Health Care Authority

Health Care Authority, the Washington State Medicaid agency and a U.S. government entity headquartered in Olympia, acts as a prime recipient of federal grants focused on behavioral health, substance use disorder treatment, crisis intervention, and rural health transformation across Washington State. The Authority does not compete for federal contracts and operates exclusively as a grant recipient, administering federal funding through sub-awards to local providers, tribal nations, county governments, and community organizations.

Health Care Authority's federal footprint centers on SAMHSA block grants and project grants for community mental health and substance abuse prevention and treatment. The Authority received a $725.030 million cooperative agreement from the Centers for Medicare and Medicaid Services on December 29, 2025, under the Rural Health Transformation Program (CFDA 93.798) to support innovative rural healthcare delivery across Washington through December 2030, distributing funding to 16 tribal governments and state organizations. The Authority administers a $56.046 million Block Grant for Community Mental Health Services (CFDA 93.958) awarded October 1, 2025, through September 30, 2027, passing funds to sub-recipients including Sea Mar Community Health Centers, Pathways of Washington LLC, county behavioral health divisions, and peer-support organizations to deliver First Episode Psychosis services and Housing and Recovery through Peer Services (HARPS) programs. The Authority manages a $115.525 million Substance Abuse Prevention, Treatment, and Recovery Services Block Grant (CFDA 93.959) awarded October 1, 2025, through September 30, 2027, sub-awarding to 29 named sub-recipients including federally recognized tribal nations (Nisqually Indian Tribe, Tulalip Tribes, Quinault Indian Nation, Yakama Nation, and 21 others), county behavioral health organizations, and recovery housing providers for mental health promotion, prevention, treatment, harm reduction, and recovery support services statewide.

The Authority also receives formula grants under the Projects for Assistance in Transition from Homelessness (PATH) program (CFDA 93.150) from SAMHSA Center for Mental Health Services, with consecutive awards of $1.468 million (July 1, 2026 through June 30, 2028) and $1.478 million (July 1, 2025 through June 30, 2027), administering PATH funding through sub-awards to behavioral health administrative services organizations, peer-run recovery support organizations, tribal nations, and community mental health centers. The Authority received a $2.654 million project grant on September 30, 2026, under the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances (SED) program (CFDA 93.104) to operate the Kids Mental Health Washington Regional System of Care Project, serving 2,650 youth and connecting 1,280 to mental health services across King, Thurston-Mason, and North Central regions through September 29, 2030.

The Authority also operates Residential Substance Abuse Treatment (RSAT) programs for incarcerated individuals. The Bureau of Justice Assistance awarded $425.352 thousand on October 1, 2024, through September 30, 2028, to deliver evidence-based substance use disorder treatment at Jefferson County Jail, Island County Jail, the Washington State Corrections Center for Women, and Mission Creek Corrections Center for Women. A subsequent RSAT award of $213.544 thousand was obligated October 1, 2025, through September 30, 2029, continuing services at three facilities. The Bureau of Justice Assistance also awarded the Authority project grants addressing the sequential intercept model for substance use disorder response, funding opioid treatment networks, community prevention coalitions, mobile crisis units, and peer mentor programs for criminal justice-involved populations.

SAMHSA Center for Substance Abuse Treatment awarded the Authority a $580.444 thousand formula grant on October 1, 2023, and has funded multiple opioid response and prevention initiatives, including the Washington State Opioid Response grant (SOR IV, awarded September 30, 2024, through September 29, 2027) to support 22 community prevention and wellness initiative coalitions, 13 opioid treatment networks, 5 opioid treatment network hub-and-spoke sites, and tribal opioid prevention and treatment services. The Authority received supplementary project grants supporting mobile response and stabilization services for youth in crisis (Pierce and Spokane counties), transition-aged youth engagement and integrated care for children and adolescents with serious emotional disturbances and co-occurring physical health conditions, and a Culturally Responsive Mobile Crisis Team pilot with the Tulalip Tribe.

Customer concentration reflects heavy reliance on SAMHSA. The Department of Health and Human Services Substance Abuse and Mental Health Services Administration accounts for 63 awards across its three component centers (Center for Mental Health Services, Center for Substance Abuse Treatment, and Center for Substance Abuse Prevention), the Department of Justice Bureau of Justice Assistance holds 7 awards, and the Centers for Medicare and Medicaid Services holds 7 awards. Recent activity shows a downward trend: eight awards obligated in 2022, ten in 2023, thirteen in 2024, eleven in 2025, and two in the first nine months of 2026. Seventeen awards reach completion within the next twenty-four months, presenting recompete exposure across PATH formula grants, community mental health block grants, substance abuse prevention and treatment block grants, opioid response initiatives, and RSAT programming.

The Authority serves as sub-recipient on federal grant work, collaborating with Stanford University on implementation research for medications for addiction treatment under a sub-award from Stanford dated July 8, 2025, and partnering with Educational Service Districts 105 and 101 on school-based mental health programs (Project AWARE) under sub-awards. The Authority also receives technical assistance funding through sub-awards from the National Association of State Mental Health Program Directors, most recently obligated January 25, 2025, for Coalition and Transformation Transfer Initiative (TTI) technical assistance.

Health Care Authority's federal work involves no parent contract vehicles, competitive set-asides, or prime contract work. The Authority operates as Washington's state Medicaid agency and designated administrative entity for federal behavioral health and substance use treatment funding, functioning as a fiscal and administrative intermediary between federal grantors and direct-service providers across the state's public health and criminal justice systems.