ABCD
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Northwest Health Law Advocates
Health Care Access in the Washington Legislature
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2021-23 Final Supplemental Operating Budget: Select, Non-Exhaustive Provisions of Interest (Final as of April 4, 2022)
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Item (note that yellow items are of particular interest)DescriptionFinal Supplemental Budget (ESSB 5693, as signed by Gov)
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Change in State Funds (NGF-O)Change in
Total Funds
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(all numbers in thousands of dollars)
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HEALTH CARE AUTHORITY
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HCA Eligibility
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Continuous Enrollment for ChildrenImplement continuous enrollment for Medicaid-eligible children ages zero to six with income at or below 215 percent of the federal poverty level. Funding is contingent on 1115 waiver approval from the Centers for Medicare and Medicaid Services. (Amounts shown include funds from both "HCA Other" and "HCA Community Behavioral Health") 6,84913,733
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MSP Asset Test RemovalEliminate the Medicare Savings Program asset test for low-income individuals applying for assistance to pay for Medicare premiums, deductibles, and copays.5,17310,303
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Health Care for Uninsured AdultsImplement the expansion of Apple Health for Washington residents with income at or below 138 percent of the federal poverty level, regardless of immigration status, beginning in January 2024.3,2503,250
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Personal Needs AllowanceIncreases the in-home client personal needs allowance, which is an amount of personal income retained by Medicaid clients to pay for their personal needs, including housing costs, utilities, food, and personal incidentals. (See related DSHS items)3,1740
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PHE Post-eligibility ReviewProject management and contracting necessary to plan for post-eligibility review activity required after the end of the public health emergency.250500
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Eliminating ABD/HEN ReviewEliminate the mid-certification review process for the Aged, Blind or Disabled and Housing and Essential Needs Referral programs.130141
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HCA Benefits
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Apple Health and HomesImplement ESHB1866 (supportive housing). HCA must collaborate with other state agencies and contractors to assure seamless integration of community support services, stable housing, and health care services for individuals that meet eligibility criteria for the Apple Health and Homes program. (Amounts shown include funds from both "HCA Other" and "HCA Community Behavioral Health")3054,043
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Wraparound with Intensive ServicesPursuant to the settlement agreement under AGC v. WA HCA, expand eligibility for Wraparound with Intensive Service (WISe) to undocumented immigrant and refugee children ineligible for federally funded Medicaid benefits.1,2061,206
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EPSDT ServicesUpdates the Early and Periodic Screening, Diagnostic, and Treatment health care services schedule for Medicaid-enrolled children under age 21 to align with the Bright Futures guidelines, or a comparable EPSDT schedule.272421
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Remote Patient MonitoringAdds Remote Patient Monitoring as a benefit for Medicaid clients.1861
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Fertility Treatment StudyStudy to determine the utilization and cost impact of a fertility treatment benefit for Medicaid clients. (See related item at OIC)200200
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Adult Acupuncture CoverageProvides an adult acupuncture benefit beginning January 2024 (not funded this biennium)00
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Adult Chiropractic CoverageProvides an adult chiropractic benefit beginning January 2024 (not funded this biennium)00
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HIV Antiviral Drug CoverageCover all FDA-approved HIV antiviral drugs without prior authorization.3,73517,810
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HCA Behavioral Health
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See HCA Behavioral Health Supplement below
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HCA Waiver and Funding Streams
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Medicaid Transformation ProjectBudget assumes the expansion of Medicaid Transformation Project waiver activities for an additional 5 years (including Medicaid Quality Improvement Program, Foundational Community Supports, Accountable Communities of Health, Long Term Supports, services at Institutions for Mental Diseases, etc.)
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Public Health Emergency Budget assumes 6.2% enhanced Families First Coronavirus Response Act federal financial participation in the Medicaid program will end June 30, 2022 (related to FFCRA requirement to provide continuous Medicaid enrollment throughout the public health emergency).
