1. Type of ActionBudget Unit/Description of Item/Date of ImplementationFinal Budget Number Affected (approx.) ADSA Reductions Management Efficiency – Funding is reduced to reflect management and administrative reforms. For most agencies, management reductions of 7 to 10 percent are expected over the biennium. *DDD Field Services Staff and Services Reduction – Staff and services are reduced. Increased per worker caseloads will result. *DDD - RHC Staff and Services Reduction - Expenditures reduced in Residential Habilitation Centers. *DDD Central Office Reductions – Expenditures will be reduced in central office. *DDD - Professional Services Reduction – DDD therapy and technical assistance contracts will be reduced. *DDD - Reduce MH Training – Training for staff and providers who support persons with developmental disabilities reduced. *MH - Reduce WIMHRT Medicaid/State Contracts – State funding for contracts with the eastern and western branches of the Washington Institute for Mental Health Research and Training (WIMHRT) is eliminated. ($2.6) Total ($2.6) GF-S ($3.5) Total ($2.1) GF-S ($5.2) Total ($2.6) GF-S ($0.2) Total ($0.1) GF-S ($2.2) Total ($1.1) GF-S ($0.1) Total ($0.08) GF-S ($1.4) Total ($0.7) GF-S N/A 19 FTEs 40 FTEs N/A 1 2011-13 Biennium Budget Final Enacted Budget – June 22, 2011 * Continues from FY11 Supplemental

2. Type of ActionBudget Unit/Description of Item/Date of ImplementationFinal Budget Number Affected (approx.) ADSA Reductions (continued) *ASA – Reduce Administrative Staff – Five administrative positions are eliminated. *MH – Administrative Reduction – Funding for headquarters administrative and operations support is reduced. *Regional Consolidation – Consolidation of regional structure from six to three. ($0.8) Total ($0.5) GF-S ($0.5) Total ($0.5) GF-S ($2.1) Total ($1.0) GF-S 5 FTE 11 FTE Cost Avoidance*DDD/LTC - Delay Increases in Mandatory Training – Pursuant to ESHB 1548, increased training and certifications requirements for long-term care providers are delayed to the 2013-15 biennium. Increase in continuing education, certification, advanced training, peer mentorship, and higher levels of federal fingerprint background checks are delayed. LTC – Family Caregiver Medicaid Diversion – Overall savings are achieved from the expansion of the Family Caregiver Support Program (FCSP), including specialized caregiver support for people with Alzheimer’s disease. The FCSP is expected to delay or divert entries to Medicaid, thereby reducing caseloads for nursing homes and community residential beds. ($48.9) Total ($27.3) GF-S ($8.8) Total ($0.5) GF-S 11 FTE 1,500 clients 2 2011-13 Biennium Budget Final Enacted Budget – June 22, 2011 * Continues from FY11 Supplemental

3. Type of ActionBudget Unit/Description of Item/Date of ImplementationFinal Budget Number Affected (approx.) Rate Changes LTC - Nursing Home Payments – Pursuant to ESSB 5581, nursing home payment rates are adjusted. The direct care rate for clients with the lowest acuity classifications will be reduced; the financing allowance on assets will be reduced, minimum occupancy lids are increased, implementation of MDS 3.0 is delayed, and median cost lids are decreased. Rebasing will not occur in the 11-13 biennium. See also item below. LTC – Nursing Home Quality Incentive Payments – Also pursuant to ESSB 5581, nursing homes will be required to pay a Skilled Nursing Facility Safety Net Assessment. Assessment funds will be used to increase payment rates to most providers. Combined the changes above that adjust rates, the net effect is a total increase in nursing home rates of an average of 4%. *LTC - Reduce AAA Case Management Unit Rate – Payments to Area Agencies on Aging for case management of in-home clients and management of Medicaid service contracts will be reduced by about 3%. Increased per worker caseloads will result. DDD/LTC – AP/IP Health Benefits – Funding is provided for health benefits for Individual Providers and Agency providers of personal care. ($76.4) Total ($38.2) GF-S $169.6 Total ($3.2) GF-S ($3.1) Total ($1.5) GF-S $4.5 Total $2.7 GF-S 216 Nursing Homes 171 Nursing Homes 33,000 Clients 20,000 Workers 3 2011-13 Biennium Budget Final Enacted Budget – June 22, 2011 * Continues from FY11 Supplemental

