Washington is trying to answer that question differently. The state legislature is considering HB1809, a bill that would build a formal reimbursement pathway for behavioral health emergency response through the state’s medical assistance programs. First introduced in 2025 and still active in the 2026 session, it remains in the House Health Care & Wellness Committee as of this writing. At the same time, four of Washington’s largest behavioral health agencies launched a coordinated public campaign called Return on Response to make the case for co-response with real numbers, not just goodwill.
Put those two things together, and you get something worth paying attention to if you run, fund, or advocate for a co-responder program anywhere in the country: a signal that this field is trying to move from soft money to sustainable infrastructure. Here’s what HB1809 would do, what the Return on Response data shows, and what you can start doing now even if you’re nowhere near Washington state.
What Washington’s HB1809 Would Actually Do
HB1809 would professionalize co-responder work by building training, certification, and Washington co-responder reimbursement into state law, rather than leaving it up to whatever a given department can piece together.
The bill calls for three things. First, a nine-hour training course for EMTs and paramedics on behavioral health emergencies, originally slated to be in place by July 1, 2026, a deadline that has already passed while the bill sits in committee. Second, starting July 3, 2027, first responders would be able to earn a voluntary behavioral health endorsement after completing advanced training in crisis de-escalation, suicide prevention, and medical clearance for behavioral health patients. Third, and most significant for anyone building a budget case, it would require the state’s medical assistance programs to reimburse fire departments and EMS agencies for behavioral health services delivered by endorsed responders.
The bill would also fund a pilot project across four behavioral health administrative services organizations to build best practices for coordinating emergency response and to stand up a statewide co-response training academy.
Why Reimbursement Would Change the Math for Every Co-Responder Program
Grant funding asks a program to prove its value once, to one funder, on that funder’s timeline. Reimbursement asks a program to prove its value continuously, through billable, credentialed work that a payer recognizes as legitimate.
That’s a different kind of legitimacy. It’s the difference between a pilot program and a line item. Once behavioral health response has its own training pathway and its own reimbursement code, it stops looking like an experiment a department is running on the side and starts looking like a service line, the same way ambulance transport or paramedicine already is.
For program leaders, this matters no matter where your own state stands, and no matter what happens to HB1809 itself. It’s evidence you can bring to your own legislature, your own Medicaid office, or your own city council: this isn’t a novel idea anymore, it’s a model states are actively building payment infrastructure around.
“Return on Response”: Four Agencies Building the Case Together
Legislation doesn’t move through committee in a vacuum, and HB1809 hasn’t either. Compass Health, Comprehensive Healthcare, Frontier Behavioral Health, and Sound Behavioral Health, four of Washington’s largest community behavioral health organizations, coordinated under a coalition called Fourfront Contributor to launch Return on Response in June 2026, with events in Everett, Seattle, Spokane, and Yakima on the same day.
The campaign’s message is simple: co-response saves money and improves outcomes, and here’s the data to prove it. As Rayanne Paget of Frontier Behavioral Health put it, “Co-response is about dignity and stabilization in the least restrictive way possible.”
What’s notable is the coordination. These four agencies operate in different counties with different programs, but they showed up together to make one case, at the same time, to the same audience of taxpayers and lawmakers. If you’re trying to build support for a co-responder program in your own community, that’s a template worth copying: you don’t have to make your case alone, and a shared campaign carries more weight than any single program’s numbers.
Real Numbers From Year One
The Return on Response campaign leads with outcomes, not just intentions.
In Yakima County, Comprehensive Healthcare’s 18-person Field Response team, operating from 8 a.m. to 11:30 p.m., posted an average response time of 24 minutes and a 319 percent increase in crisis services delivered over one year. That’s not a marginal improvement. That’s a program that went from reaching a handful of people to reaching hundreds more, without needing hundreds more staff.
Spokane County took a different structural approach. Frontier Behavioral Health runs three co-responder teams with Spokane Police and three more with the Spokane County Sheriff’s Office, plus a Behavioral Response Unit embedded with Spokane Fire Department, Washington’s first firehouse-based diversion team. In Whatcom County, Compass Health embedded a Community Outreach Designated Crisis Responder directly inside Bellingham Fire Department’s downtown station.
Three counties, three different models, one shared result: getting a clinician physically closer to where crises happen, faster, changes what a first response looks like.
What This Means for Programs Outside Washington
If you’re running or advocating for a program in a state where nothing like HB1809 has even been introduced yet, which for now includes Washington itself, don’t read this as “check back later.” Read it as a preview of where the funding conversation is headed, and a set of talking points you can use now.
Reimbursement legislation like this doesn’t appear out of nowhere. It follows programs that spent years building a track record, then organized to show that track record publicly and collectively. That’s a sequence you can start on today, regardless of what your state legislature is doing this session.
Building a Funding Case Before the Legislation Catches Up to You
A few concrete steps, based on what’s happening in Washington:
- Track the numbers that matter to a payer, not just a grant reviewer. Response times, service volume, and reduced ER or jail utilization translate into budget language. Vague outcome statements don’t.
- Find the other programs in your state and coordinate. A shared campaign with three or four other agencies has more credibility with a legislature than any one program going it alone.
- Bring your data to whoever controls Medicaid or medical assistance reimbursement in your state, not just your city council. HB1809’s reimbursement piece, if it passes, would run through the state’s medical assistance programs, which is where the real long-term funding is likely to live.
- Treat training and credentialing as part of the funding story, not a separate HR issue. Washington’s bill ties reimbursement directly to a new behavioral health endorsement. Payers want to reimburse credentialed work, so building that credential now puts you ahead of whatever legislation comes next, in Washington or anywhere else.
Co-responder programs have spent the last several years proving they work. What’s happening in Washington is the next stage: proving it well enough, and loudly enough, that funding stops depending on the next grant cycle.
