Washington State’s Transition to Integrated Physical and Behavioral Health Care in Medicaid

Center for Health Care Strategies


Between 2016 and 2020, Washington State transitioned from three separate Medicaid systems for managing physical health, mental health, and substance use disorder services into one integrated system. In designing this new system, the state sought to advance more integrated, coordinated care for those with co-occurring physical and behavioral health conditions living in the state.

Under this fully integrated managed care system, managed care organizations are accountable for physical health, mental health, and substance use disorder services in each of the state’s regions, while behavioral health administrative service organizations manage the crisis system and other safety-net services. The state established 10 regions for contracting purposes, and each region has chosen different pathways toward implementation based on the unique landscapes of their respective regional behavioral health systems. Initial evaluations demonstrate promising outcomes.

The Center for Health Care Strategies published a case study, Washington State’s Transition to Integrated Physical and Behavioral Health Care, and held a webinar describing the state’s journey to integrated care. It offers lessons for designing and implementing state efforts to advance physical-behavioral health integration, as well as in tailoring regional approaches to use the expertise of local behavioral health stakeholders. The California Health Care Foundation supported this work.