4. Type of ActionBudget Unit/Description of Item/Date of ImplementationFinal Budget Number Affected (approx.) Rate Changes (continued) *ASA - Tribal Administrative Reduction – Funding for tribal administration of prevention and treatment programs is reduced from 10% to 8%. MH – Certified Public Expenditure (CPE) Adjustment – Adjustment to the capitation rates for the Regional Support Networks for costs associated with hospitals participating in the state’s CPE payment program. *DDD - SOLA Reductions – Expenditures in the DDD State Operated Living Alternatives reduced. ($0.06) Total ($0.06) GF-S $3.0 Total $1.5 GF-S ($0.2) Total ($0.06) GF-S N/A 116 Clients Service Alternative *MH - Medicaid for PACT and PALS – The Program for Assertive Community Treatment (PACT) and the Program for Adaptive Living Skills (PALS) are funded in part with Medicaid dollars. More federal funding is assumed for PACT assumption than in the FY11 supplemental. PALS is new for 2011-13. DD - RHC Consolidation – Pursuant to 2SSB 5449, Frances Haddon Morgan Center (FHMC) will close by December 31, 2011. Funding is prioritized for transitioning clients into community settings or other RHCs. Any net savings will be used to improve and enhance community-based services. ($0.0) Total ($1.9) GF-S No Net Impact N/A 45 FHMC Residents; 4 2011-13 Biennium Budget Final Enacted Budget – June 22, 2011 * Continues from FY11 Supplemental

5. 2011-13 Biennium Budget Final Enacted Budget – June 22, 2011 Type of ActionBudget Unit/Description of Item/Date of ImplementationFinal Budget Number Affected (approx.) Service Reduction *DDD/LTC - Personal Care Reduction, Acuity Based – The monthly amount of in- home personal care hours for adult clients will be reduced by an average of 13 hours (10%). Clients with lower need levels will have larger proportional reductions than those with higher needs. *MH - Reduce RSN Funding – Regional Support Network Medicaid rates are reduced by approximately 3 percent (new for 2011-13). Non-Medicaid funding is reduced by approximately 3.5 percent and continues at a lesser level than FY11 supplemental. *DDD- Residential Services Reduction – Funding for residential services to people with developmental disabilities is reduced by approximately 1.0%. *DDD - Individual & Family Services – Funding for the Individual and Family Support Program is reduced by 10%. *DDD/LTC – Medicare Part D Copayments – Funding is provided in both budgets to recognize changes in client participation when Medicare Part D copayments are discontinued in the state medical assistance program. ($196.2) Total ($98.1) GF-S ($26.2) Total ($17.4) GF-S ($6.4) Total ($3.2) GF-S ($1.2) Total ($1.2) GF-S $1.4 Total $.7 GF-S 43,000 Clients 26,000 Clients 3,800 Clients Approx. 1,800 families N/A 5 * Continues from FY11 Supplemental

6. Type of ActionBudget Unit/Description of Item/Date of ImplementationFinal Budget Number Affected (approx.) Service Reduction (continued) *LTC - Senior Citizens Services Act – Reductions are made to Senior Citizens Services Act funding. This affects services to senior citizens such as information and referral, foot care, bath assistance, minor home repair, adult day health/day care, transportation, meals, and case management. *ASA - Reduce Chemical Dependency Services – Funding is reduced for outpatient and residential chemical dependency services. Continues reduction at a deeper level than FY11 supplemental. *DDD - Voluntary Placement Savings – Funding is aligned with past years’ expenditure levels. DDD/LTC - Adult Day Health (ADH) and DD Employment Changes - Three major changes: 1) Adult Day Health (ADH) will become a COPES home and community- based (HCBS) waiver option. Currently, ADH is provided in addition to what is available under any of multiple ADSA HCBS waivers. 2) For people with developmental disabilities, after nine months of participation in employment supports, individuals will be offered the option of continuing employment or receiving a community access or day program. 3) Overall funding for these programs is reduced. Individual service plans will need to be adjusted based on the new array of options and resource levels. ($1.2) Total ($1.2) GF-S ($7.0) Total ($7.0) GF-S ($0.4) Total ($0.4) GF-S ($20.1) Total ($11.5) GF-S 113,000 Clients 2,800 Clients N/A 1,600 Total ADH 8,900 DD Employment 6 2011-13 Biennium Budget Final Enacted Budget June 22, 2011 * Continues from FY11 Supplemental

