As lawmakers grapple with writing a budget, they appear set to redirect marijuana tax money that voters approved for community health clinics instead to other needs.

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OLYMPIA — When voters in 2012 legalized recreational marijuana under Initiative 502, they also gave specific directions for where taxes from the product would be spent.

Among other things, marijuana revenue was to be used to fund substance-abuse programs, health care and research.

As that money starts to roll in, budget writers may use at least some of it — originally destined for nonprofit community health centers — for other purposes.

That money was designated to help fund care for underserved populations, like minorities and immigrants. It is intended to provide for health-care costs that other government spending, like Medicaid, doesn’t cover.

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But lawmakers this year are struggling to write a budget that complies with court orders to fix education, mental health and other social-service programs, as well as provide cost-of-living raises for teachers and state employees.

In the overall budget that could be more than $38 billion, the community health-center money is small change. Recent estimates peg the revenue between $17 million and $18 million for the 2015-17 budget cycle, according to Molly Firth of Community Health Network of Washington.

The chief Democratic budget writer, Rep. Ross Hunter of Medina, points to the nation’s health-care-reform law, the Affordable Care Act, which has reduced the number of uninsured — and, thus, the need for community health-center funding.

“I have higher priorities for use of [those] funds,” Hunter said.

But after funding cuts in previous budgets, health centers have been looking forward to the marijuana revenue to restore services, according to Firth, director of public policy at the network.

“People look at the Affordable Care Act and Medicaid and they think, ‘OK, problem solved,’ ” Firth said. But, “We still have about half a million uninsured people in our state, or more.”

Uninsured

While the number has dropped significantly in recent years, about 8.5 percent of Washingtonians now lack health insurance, according to Stephanie Marquis, spokeswoman for the state Office of the Insurance Commissioner.

When they walk through the doors of Olympia’s Sea Mar Community Health Center, uninsured patients often bring a tangle of chronic conditions, according to Sean McCliment, clinic manager.

First, there are the health conditions: diabetes, congestive heart failure and behavioral health issues. And then there are the life circumstances: stress over the lack of money, a tough time getting to and from the clinic.

Some uninsured patients have had circumstances that bump them off insurance they were on, which McCliment calls “insurance churn.” Others are undocumented immigrants or people who have qualified for a plan under the state health care exchange but still can’t afford coverage.

“We’re here to serve those people regardless of their current status,” McCliment said.

Dwayne Dixon, 54, is one of those who could be considered “insurance churn.” A mental-health worker, Dixon came earlier this year to the Olympia Sea Mar clinic with what he said was a shoulder injury suffered while on the job.

But Dixon had a problem with his insurance, and staff at the clinic helped him sign up for Medicaid.

“I’m very grateful for that,” Dixon said one day as he sat in the clinic lobby waiting for an appointment. “Because these are the things I didn’t even know about.”

The Olympia clinic saw 488 uninsured patients in 2014, about 7.5 percent of the 6,533 patients it saw that year, according to McCliment.

Around Washington state, the Sea Mar clinic system in 2014 saw 33,518 uninsured patients, McCliment said. Overall, about 20 percent of patients seen at community health centers in the state are uninsured, according to Firth.

The revenue expected from I-502 could fund grants to help fund dietitians, referral coordinators, customer- service representatives and care coordinators, according to McCliment.

These are the types of employees that can help uninsured patients sign up for insurance, get successfully referred to see specialists and get access to a pharmacy and the care they need.

That kind of help can keep patients from “ending up in the ER or the hospital because of things that could have been avoided or dealt with at a primary care level,” McCliment said.

While any loss of anticipated I-502 money may not cause existing positions to be cut, it could force the clinic to restructure current positions if not enough money can be found elsewhere, he said.

Shutdown

With only weeks to go before the government would partly shut down from the lack of a new budget, it’s still hard to know what government programs lawmakers will fund. Budget negotiators aren’t speaking to whether any progress has been made.

The original Republican budget proposal swept all the marijuana revenue from its designated uses to help fund other programs. The Democratic proposals have kept the I-502 revenue in its designated account but then redirected the money to be used as Medicaid funding for community health centers, according to Firth.

The updated Republican budget proposal uses the money similar to the Democratic proposals, Firth said.

Hunter, the Democratic budget writer, says the state already helps reimburse community health centers through the Medicaid money, though that money doesn’t fund the grant programs.

“They’re nonprofit clinics,” Hunter said. “We’re not here to have them make profit.”

Sen. Andy Hill, R-Redmond and chief GOP budget writer, said there’s still a possibility for some funding.

But Firth said that in conversations with the Republican side, “We’re not getting a lot of positive feedback.”