Department of Social and Health Services

	Annual FTEs	General Fund State	Other Funds	Total Funds
	(Dollars in Thousands)
Estimated Expenditures	12,613.2	6,418,005	7,723,795	14,141,800
2019-21 Maintenance Level	10,733.2	6,029,869	7,028,249	13,058,118
Difference from 2017-19	(1,880.0)	(388,136)	(695,546)	(1,083,682)
% Change from 2017-19	(14.9%)	(6.0%)	(9.0%)	(7.7%)
2019-21 Policy Other Changes
RTF Staffing - Building 27	43.9	9,352	0	9,352
BHA Administration Support	10.0	2,618	0	2,618
Direct Care and Support - Unit 1N3	68.1	16,963	0	16,963
State Hospital Operations	362.3	82,136	0	82,136
Direct Care and Support - Unit 3N3	68.1	16,963	0	16,963
Trueblood Fines	0.0	(96,000)	0	(96,000)
Community Competency Evaluations	0.0	(462)	0	(462)
Civil Capacity Project Manager	1.0	280	0	280
Psychiatric Intensive Care Unit	40.7	10,164	0	10,164
WSH Safety Response	77.9	22,200	0	22,200
Trueblood Settlement Agreement	61.5	16,494	0	16,494
Consolidated Maintenance/Operations	13.4	2,296	0	2,296
CSTC - New Cottage Operating Costs	47.1	10,816	0	10,816
Ross Lawsuit Compliance	22.9	6,188	0	6,188
Forensic Competency Restoration	0.0	3,124	0	3,124
Leased Facilities One-Time Costs	0.0	10,629	7,512	18,141
Community Transition Expansion	112.3	11,215	10,499	21,714
Community Respite Beds	2.0	5,296	976	6,272
Children's SOLA	29.0	2,456	2,340	4,796
Supported Living Investigators	5.4	(2,330)	11,388	9,058
RHC Compliance	119.0	20,118	20,118	40,236
Electronic Visit Verification	0.0	6,383	8,189	14,572
Targeted Vendor Rate Increase	0.0	30,404	35,488	65,892
Adult Family Homes Award/Agreement	0.0	37,577	46,834	84,411
In-Home Care Providers Agreement	0.0	72,391	92,287	164,678
Agency Provider Parity	0.0	21,316	27,128	48,444
BH: Group Training Homes	14.0	2,640	0	2,640
Enhance Community Residential Rate	0.0	59,446	58,170	117,616
Abuse Registry	1.0	170	72	242
Updated Facility Definition	(66.5)	(10,714)	(4,927)	(15,641)
Automatic Voter Registration	1.3	501	229	730
IT Systems Modernization	14.0	200	200	400
Increase In-Home PNA	0.0	10,868	13,819	24,687
ESF Capacity Mental Health	0.0	14,893	14,896	29,789
BH: Additional Enhanced Discharge	32.2	34,898	31,328	66,226
Kinship Care Support Program	0.0	500	0	500
ADRC Business Case Grant	0.0	0	128	128
Families Forward Washington Grant	0.80	0	481	481
Child Support Annual Fee Increase	0.70	(251)	(487)	(738)
Meet Basic Food Integrity Standards	1.0	104	104	208
Naturalization Services Increase	0.0	2,000	0	2,000
PWA Grant Increase	0.0	300	0	300
Transportation Pilot Study	0.0	100	0	100
Support Most Significantly Disabled	0.0	2,000	0	2,000
Finance Staffing	3.0	520	114	634
Continuation of Enterprise Services	0.0	5,630	1,876	7,506
Safety, Compliance & Accountability	26.0	3,955	868	4,823
Language Access Providers CBA	0.0	94	142	236
Community Expansion	1.0	310	0	310
King County Expansion	9.0	1,803	0	1,803
Transport and Hospital Watch Staff	6.5	1,111	0	1,111
2019-21 Policy Other Changes Total	1,128.6	449,665	379,772	829,437
2019-21 Policy Comp Changes
State Public Employee Benefits Rate	0.0	217	103	320
WFSE General Government	0.0	103,146	48,952	152,098
State Rep Employee Benefits Rate	0.0	1,439	652	2,091
Coalition of Unions	0.0	10,177	857	11,034
Non-Rep General Wage Increase	0.0	12,845	5,977	18,822
Non-Rep Targeted Pay Increases	0.0	1,440	1,543	2,983
SEIU 1199 General Government	0.0	9,686	3,150	12,836
Orca Transit Pass - Outside CBAs	0.0	322	72	394
PERS & TRS Plan 1 Benefit Increase	0.0	1,863	826	2,689
Non-Rep Salary Schedule Revision	0.0	1,054	333	1,387
State Tax - Wellness Gift Card	0.0	12	6	18
Non-Rep Premium Pay	0.0	1,207	697	1,904
2019-21 Policy Comp Changes Total	0.0	143,408	63,168	206,576
2019-21 Policy Transfers Changes
Orca Transit Pass Funding Transfer	0.0	(3,226)	(1,438)	(4,664)
Health Coalition FSA Fund Transfer	0.0	(3,222)	0	(3,222)
Domestic Violence Unit Transfer	5.0	12,262	6,390	18,652
2019-21 Policy Transfers Changes Total	5.0	5,814	4,952	10,766
2019-21 Policy Central Services Changes
Electric Vehicle Infrastructure	0.0	95	32	127
Archives/Records Management	0.0	63	22	85
Audit Services	0.0	115	44	159
Legal Services	0.0	1,936	411	2,347
Administrative Hearings	0.0	432	408	840
CTS Central Services	0.0	(4,505)	(1,886)	(6,391)
DES Central Services	0.0	611	253	864
OFM Central Services	0.0	8,863	3,481	12,344
2019-21 Policy Central Services Changes Total	0.0	7,610	2,765	10,375
Total Policy Changes	1,133.6	606,497	450,657	1,057,154
2019-21 Policy Level	11,866.8	6,636,366	7,478,906	14,115,272
Difference from 2017-19	(746.4)	218,361	(244,889)	(26,528)
% Change from 2017-19	(5.9%)	3.4%	(3.2%)	(0.2%)