7. Type of ActionBudget Unit/Description of Item/Date of ImplementationFinal Budget Number Affected (approx.) Service Reduction (continued) MH – Spokane Acute Care Diversion – Funding provided to the Spokane Regional Support Network is reduced by 25%. Funding is used to implement services to decrease the use of Eastern State Hospital by the RSN. ($0.8) Total ($0.8) GF-S N/A RevenueDDD/LTC – Vulnerable Adults – Safety Improvement and Fees – Pursuant to ESHB 1277 and related budget action, licensing fees are increased for Adult Family Homes (AFHs) to increase the coverage of oversight costs from 6% to 60%. New investigator staff to keep up with increased numbers of citizen complaints. ASA/MH – License and Certification Fees – Licensing and certification fees are established at an amount adequate to reimburse or offset the Department for costs for approved chemical dependency treatment programs and licensed community mental health agencies. *ASA - Federal Waiver – Federal funds are provided for clients served by Disability Lifeline and Alcohol and Drug Addiction Treatment Support Act. $6.2 Total ($2.8) GF-S $0.0 Total ($1.9) GF-S $0.0 Total ($16.1) GF-S Approx 3,000 AFHs; 7.6 FTEs Approx. 1,000 facilities N/A 7 2011-13 Biennium Budget Final Enacted Budget – June 22, 2011 * Continues from FY11 Supplemental

8. Type of ActionBudget Unit/Description of Item/Date of ImplementationFinal Budget Number Affected (approx.) Service Additions DDD - Critical Community Placement – Funding is provided for out-of-home community residential placements for 58 individuals with developmental disabilities who need placement as they move from foster care, juvenile rehabilitation, mental health institutions, and the Department of Corrections. DDD – Parent to Parent – Funding is provided for direct support to local organizations that utilize parent-to-parent networks and communication. DDD/MH – Essential Equipment – Funding is provided for replacement of equipment in the Residential Habilitation Centers and State Hospitals. ASA – Disability Lifeline – Funding is provided for the increased caseload of Disability Lifeline-Unemployable clients who are required to participate in treatment. LTC/DD (in HCA budget) – Adult Dental – Dental services for adults will be provided for eligible clients as a benefit through home and community based waiver programs. $11.0 Total $5.6 GF-S $0.15 Total $0.15 GF-S $1.4 Total $1.0 GF-S $2.8 Total $0.4 GF-S (Funding is preserved in Health Care Authority budget) 58 Clients N/A 8 2011-13 Biennium Budget Final Enacted Budget – June 22, 2011 * Continues from FY11 Supplemental

9. Type of ActionBudget Unit/Description of Item/Date of ImplementationFinal Budget Number Affected (approx.) State Hospital Reductions *WSH – Ward Closures – One Psychiatric Recovery and Treatment Center ward serving patients with severe psychiatric disorders who are civilly committed was closed in October 2010. Patients were moved to other open beds on other wards. *WSH Staff Costs – Savings will be achieved by managing vacancies, limiting overtime, and staff reorganization. *Child Study and Treatment Center – Administrative staffing costs are reduced.. *Eastern State Hospital – Staffing costs will be reduced through increased efficiencies. Continues reduction from FY11 supplemental at a deeper level. ($6.6) Total ($6.6) GF-S ($4.2) Total ($4.2) GF-S ($0.6) Total ($0.3) GF-S ($3.6) Total ($3.6) GF-S N/A N/A 9 2011-13 Biennium Budget Final Enacted Budget – June 22, 2011 * Continues from FY11 Supplemental