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Other Enhanced FMAPBudget assumes enhanced federal matching funds associated with: (1) changes in federal match for Medicaid enrollees receiving behavioral health services; (2) increases in federal match for Medicaid Urban Indian Health Organization and Native Hawaiian Health Care System services through March 31, 2023; and (3) 10% enhanced federal match for Medicaid Home and Community-based Services.
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Rural CHARTBudget plans for receipt of a federal Community Health Access and Rural Transformation grant to partner with rural hospitals and stakeholders to reduce access disparities.
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Other HCA Programs & Services
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ABCD OutreachFunds the Office of Equity to provide training for local Access to Baby Child Dentistry coordinators.200400
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Customer Service StaffAdds 9 FTEs at HCA to address customer service responsiveness through phone calls and web portal navigation, and open enrollments.0604
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School-Based Health ServicesSupport school-based health services by removing the financial contribution requirement for school districts. General Fund-Local expenditure authority is shifted to General Fund-State.4,359415
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Total Cost of InsulinEstablish the Total Cost of Insulin Work Group, pursuant to Ch. 346, Laws of 2020 (ESSHB 2662).363363
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Rx Drug Affordability BoardStaffing and contracting support to implement 2SSB 5532 (rx drug affordability board).1,4601,460
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Primary Care SpendingStaffing for SSB 5589 (primary care spending).297297
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Primary Care Case Mgmt - TribalExpand the Primary Care Coordination Management program with Indian Health Service clinics to improve care coordination and client outcomes.1413,159
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Supported Housing ServicesFunds a supported housing program for individuals who don't qualify for Medicaid or who need an extended time to apply for and obtain Medicaid (comparable to the foundational community supports initiative in the Medicaid transformation waiver)208208
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Supported Employment ServicesFunds a supported employment program to serve individuals who don't qualify for Medicaid or who need an extended time to apply for and obtain Medicaid (comparable to the foundational community supports initiative in the Medicaid transformation waiver). 202202
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Psilocybin ReportReport on psilocybin services wellness and opportunities in consultation with stakeholders.200200
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HCA Infrastructure
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Master Person IndexBuild and maintain a Master Person Index database, to identify and link clients across "HHS coalition" agencies (centralized index of client information). 47467
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Electronic Consent ManagementFunds an electronic consent management solution for patients and health care providers to exchange health-related information.3563,080
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Community Information ExchangeStudy the cost and implementation impacts of a statewide community information exchange for community-based organizations, health plans, accountable communities of health, and safety net providers. 5002,000
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HCA Provider Reimbursement
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Budget funds provider rate increases, including:Behavioral health providers, including: (1) 7% increase in Medicaid reimbursement for BH providers contracted through MCOs by Jan. 2023; (2) 7% increase in non-Medicaid reimbursement for Behavioral Health Services Organizations and MCO wraparound contracts; (3) one-time grants to non-hospital community BH providers to stabilize the workforce; (3) bundled payments for opioid disorder treatment services; (4) BH personal care wraparound services for individuals with long-term care and behavioral health needs (including those discharged from the state hospitals); and (5) Parent Child Assistance Program providers
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Children's dental services
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Home-based care, including: (1) home health; (2) skilled nursing services for children who require medically intensive care in a group setting, (3) in-home skilled nursing services, nurse delegation, in-home private duty nursing, and adult family home private duty nursing.
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Skilled nursing facilities to incentivize admittance of Medicaid clients discharged from inpatient care.
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One-time funds to community health centers to address pandemic payment methodology misalignment (see also Capital Budget for investments in health center infrastructure)
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Two-year grant program to reimburse community health workers whose patients are significantly comprised of pediatric patients and enrolled in medical assistance programs.