Policy Changes

RTF Staffing - Building 27

A new 30-bed residential treatment facility (RTF) will open on the grounds of Western State Hospital as part of the Trueblood, et. al. v. DSHS lawsuit. Funding is provided for staff to operate these new forensic competency restoration beds.

BHA Administration Support

Funding is provided to adequately staff the core business functions and processes of the Behavioral Health Administration (BHA). This includes oversight of daily operations, tribal relations, policy development and analysis, and records management.

Direct Care and Support - Unit 1N3

As part of the Trueblood, et. al. v. DSHS lawsuit, funding is provided for additional forensic competency restoration beds at Eastern State Hospital. Funding is provided for staff to fully operate an additional 25 beds.

State Hospital Operations

Funding is provided to maintain the current level of operations at the two state adult psychiatric hospitals, Western State Hospital in Lakewood and Eastern State Hospital in Medical Lake.

Direct Care and Support - Unit 3N3

Trueblood Fines

A settlement agreement was reached between the parties of the Trueblood et. al v. DSHS lawsuit in August 2018 which proposes the suspension of fines beginning December 2018, provided the state maintains substantial compliance with the terms laid out in the settlement agreement. The settlement agreement was approved by the U.S. District Court - Western District on December 11, 2018. Appropriations are adjusted to reflect the suspension of fines beginning in December 2018.

Community Competency Evaluations

RCW 10.77.073 requires the department to reimburse counties that appoint qualified experts to complete in-jail competency evaluations. Savings are assumed due to the June 30, 2019 expiration date specified in statute.

Civil Capacity Project Manager

Governor Inslee laid out his vision for behavioral health transformation which includes transitioning all civil commitments from the two state psychiatric hospitals, Eastern State Hospital and Western State Hospital, to the community where patients can stay connected to their home communities. To coordinate, plan and implement this vision, funding is provided for a project manager.

