CPP State Policy Feature: Washington

Learn More

Key Organizations

Washington State Healthcare Authority (HCA)
Learn more about the state’s single agency for Medicaid administration, including how it funds and champions CPP training in Washington.

Barnard Center for Infant and Early Childhood Mental Health
Explore the University of Washington-affiliated center that delivers training and supports agencies in implementing CPP across the state.

Key Resources

• Infant-Early Childhood Mental Health Statewide Tour Report (2024) – Learn from the Washington Healthcare Authority about the state’s IECMH system of care.
  
• Washington’s Reporting Guide for Research & Evidence-based Practices in Children’s Mental Health (2023) – Learn about the system and processes used by agencies to report data to the Washington Healthcare Authority.
  
• Washington’s Title IV-E Prevention Program Five-Year Plan (FY 20-24) – Explore Washington’s plan for preventive care, including its inclusion of CPP as a chosen evidence-based practice.

Medicaid Administrative Claiming

The information below is intended as informative, not prescriptive. Please consult official literature.

Federal Medicaid funds can be claimed to match non-federal funds spent by states “for the proper and efficient administration of the state plan” (source). This funding can be applied to reimburse costs for provider training “regarding the scope or the benefits of Medicaid covered services, or that is aimed at improving the delivery of Medicaid services” (source). Typically, Medicaid funding is eligible to cover 50% of costs but for activities requiring Skilled Professional Medical Personnel (SPMP), these funds can be eligible to cover up to 75% of costs. Any state can claim these funds through the following process:

1. Develop a Public Assistance Cost Allocation Plan (PACAP)
2. Identify and categorize allowable costs
3. Ensure compliance with cost principles
4. Submit to the Centers for Medicare & Medicaid Services for approval

Public Assistance Cost Allocation Plan (PACAP)

The PACAP is essentially a proposal for claiming Medicaid administrative funds for specific activities. This document should include a narrative describing the specific activities, a detailed cost allocation methodology, and an explanation of how the activities will accrue benefits to the Medicaid program. Examples of benefits include 1) improved quality of care for Medicaid beneficiaries, 2) enhanced access to mental health services, 3) cost savings to the Medicaid program, and 4) alignment with state Medicaid plan goals. Applicants should include documentation to support the stated benefits; documentation could include research studies, program evaluations, data on prevalence of mental health needs, projections on potential cost savings, and letters of support from stakeholders.

The PACAP must be submitted by the state’s single Medicaid agency. 

Cost Identification and Allocation

Applicants must break down funding into specific costs to demonstrate that 1) costs are “proper and efficient” and 2) funding will only be used to support the Medicaid program. Costs must be categorized as direct or indirect. Examples of direct costs include trainer time, provider time, and training materials. Examples of indirect costs include administrative support and facility costs. For each indirect cost, applicants must develop and apply a cost allocation methodology to calculate the actual cost that is serving the Medicaid program. For example, the cost allocation for an administrative support professional could be calculated as the professional’s total salary multiplied by the portion of the professional’s FTE devoted to the activities detailed in the PACAP.

Cost Principles

All costs must comply with federal regulations, particularly 2 CFR Part 200 and 45 CFR Part 75. Additionally, states must maintain supporting documentation of all costs for three years from the submission of the final expense report.

Children and Youth Behavioral Health Working Group

Below is an example of how Washington’s Children and Youth Behavioral Health Work Group (CYBHWG) might advocate for increased reimbursement rates for family therapy for children aged 0-5:

1. CYBHWG engages stakeholders (caregivers of children aged 0-5, licensed behavioral health agencies, Fee-for-Service (FFS) providers, HCA, legislators, early childhood development experts, health economists, advocacy groups for children’s mental health)
2. CYBHWG analyzes existing Medicaid reimbursement rates and policies to identify mismatches between family therapy reimbursement rates and rates for treatments of similar duration and intensity
3. CYBHWG presents its recommendations to the legislature, advocating for policy and funding changes to support the increased rates. It may also provide data on the effectiveness of family therapy for young children, the cost-effectiveness of such interventions, and examples of other states that have successfully implemented similar policies

Funded Activities

Blended funding* from the Washington State Healthcare Authority and the Perigee Fund is used for a variety of activities:

• Training fees to trainers
• Lost productivity time for trainees
• Development of regional leaders
• CPP booster training sessions
• Affinity groups for BIPOC clinicians trained in CPP
• CPP CAMP consultation groups

*Note: Some of the activities listed above are funded through Medicaid Administrative Claims, and others are supported with alternative blended funding.

Additional Challenges to Sustainability

Training Attrition

Implementation-level CPP training is an 18-month process, and participants sometimes do not complete training. To reduce attrition, the Barnard Center employs implementation liaisons—positions which are generously funded by Perigee Fund. These liaisons educate agencies on CPP training requirements, billing mechanisms, and referral pathways. They also engage with participants to support them across the entire training pipeline, from readiness assessment to registration on the CPP roster.

Future CPP Sustainability Considerations

• Utilize implementation evaluation results to target opportunities for sustained and improved practice
• Transition away from private funding in favor of agency- and state-based funding streams
• Continue to develop implementation support to minimize training attrition
• Continue to support agencies in non-clinical uptake such as billing and referral pathways
• Deepen the partnership with the Washington State Department of Children, Youth, and Families