The Centers for Medicare & Medicaid Services said in a recent letter that state officials aren't going through a proper bidding process for regional networks. If the state doesn't change course, federal support could be pulled.
"CMS has a fair amount of power in this relationship," said Jane Beyer, assistant secretary for behavior health issues at the state Department of Social and Health Services.
Regional Support Networks in Washington administer mental health services in the state, with many counties joining together to operate within the same regional network. The idea behind the networks is to keep mental health services at the local-government level, since there is a close relationship between mental health problems and local courts, law enforcement and jails.
Democratic state Sen. Jeannie Darneille said she sees pitfalls of moving away from that model and providing open bidding. The winning provider may not be aligned with the same goals as local officials, and some regions of the state may not even draw bids.
Right now, the state is undergoing a task force review of broader issues, and Darneille wants to wait until that process has been completed before making any major changes. That may be in 2015.
"It's really incumbent on us to do it in a thoughtful way - not to rush ahead," Darneille said.
In a letter sent last month, the federal government suggested the state should have a plan to correct the system in 90 days and should change the law when lawmakers return to Olympia early next year. Darneille acknowledged that the federal government could play hard ball and demand swift change, but she believes the state can make a strong case that the process should take time.
Beyer said the state has some questions about some of the conclusions that CMS reached and wants to have a broader discussion with federal officials.
Barbara Edwards, the director of the Disabled and Elderly Health Programs Group at CMS, said the issues identified in Washington came up as part of a general review. She said the letter seeking changes was based upon the government's current understanding of Washington's system, but she noted that both sides were having conversations right now and that the state has a chance to make the case that the current system is OK.
"This is really just the beginning of a more in-depth examination of the situation," Edwards said.
Edwards emphasized that CMS recognizes the value of the programs the state provides.
"It's certainly not our intent to ever create a challenge for consumers to get the services they need," Edwards said.