Psychiatric Intensive Care Unit

Funding is provided for a Psychiatric Intensive Care Unit (PICU) to serve assaultive patients at Eastern State Hospital. The PICU will house high acuity patients for short-term stays with a transition back to a standard ward after stabilization. These patients will receive specialized patient care and treatment.

WSH Safety Response

A multi-faceted approach to reducing violence and increasing patient and staff safety at Western State Hospital is funded. Two new units will be established to serve the highest acuity patients through evidence-based best practices: a Specialized Treatment Assessment and Recovery (STAR) unit will serve up to 10 patients at a time and a Step Up unit will serve up to 20 patients as a transition from the STAR unit to a standard ward. Other initiatives include increased security and staff training and enclosed nurses stations.

Trueblood Settlement Agreement

A settlement agreement has been approved in the Trueblood. et. al. v. DSHS lawsuit. Implementation of the agreement will occur in phases within different regions of the state with the first phase including Pierce and Spokane counties and the southwest region. The agreement outlines five key areas of investments: competency evaluations, competency restoration, crisis diversion and supports, education and training, and workforce development.

Consolidated Maintenance/Operations

Ongoing funding is provided for Consolidated Maintenance and Operations staff to perform preventative maintenance at Western State Hospital and Eastern State Hospital.

CSTC - New Cottage Operating Costs

Funding is provided for staff to operate a new 18-bed cottage at the Child Study and Treatment Center (CSTC). CSTC serves the most acute children in the state in the Children’s Long-term Inpatient Program (CLIP). This new cottage increases state CLIP bed capacity by over 38 percent.

Ross Lawsuit Compliance

As part of the settlement agreement in Ross v. Lashway, funding is provided to improve the quality and timeliness of treatment for patients found not guilty by reason of insanity.

Forensic Competency Restoration

Funding is increased to cover the cost of operating the Yakima Competency Restoration Program and the Maple Lane Competency Restoration Program. These two facilities provide 54 beds to the statewide forensic competency restoration system.

Leased Facilities One-Time Costs

Funding is provided for one-time costs related to relocation and facility upgrades necessary to efficiently utilize work space.

State Public Employee Benefits Rate

Health insurance funding is provided for state employees who are not represented by a union, who are covered by a bargaining agreement that is not subject to financial feasibility determination, or who are not part of the coalition of unions for health benefits. The insurance funding rate is $977 per employee per month for fiscal year 2020 and $978 per employee per month for fiscal year 2021.

WFSE General Government

Funding is provided for a collective bargaining agreement with the Washington Federation of State Employees - General Government. The agreement includes a general wage increase of 3 percent, effective July 1, 2019; a general wage increase of 3 percent, effective July 1, 2020; premium, shift, and other special pay changes, and increases in targeted job classifications. Employee insurance included in the agreement is displayed in a separate item.

State Rep Employee Benefits Rate

This provides health insurance funding as part of the master agreements for employees who bargain for health benefits as part of a coalition of unions. The insurance funding rate is $977 per employee per month for fiscal year 2020 and $978 per employee per month for fiscal year 2021.

Coalition of Unions

Funding is provided for a collective bargaining agreement with the Coalition of Unions. The agreement includes a general wage increase of 3 percent, effective July 1, 2019; a general wage increase of 3 percent, effective July 1, 2020; increases in premium pay and increases in targeted job classifications. Employee insurance included in the agreement is displayed in a separate item.

Non-Rep General Wage Increase

Funding is provided for wage increases for state employees who are not represented by a union or who are covered by a bargaining agreement that is not subject to financial feasibility determination. It is sufficient for a general wage increase of 3 percent, effective July 1, 2019, and a general wage increase of 3 percent, effective July 1, 2020. This item includes both general government and higher education workers.

Non-Rep Targeted Pay Increases

Funding is provided for classified state employees who are not represented by a union for pay increases in specific job classes in alignment with other employees.

SEIU 1199 General Government

Funding is provided for a collective bargaining agreement with the Service Employees’ International Union Local 1199 NW. The agreement includes a general wage increase of 3 percent, effective July 1, 2019; a general wage increase of 3 percent, effective July 1, 2020; premium pay changes; and increases in targeted job classifications. Employee insurance included in the agreement is displayed in a separate item.