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Health Benefit Exchange
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Health Care for Uninsured AdultsImplement the expansion of Apple Health to Washington residents with income at or below 138% FPL, regardless of immigration status, beginning in January 2024733733
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Child Care Premium UtilizationLowers appropriation to align with projected utilization of the Health Care Insurance Premium Assistance Program for employees who work in licensed child care facilities. Budget language also extends the program through 1/1/24. 0-26,050
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1332 WaiverSystem updates and community-led engagement activities necessary to implement a Section 1332 waiver for uninsured individuals regardless of immigration status. Also adds $5M in Cascade Care subsidy funds, contingent on receiving the 1332 waiver (in addition to existing Cascade Care appropriation). 2,9417,941
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Student Health CoverageProvides resources and assister training for a pilot to connect students with health care coverage2020
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Continuous coverageOne-time activities to promote continuous coverage for individuals losing Apple Health at the end of the COVID-19 public health emergency1,0001,000
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DEPARTMENT OF SOCIAL AND HEALTH SERVICES
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DSHS - Admin Services
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Medicare Cliff StudyStudy the cost and benefit of adopting available options to expand Medicare savings programs and classic Medicaid programs, including categorically needy and medically needy, to promote affordable care, premiums, and cost-sharing for Medicare enrollees.7575
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Medicaid Utilization StudyStudy describing the service experiences and characteristics of persons receiving Medicaid-funded long-term services and supports and persons receiving services related to developmental or intellectual disabilities, and associated social and health services expenditures.7575
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Poverty Reduction Advisory GroupFunds technical analytics staffing on poverty reduction within DSHS.461461
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Poverty Reduction Coordinationunds staff to convene subcabinet meetings on poverty reduction, coordinate with agencies, and track progress toward poverty reduction goals.364364
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DSHS - Economic Services Administration
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Health Care for Uninsured AdultsSystem changes necessary to expand Apple Health for all Washington residents, regardless of immigration status, beginning in January 2024.207207
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MSP Asset Test RemovalSystem changes necessary for the removal of asset limits for HCA's Medicare Savings Plan program, effective January 1, 2023.95156
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Afghan Refugee Health PromotionOne-time federal funds to ESA's Office of Refugee and Immigrant Assistance to support the physical and mental health needs of Afghan refugees arriving in Washington state. Note: Budget also includes funds for other supportive services for Afghan SIV & SI Parolees and Afghan Refugees.01,532
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Admn Hearing Deadline ExceptionPursuant to ESSB 5729 (hearing deadlines/good cause), funds additional good cause exceptions for administrative hearing deadlines for clients who apply for or receive public assistance benefits.2727
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Integrated Eligibility SystemBuild the foundation of an integrated eligibility system across health and human services programs, including Medicaid, basic food, child care, and cash assistance.5,93819,700
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Aligning the ABD Grant StandardIncreases the Aged, Blind, or Disabled (ABD) grant standard to a maximum amount of $417 per month for a one-person grant and $528 for a two-person grant, effective September 1, 2022.36,86036,860
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Eliminating ABD/HEN MCREliminates the Mid-Certification Review requirement for blind and disabled recipients of the ABD program and Housing and Essential Needs (HEN) Referral program.513513
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Expanding ABD to InstitutionsExpands the ABD program to individuals ages 21-64 residing in a public mental institution, effective September 1, 2022. Eligible individuals would receive a monthly payment of $41.62 to cover clothing, personal maintenance, and necessary incidentals (CPI).195195
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ABD and HEN Human TraffickingExpands ABD and HEN to certain victims of human trafficking, effective July 1, 2022. Funding in FY 2023 covers costs associated with the expected caseload increase and one-time IT enhancements.207207
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Immigrant Funding/Recent ArrivalsContract with nonprofit organizatons to provide services for refugees and immigrants that have arrived in WA, including those from Afghanistan and Ukraine. 28,39828,398
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Refugee Cash and MedicalFederal grants to ORIA for cash and medical assistance for eligible immigrants arriving in WA.06,241
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Food Assistance ChangesBudget proposes various expansions to food assistance, including: (1) continued administration of pandemic EBT cards, (2) and expanded transitional food assistance in sanctioned households.
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TANF ChangesBudget proposes various expansions to TANF, including: (1) eliminating the 60 month time limit in certain cases, (2) increasing the TANF family size, and (3) providing an additional diaper subsidy to households with a child under 3.
