commitment Services for more information on investigations and involuntary hospitalization.

Whatever the outcome, YOU may need to attend to your own self-care.  Local chapters of the National Alliance for the Mentally Ill (NAMI) are available in King County with support groups for individuals with mental illness and for family members of persons who are mentally ill. Call NAMI-Greater Seattle at (206) 783-9264, NAMI Eastside at (425) 885-6264 or NAMI-South King County at (253) 839-6529 for a complete listing of forums, support group meetings and training opportunities.

Q: I know someone that I think is being served in one of your agencies. Can you tell me what services they are getting? How can I let someone know I think this person needs more help?

Washington State law protects the confidentiality of people who receive mental health services. Even if you are the parent of someone with a mental illness who is now an adult, the law would not allow the agency to talk to you about their care (see below for the exceptions). You may call the agency you believe is involved, acknowledge that you understand that they cannot confirm that the person is a client, tell them that IF the person you are calling about IS a client someone needs to be informed that you have called with concerns. You may also contact KCMHP Client Services (800) 790-8049 to register concerns; while they cannot confirm enrollment either, the KCMHP enrollment system can be checked and the agency alerted.

The exceptions to the law of confidentiality refer to the potential for danger to self or others. Professionals are required to break confidentiality if they believe a client is seriously suicidal, homicidal, gravely disabled, abusing a child or elderly person, or have threatened to commit serious property damage.

Generally speaking, agency or KCMHP staff can only speak freely to a friend, family member or other advocate if the client has signed a Release of Information form.

Q: What are the employment opportunities with Mental Health in King County?

Any openings within the King County Mental Health, Chemical Abuse and Dependency Services Division that are available to external recruitment are posted on the King County Office of Human Resource Management web site ( http://www.metrokc.gov/ohrm/jobs/). The community mental health centers that contract with King County to provide mental health services have independent hiring procedures. For a list of MHP providers, click KCRSN/MHP Providers or call MHP Client Services at (800) 790-8049.

Q: How can I become a licensed counselor in Washington State?

Licensing for counselors is handled by the Washington State Department of Health, Licensing and Certification Section at (800) 458-5276.

Q: How do I get a food handler’s permit... flu shot... immunizations for my children...information on birth control... (and any other Public Health questions)?

For information on services provided by the Public Health system call Seattle-King County Public Health at (206) 296-4600 or visit www.metrokc.gov/health