Orca Transit Pass - Outside CBAs

This funds transit passes (ORCA cards) for state employees (outside of higher education) in King, Pierce, and Snohomish counties, other than those in certain collective bargaining agreements.

PERS & TRS Plan 1 Benefit Increase

For eligible Public Employees' and Teachers' Retirement Systems Plan 1 members, this item provides a one-time, ongoing increase of 3 percent, up to a maximum of $62.50 per month.

Non-Rep Salary Schedule Revision

This funds a revised salary schedule for non-represented employees in information technology jobs, in alignment with other state employees.

State Tax - Wellness Gift Card

Some employees are eligible to earn a $25 gift card after completing a health risk assessment. This item provides funding to agencies to pay the employer's share of Social Security and Medicare taxes on gift cards for additional employees who are eligible for the gift cards.

Orca Transit Pass Funding Transfer

This moves funding for employee transit passes from agencies to WSDOT, which administers the program. The transfer includes both funding added in 2019-21 for expanded access, as well as funding that was provided in the 2017-19 budget.

Health Coalition FSA Fund Transfer

This moves funding for negotiated medical flexible spending arrangements (FSA) from individual agency budgets. It will be provided to the Health Care Authority, which will administer the benefit.

Community Transition Expansion

Funding is provided for Leased Facilities and Maintenance Operations (LFMO) to assist with procuring expanded capacity in the State Operated Living Alteratives (SOLA) program and related transition services by preparing modified pre-designs of new leased spaces and coordinating leases for both SOLA management offices (five-year term leases) and SOLA homes (temporary until a client assumes the lease).

Community Respite Beds

Overnight Planned Respite Services (OPRS) for adults, and Enhanced Respite Services (ERS) for children, are expanded by six beds each. An increase in the daily rate for existing beds from $374 to $450-$550 for ERS and from $350-$448 to $400-$510 for OPRS is also provided starting July 1, 2019.

Children's SOLA

Funding is provided to add two new children's State Operated Living Alternative (SOLA) homes on the west side of the state to serve children age 20 and younger. These children are no longer eligible for Residential Habilitation Center (RHC) admission and are not able to successfully transition to out-of-home residential placement because suitable community options do not exist. These SOLA homes will house six children in King and Pierce counties.

Supported Living Investigators

Fee authority is provided for supported living providers sufficient to cover oversight and investigation costs for clients residing in supported living settings. Provider rates are increased to cover the cost of the fee, which is eligible for federal matching funds, resulting in a net General Fund-State savings when combining the Developmental Disabilities Administration and Aging and Long-Term Support Administration.

RHC Compliance

Funding is provided to hire staff to meet requirements from the Centers for Medicare and Medicaid Services (CMS) concerning continuous, aggressive active treatment in all intermediate care facilities for individuals with intellectual disabilities.

Electronic Visit Verification

Funding is provided to comply with the federal "21st Century Cures Act," which requires states to implement an Electronic Visit Verification (EVV) system by January 1, 2020 or receive a federal match rate reduction that escalates from 0.25 percent in 2020 up to one percent by 2024. An EVV system will electronically report and verify information about the delivery of personal care services, such as the date and time, service type and location.

Targeted Vendor Rate Increase

Funding is provided to increase certain contracted provider rates in order to maintain client access and choice, and to promote cost-efficient delivery of care across the entire system. The increases are for nursing homes, assisted living facilities, and critical nursing services.

Adult Family Homes Award/Agreement

Funding is provided for a wage and benefit increase to workers who provide in-home personal care services and are employed by private agencies. The increase corresponds to the salary and wage component of the in-home care agreement for individual providers.

In-Home Care Providers Agreement

Funding is provided for an agreement with individual providers of in-home personal care services, which includes increases to the wage scale; increases in contributions to the health care, training and retirement trusts; and an increase in paid time off.

Agency Provider Parity

BH: Group Training Homes

Funding is provided for 14 group training home beds. This item is part of the Governor's statewide behavioral health reform package.