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DSHS - Aging & Long Term Care Administration
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ALTSA Programs & Services
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Increase In-Home PNAIncreases the Personal Needs Allowance for in-home clients to 300% of the Federal Benefit Rate, effective July 1, 2022. This change creates parity in the PNA between ALTSA and DDA in-home clients. The PNA is the amount of personal income retained by Medicaid clients to pay for their personal needs, including housing costs, utilities, food, and personal incidentals. (See related HCA item)25,57158,117
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Personal Needs Allowance COLAFunds a cost-of-living adjustment in the Personal Needs Allowance for Medicaid clients in residential and institutional settings, effective July 1, 2022, to reflect the 5.9 percent COLA announced by the federal SSA for CY 2022.6089
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Tribal Medicaid EligibilityFunds a FTE to engage with tribes that are involved in eligibility determination and case management for tribal members eligible for Medicaid Long-Term Supports and Services.68135
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Senior Farmer's Market NutritionExpands the senior farmer's market nutrition program to 7,100 seniors and make other improvements.1,5241,524
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Case Management RatiosAdditional staff to reduce caseload ratios, effective July 2022 (11:1 for hospital discharge case managers; 75:1 for AAA case managers; and 75:1 for Home and Community Services case managers serving clients in residential settings.8,23416,976
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Specialized Behavior ContractsServe 50 ALTSA clients who are registered sex offenders in community settings with specialized behavior contracts.1,1162,233
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Behavioral Health TransitionsFunds 19.9 FTE to: (1) reduce the number of cases per case manager from 42 to 35 for clients served under the residential support waiver, and (2) phase-in 60 additional placements in Enhanced Adult Residential Care facilities by October 2023 at an enhanced daily rate.2,0004,001
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LTSS Program Delay/Partial BenefitsPursuant to Ch. 1, Laws of 2022 (SHB 1732), funds customer support staff, outreach to educate the public on the changes made to the Long-Term Services and Support Trust Program, and an updated baseline actuarial analysis of the program.02,080
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LTSS Program ExemptionsPursuant to Ch. 1, Laws of 2022 (ESHB 1733), funds outreach to groups exempted by the legislation to educate them about these exemptions.0280
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AAA Care TransitionsFunds AAA case managers to assist in transitioning individuals from acute care hospitals after their medical needs have been met (particularly those not relying on Medicaid for their transition).1,7502,100
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Long Term Care Feasibility StudyLong-term care feasibility study to look at options for incarcerated individuals under DSHS jurisdiction who need long term care support. Requires a preliminary report by October 1, 2022 and a final report by June 30, 2023.350350
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Home-Delivered MealsExpand the availability of home-delivered meals for eligible long-term care clients.900900
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Rapid Response TeamsOne-time funds for contracted nurse staffing teams to support beds opened in nursing homes that will serve individuals discharged from acute care hospitals after their medical needs have been met.12,02026,335
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Transition and Eligibility DetermFunds to assist in client eligibility determinations and transitions from acute care hospitals to community settings.2,0314,062
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GuardianshipFunds staff to assist individuals whose transitions from acute care hospitals is delayed due to guardianship issues, as well as pass-through funding to the Office of Public Guardianship for staff and the cost of guardianship and legal fees.1,2271,548
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LTSS TrustFunds activities necessary to prepare for the LTSS Trust Program's implementation.01,770
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Tribal Medicaid EligibilityFunds staff to engage with tribes to offer technical assistance, coordination, training, and support on Medicaid eligibility and case management, pursuant to SB 5866 (Medicaid LTSS/tribes).68135
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AFH Air Conditioning Grant ProgramNot funded: One-time grant program to expand the use of air conditioning in adult family homes that serve Medicaid clients or clients receiving services through state funded long-term care programs.00
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ALTSA Funding Streams
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Public Health EmergencyBudget assumes 6.2% enhanced Families First Coronavirus Response Act federal financial participation in the Medicaid program will end June 30, 2022 (related to FFCRA requirement to provide continuous Medicaid enrollment throughout the public health emergency).
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State Match for Federal GrantsBudget provides state funds to meet federal match requirements associated with American Rescue Plan Act funding for Older American Act services and supports.