Medicaid is, to put it mildly, a big deal: Medicaid programs account for approximately 70 percent of DSHS's budget. Created by the U. S. Congress in 1965, Medicaid's main purpose is to provide medical care to very low-income people. But Medicaid also funds mental health services, long-term care for people with disabilities and the elderly, and substance abuse treatment.

In the past, each of these pieces of Medicaid has been a separate enterprise, with a separate funding stream and a separate organization responsible for delivering services. These are the Medicaid "silos" that stood squarely in the way of creating a single, integrated service delivery system.

For clients, these silos and the organizations that represent them present a bewildering collection of offices, agencies, rules, and paperwork. But, at least, in Snohomish County all that is about to change.

The Washington Medicaid Integration Partnership (WMIP) is poking holes in the silos, and, for the first time, blending funds to combine, in a single managed care organization, all the services that Medicaid addresses: medical care, long-term care, mental health services, and drug and alcohol treatment.

This is a truly revolutionary achievement, and it has taken extensive planning over many months to achieve it. Overcoming decades of organizational habits, federal rules and regulations, community skepticism, and cultural differences among agencies, the leaders of this project have kept the 30-year-old promise on which DSHS was founded: they have integrated services to make the lives of clients easier and healthier.

This has not been achieved by DSHS alone; it has involved an extensive network of partners, who all deserve credit for bringing this project to the brink of success. The federal government, health-care providers, community activists, DSHS clients, Snohomish County leaders and county agencies, and the state Legislature are all actively involved in planning, overseeing, and evaluating this effort.

Molina Healthcare of Washington has contracted to be the managed care company that will guarantee 5,000 adult Medicaid enrollees in Snohomish County have access to their own care coordinator, their own primary care provider, all the specialty care they need, and drug and alcohol services. Within the next year, as the project matures, clients will also have long-term care and mental health services integrated into the same system. Each client's care coordinator will ensure that people are able to get all of these services when they need them.

This new system has enormous potential to improve people's lives. Without it, it's often hard for Medicaid clients to find doctors who will take them as patients, and even harder to find the specialists (such as cardiologists or neurologists) their lives may depend on. The result is often chaotic and irregular care that makes chronic diseases worsen and lands many people in hospital emergency rooms far too often. When these people - often ill and vulnerable - need home care, mental health care, or drug or alcohol treatment, they must navigate entirely separate systems that would tax even the healthiest among us.

Bringing all these services under one roof will provide a "medical home" for clients where they are seen as whole people, and cared for by a stable team of professionals they can come to know and trust. This will allow for a much more focused and consistent emphasis on preventive care and services that keep people healthier. In the long run, this is likely to save money as well as improve lives.

It has taken a long time to bring this project to life, and there is sure to be a rousing celebration when the first clients begin enrolling this month. WMIP Project Team members have been meeting with community local government representatives as well as providers since early this year. Special informational sessions have been scheduled across Snohomish County in mid-November to answer questions that clients or their families may have. There will continue to be close monitoring on how the clients in this project fare, what they think of the services they are getting, and how having access to integrated services improves their lives.

If all goes well in Snohomish County, this project may benefit hundreds of thousands more Medicaid clients in Washington. There is hope that the success of this project will lead to a statewide system modeled on this pioneering effort.

For regular updates on WMIP information, check out the WMIP Web site. Also, for more information, contact Medicaid Communication Director Jim Stevenson at (360) 725-1915 or via e-mail at stevejh2@dshs.wa.gov.