BREMERTON – More than 600,000 Washingtonians have gained access to health care through the expansion of Medicaid, including about 20,000 people in Kitsap County.

Overall, more than 44,000 people in Kitsap County are covered through Medicaid and the related Children’s Health Insurance Program.

“Washington state’s success in reducing costs in the Medicaid program while improving health outcomes for patients stems from innovations in the delivery of health care,” according to the Washington Association of Area Agencies on Aging. “Washington state — as an early Medicaid innovator — has saved more than $2.5 billion over the past 15 years by transitioning people from more expensive nursing homes into less expensive home- and community-based care that helps them age in place – a process known as ‘re-balancing.’”

Local health care providers and elected officials believe that kind of success could be in jeopardy because of capitation — a proposed system of reimbursing health care providers that Sen. Maria Cantwell, D-Washington, said would reduce support for low-income and older Americans.

“Innovate don’t capitate” was the theme of Cantwell’s visit with Kitsap-area health care providers, elected officials and others on March 11 at Harrison Medical Center, Bremerton.

The purpose of the meeting was to discuss the importance of Medicaid, as well as the possible effects of the plan put forward in Congress to cut and cap Medicaid and how it could affect Kitsap.

Participants included David Shultz, CHI market president, Peninsula region; Joe Roszak, CEO, Kitsap Mental Health Services; Jennifer Kriedler-Moss, CEO, Peninsula Community Health; Bremerton Mayor Patty Lent; Kitsap County Commissioner Charlotte Garrido; Karol Dixon, medical director, Port Gamble S’Klallam Tribe; Elya Moore, director, Olympic Community of Health; Robin Sigo, Suquamish Tribal Council liaison; Dr. Karen Schindler, emergency room physician, Harrison Medical Center; Renee Kimball Rouse, a Medicaid patient; and Lori Kerr, CHI Case Management System manager, Peninsula region.

Throughout the meeting, empirical and anecdotal evidence was presented demonstrating that, with sufficient resources, innovative and collaborative programs could save taxpayers far more money than the cost of the programs.

Much of that success comes from the creation of coalitions and the use of evidence-based programs. For example, when it came to homelessness, Bremerton Mayor Patty Lent pointed out that the city identified 50 of the most chronically homeless residents through statistical analysis and then set about finding out how address the root problems, starting with availability of housing.

On the issue of mental health, Lent said Bremerton is now working with the City of Poulsbo and having mental health workers work with police.

“These are grant-funded programs that require Medicaid support,” Lent said.

Roszak said the use of a care coordinator has reduced emergency room usage by those who are uninsured. By law, emergency rooms have to treat all persons who come to them, whether or not they can afford to pay. Such unreimbursed expenses increase the cost of care for everyone, it was noted.

With the Affordable Care Act, the rate of uninsured individuals coming to Harrison Medical Center’s emergency room is down, according to Dr. Karen Schindler, emergency room physician.

“There is a huge percentage of healthy people who need help navigating the health care system,” Schindler said.

Sigo concurred, saying that the need is particularly strong with regard to mental health services.

Rouse added, “Medicaid had helped us be most authentically ourselves.” She said she had lost her job, health care and her house. She didn’t have insurance and needed mental health help. She wound up committing a crime and going to jail, she said. Now she is enrolled in college and has a job, thanks to the help she received.

Kriedler-Moss summarized: “If you had asked me what we needed five years ago, I would have told you we had an access crisis (because the neediest people were uninsured).

Now we have a wellness crisis … Because of the money in Medicaid, we are focusing on their well-being. We provide great care now. That’s what Medicaid and the Affordable Care Act have done for us.”

Terryl Asla is a reporter for Kitsap News Group. He can be reached at tasla@soundpublishing.com.