State briefing: health engagement hubs reach thousands but current reimbursement leaves a nearly $200 shortfall per encounter

Sarah Deutsch of the Health Care Authority briefed the committee on the health engagement hub pilot evaluation and fiscal findings. HCA reported that, from pilot start through April 2026, hubs have served 3,265 unique individuals who use drugs and recorded 11,713 clinical encounters in the first year of service-level reporting.

Sarah said most clients have insurance (commonly Apple Health) but arrive with low prior health engagement; intake data showed high rates of methamphetamine (79%) and fentanyl (62%) use in the prior three months and high housing instability. Sites reported that prescribers participated in about 41% of encounters, outreach staff in about 35% and care navigators in 16%.

Mercer's preliminary fiscal analysis examined non-tribal pilot sites and concluded that average cash revenue per encounter was approximately $31 while average cost per encounter was about $218, producing a near-$200 shortfall per visit. "To achieve sustainability," Sarah said, "we really need to increase or get to a materially higher payment and/or a really stable braided funding model to support the non-billable but essential components of the model."

The hubs operate on a low-barrier, harm-reduction model offering walk-in and outreach-based services (medical care, harm reduction supplies, MOUD induction, care navigation). Sarah and Tim noted that Medicaid billing covers billable services but HCA legislative funding braided with Medicaid is essential to sustain non-billable services such as outreach and standby capacity.

HCA and evaluation partners said next fiscal work will explore payment structures to cover ongoing costs while retaining program accountability for access, linkage to treatment and reductions in downstream system utilization.