Enhance Community Residential Rate

Funding is provided to increase the rate for Developmental Disabilities Administration (DDA) community residential service providers including supported living, group homes, and licensed staffed residential homes. The rates across geographic classifications will increase by 10 percent effective January 1, 2020, and by an additional 10 percent, effective January 1, 2021.

Non-Rep Premium Pay

Funding is provided for increases in premium pay for state employees who are not represented by a union or who are covered by a bargaining agreement that is not subject to financial feasibility determination. Funding is sufficient to support changes in shift differential, call back and standby pay, as well as a 5 percent increase for employees working in King County.

Abuse Registry

Funding is provided for the department to make statutory changes to implement a process to review and reconsider the permanent prohibition placed on certain individuals from providing long-term care services.

Updated Facility Definition

Section 9016(6) of Second Engrossed Substitute House Bill (2ESHB) 1388 expands the definition of a “facility” to include any other facility licensed or certified by the Department of Health (DOH). The expanded definition includes 14,281 community acute care hospital beds and 4,900 residential treatment facility beds which were not previously included in the Adult Protective Services (APS) workload. This step corresponds with agency request legislation to remove the expanded facility types. The department missed this change and didn’t request an increased appropriation during the 2018 legislative session. This step is a reversal of a separate maintenance level step which provides funding for the department to conduct the necessary investigations. DOH has historically and will continue to inspect and investigate the expanded facility types.

Automatic Voter Registration

Funding is provided for staffing and information technology impacts associated with the implementation of automatic voter registration, consistent with Chapter 110, Laws of 2018.

IT Systems Modernization

Funding is provided for the department to purchase network switches which are outdated, out of warranty, and past their expected useful life of five years.

Increase In-Home PNA

Funding is provided to decrease the amount some Medicaid clients are required to contribute to the cost of their in-home personal care. This will allow the clients to retain more of their income, or increase their Personal Needs Allowance (PNA), for housing and other expenses that are necessary for them to remain in their homes rather than move to more expensive residential settings.

ESF Capacity Mental Health

Funding is provided for increased payment rates and capacity for long-term care services provided in Enhanced Services Facilities (ESF).

BH: Additional Enhanced Discharge

Funding is provided for additional community placement beds for discharging patients out of the state psychiatric hospitals. Specific placement options include enhanced service facilities, adult family homes, skilled nursing facilities, shared supportive housing, assisted living facilities, specialized dementia, and state-operated living alternatives. This item is part of the Governor's statewide behavioral health (BH) reform package.

Kinship Care Support Program

Funding is provided for the Kinship Care Support Program which assists low-income caregivers with short-term financial supports to meet children’s urgent needs and provide greater stability for children. Program funds can be used to purchase goods such as beds, clothing, safety items or supplies, and services when no other resources are available.

ADRC Business Case Grant

Increased federal authority is provided for the ADRC/NWD System business case development grant awarded for the period of September 2018 through August 2019.

Families Forward Washington Grant

One-time federal expenditure authority is increased to allow the Economic Services Administration to implement the Families Forward Washington grant, a multi-year grant that the Division of Child Support received through the W.K. Kellogg Foundation. This demonstration project allows DCS to test strategies through contracting with local partners to provide occupational skills training, financial education and asset building, and case management services to non-custodial parents in Benton and Franklin counties who owe child support and have difficulty meeting their obligations due to low earnings.

Child Support Annual Fee Increase

Funding is provided for staffing, system modifications, and client communications needed to implement a federal policy requiring the Division of Child Support (DCS) to increase the annual non-assistance user fee from $25 to $35, and to increase the threshold level of support collections that trigger the annual fee from $500 to $550 in any federal fiscal year. Overall, this item results in a General-Fund State savings due to the increase in the annual fees collected by the division.

Meet Basic Food Integrity Standards

Funding is provided for a quality control staff to increase the agency's capacity to meet federal Food and Nutrition Services quality control standards for the Supplemental Nutrition and Assistance Program.

