Frequently Asked Questions

Do I qualify for psychiatric hospitalization services under the King County Mental Health Plan?

The King County Mental Health Plan pays for care in hospitals for Medicaid and low-income persons who have a mental illness and who require this level of care. To receive this care, a person must meet:

• Medical Necessity Criteria and
• Financial Qualifications.

Medical Necessity Criteria

“Medical necessity criteria” refers to whether a person qualifies for specific types of medical services based on his/her current medical condition(s).

Medical necessity criteria for voluntary care includes the following requirements:

• No outpatient services can meet the person’s mental health needs.
• Proper treatment of the person’s condition requires inpatient services under the direction of a psychiatrist.
• The inpatient services will likely improve the person’s level of functioning or prevent further decline in functioning.
• The person has a qualifying mental health diagnosis.
• The person meets the legal criteria for involuntary care but agrees to the hospitalization.

For involuntary care, the person needs to meet the legal criteria described in 71.05 RCW for adults and 71.34 RCW for children.

Generally, hospitalization is an acceptable alternative after exploring all other outpatient service options. In situations where a safe alternative to hospitalization is available, the King County Mental Health Plan encourages consumers to receive care through hospital alternatives. Hospital alternatives may include intensive outpatient services. When a mental health professional refers an individual for admission to a hospital through the KCMHP, KCMHP staff may offer and discuss several alternatives to hospitalization.

Financial Qualifications

The King County Mental Health Plan financial qualifications require an individual have one of the following:

• Inpatient coverage through Medicaid
• Inpatient coverage through GAU or GAX
• No coverage but meets qualifications for the PII program* (see 71.24 RCW), OR
• No coverage but meets qualification for the state coverage for persons being involuntarily hospitalized for psychiatric care.*

*In these categories, the person often applies for financial benefits during the hospitalization.

What Happens During a Stay

• Each person receives a complete evaluation of his/her mental health, physical health and a screening for substance abuse.
• The individual develops a treatment plan with hospital staff and professionals involved in the person’s outpatient care. Treatment planning may also include input from family members or other interested parties. The treatment plan includes a plan for continued care when the person leaves the hospital.
• Services in the hospital include individual therapy, group therapy, other group or individual services, and medications, as needed.
• The average length of stay in the hospital is 1½ to 2 weeks for individuals admitted voluntarily and somewhat longer for those on an involuntary hospital admission. The length of stay for voluntary persons is determined by his/her needs. Sometimes a hospital stay is shortened if the person decides to leave early. A judge in a civil proceeding may determine the length of stay for a person who has been involuntarily admitted to the hospital. In this case, the hospital will make recommendations to the judge according to the treatment needs of the person.

What Happens After a Stay

Individuals discharged from inpatient care are linked to additional services according to their need and eligibility, which may include outpatient mental health services, post-hospital stabilization services including referral for residential facility services or other intensive mental health service program, referral to a chemical dependency program, or to other community support services.