Naturalization Services Increase

Funding is provided to the Office of Refugee and Immigrant Assistance to expand the capacity of the Naturalization Services Program to help more Washingtonians become United States citizens.

PWA Grant Increase

Beginning in fiscal year 2020, funding is provided to increase the Pregnant Women Assistance (PWA) program grant standard from a maximum of $197 per month to a maximum of $363 per month. This will allow low-income pregnant individuals the opportunity to cover more of their basic needs, which increases their chances of having a healthy baby.

Transportation Pilot Study

One-time funding is provided to the Economic Services Administration (ESA) to conduct a comprehensive study of the WorkFirst transportation pilot which has been in effect since 2015. ESA must submit the study by November 1, 2021 to the governor and appropriate fiscal and legislative committees.

Domestic Violence Unit Transfer

This is a net zero transfer wherein FTEs and funding for the Domestic Violence Unit and its associated programs are transferred from the Department of Children, Youth and Families to the Department of Social and Health Services.

Support Most Significantly Disabled

The Division of Vocational Rehabilitation (DVR) does not have adequate resources to provide supported employment services to all eligible individuals and has implemented a waitlist. Increased funding allows DVR to continue offering supported employment services to eligible individuals with the most significant disabilities so they can achieve competitive, integrated employment.

Finance Staffing

Staffing is provided to strengthen the Facilities, Finance and Analytics Administration (FFA) operations and address critical staff and skill shortfalls.

Continuation of Enterprise Services

Funding is provided to maintain the current level of enterprise technology services. Funding for this item resides in Administrative and Supporting Services, but benefits the agency as a whole.

Safety, Compliance & Accountability

Funds are provided to maintain safety, internal audit, human resources, emergency management, travel, payroll, and financial compliance resources at levels necessary to ensure safe, compliant, and accountable public service operations.

Language Access Providers CBA

Funding is adjusted for interpreter services based upon the language access providers collective bargaining agreement (CBA) for the 2019-21 biennium.

Community Expansion

One program administrator is provided to assist in the siting process for new secure community transition facilities, as proposed in the 2019-21 capital budget (project 30003577).

King County Expansion

Funding is provided for vehicles, equipment and operating functions associated with the King County secure community transition facility (SCTF) six-bed expansion project funded in the 2017-19 capital budget.

Transport and Hospital Watch Staff

As the Special Commitment Center (SCC) residential population ages, the department continues to experience an increase in medical demands for off-island specialty and hospital services. This funding will provide 6.5 FTE security guards to assist the SCC transport teams in performing hospital watches for residents who are admitted into local area hospitals as required by state law and to safeguard the public and residents.

Electric Vehicle Infrastructure

Agency budgets are adjusted to reflect each agency’s estimated portion of increased fee for service charges from the Department of Enterprise Services to expand electric vehicle infrastructure for the state Motor Pool fleet.

Archives/Records Management

Agency budgets are adjusted to reflect each agency’s allocated share of charges for the state archives and state records center.

Audit Services

Agency budgets are adjusted to reflect each agency’s allocated share of charges for state government audits.

Legal Services

Agency budgets are adjusted to reflect each agency’s anticipated share of legal service charges.

Administrative Hearings

Agency budgets are adjusted to reflect each agency’s anticipated share of charges for administrative hearings.

CTS Central Services

Agency budgets are adjusted to reflect each agency’s allocated share of charges from the Consolidated Technology Services Agency (WaTech) for the Office of the Chief Information Officer, Office of Cyber Security, state network, security gateways, and geospatial imaging services.

DES Central Services

Agency budgets are adjusted to reflect each agency’s allocated share of charges from the Department of Enterprise Services (DES) for campus rent, utilities, parking, and contracts; a capital project surcharge; financing cost recovery; public and historic facilities; real estate services; risk management services; personnel service rates; the Perry Street child care center; and the department’s enterprise applications.

OFM Central Services

Agency budgets are adjusted to reflect each agency’s allocated share of charges from the Office of Financial Management (OFM) for the One Washington project and OFM enterprise systems.

Office of Financial Management

Budget

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