ABIJ
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Northwest Health Law Advocates
Health Care Access in the Washington Legislature
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2021-23 Biennial Operating Budget Proposal: Select, Non-Exhaustive Provisions of Interest (final budget as of May 4, 2021)
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ItemDescription of Final BudgetESSB 5092 as final (conference) 4/25/2021
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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 Waiver and Funding Streams
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Healthier WA Savings RestorationRestores assumed savings from Healthier Washington/Medicaid Transformation Project 1115 waiver activities that had been included in the 2019-2021 budget but are now no longer expected to occur. 61,584142,432
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Restore Program Integrity SavingsRestores assumed savings from program integrity activities that had been included in the 2019-2021 budget but are now no longer expected to occur.142,000460,000
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Extend MTP (various items)Multiple budget items extend Medicaid Transformation Project 1115 waiver activities for a 6th year through 12/22, including: Medicaid Quality Improvement Payments, Initiative 1 (accountable communities of health), Initiative 2 (long-term services and supports) and Initiative 3 (foundational community supports, such as supportive housing and employment). Details are not described here.
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Low-Income Health Care I-502Adjusts level of anticipated revenue from I-502 taxes on the sale of marijuana available for use in Medicaid MCO capitation payments. -71,9690
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Covered Lives TaxNot funded in final. Gov had proposed funds for the payment of a proposed Covered Lives Assessment (health insurance fee) for lives covered under the Medicaid program. Fees would be directed toward foundational public health services. 00
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HCBS Enhanced FMAPAssumes increase to the state's Federal Medical Assistance Percentage (FMAP) for Medicaid home and community-based services by an additional 10% under the American Rescue Plan Act (ARPA). These funds are available through 3/31/22, and must be utilized to enhance, expand, or strengthen home and community-based services. See related items in DSHS and Governor categories. Note: Sen also included a separate item investing $60.3 M NGF-0 and $162.9M Total funds in HCBS in the HCA budget. -59,6200
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COVID FMAPAssumes that the federal public health emergency will extend through CY2021, allowing a temporary 6.2 percentage point increase to the state's FMAP for Medicaid services for this period. -149,9560
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ARPA UIHP Enhanced FMAPAssumes increase to the state's FMAP for Medicaid Urban Indian Health Program services to 100% for eight quarters under the ARPA (from 4/1/21 through 3/31/23). -18,6710
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HCA Behavioral Health
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Trueblood ImplementationFunds the second phase of the Trueblood v. DSHS settlement. The first phase, funded in the 2019-21 budget, included Pierce and Spokane counties and the southwest region. The second phase will include King County. The agreement outlines five key areas of investments: competency evaluations, competency restoration, forensic Housing and Recovery through Peer Services, forensic Projects for Assistance in Transition from Homelessness, crisis diversion and supports, education, training and workforce development. See related DSHS funding below.17,15519,774
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Community Long-Term Inpatient Beds/ Inpatient Treatment CapacityFunds additional inpatient treatment capacity in community behavioral health settings, expanding from 167 beds to 221 beds by the end of FY 22 and 273 by the end of FY 23. The outlook assumes that a total of 369 beds are funded by the end of FY 25. The funded level is sufficient to implement recommended rate methodologies for various providers pursuant to a 2020 report submitted to the Legislature. Beginning in FY 2023, HCA shall cap reimbursement for vacant beds at 6%.27,99651,982
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Adult & Youth Mobile Crisis TeamsFunds Behavioral Health Administrative Services Organizations to add mobile crisis response teams throughout the 10 regional service areas, in anticipation of the 988 crisis hotline. In prioritizing this funding, HCA shall assure that a minimum of 6 new children and youth mobile crisis teams are created, and that there is one children and youth mobile crisis team in each region by the end of fiscal year 2022.25,84838,579
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Co-Responder GrantsFunds grants to add mental health practitioners to the team of personnel responding to an emergency involving a behavioral health crisis, particularly in BIPOC communities. 02,000
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Bed Tracker SystemNot funded in final. Gov & Sen had proposed funds for a system to create a statewide behavioral health treatment bed registry system to find an inpatient involuntary commitment bed.00
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PAL and PCL Funding ModelFunds to administer the Partnership Access Line (PAL), PAL for Moms, the Mental Health Referral Service for Children/PAL for Kids, and the Psychiatric Consultation Line (PCL) programs through the carrier assessment established under Chapter 291, Laws of 2020 (SHB 2728).-3,6463,262
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Problem Gambling StudyFunds an adult problem gambling prevalence study, shifting funding to FY21 with report due 6/30/22. 0500
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Mental Health Education and SupportFunds a grant to a statewide mental health non-profit that provides free community and school-based mental health education and support programs.500500
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Behavioral Health Personal Care/ReliefFunds behavioral health personal care enhancements for individuals in long-term care through DSHS due to increased caseload.12,26812,268
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Short-Term BH Housing SupportsFunds short-term rental subsidies and recovery housing for individuals with mental health or substance use disorders.6,2186,218
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BH Peer Support/ Recruitment
Funds to maintain and increase resources for peer support program for individuals with substance use disorders, as well as recruit peer specialists. Budget also includes small appropriations for peer crisis response training and peer emotional support, which are not detailed here. 1,7621,762
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Civil Committment TransitionFunds to implement E2SSB 5071 (civil commitment transition), which establishes transition teams for individuals released from civil commitments related to criminal proceedings.132330
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Safe Station Pilot ProgramsFunds to implement SB 5074 (safe station pilot programs), which pilots the use of fire stations for substance use disorder screening. 3951,150
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Incentives - Criminal JusticeFunds to expand contracting with HCA's External Quality Review Organization to measure performance related to client involvement with the criminal justice system in relation to health status under SSB 5157 (behavioral disorders/justice).44178
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Opioid Grants to TribesNot funded in final. Sen had proposed grants to tribes to prevent opioid use and expand treatment for opoid use disorders. 00
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MAT TrackingFunds to enhance a tool that tracks medication assisted treatment provider capacity.260260
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SUD Family NavigatorsFunds grants for substance use disorder family navigators. 1,0001,000
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Recovery CafesFunds to expand recovery cafes (for substance use disorders) throughout the state.250250
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Opioid Overdose MedicationFunds to implement 2SSB 5195 (opioid overdose medication), which would require certain providers to dispense and Medicaid to reimburse for opioid overdose reversal medication. 1,4584,882
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Mobile Integrated Health PilotFunds a mobile integrated health pilot project to provide intervention services and care coordination.750750
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BH Respite Waiver & Medical & Psychiatric Respite Care Funds related to behavioral health respite care: direction to seek a Medicaid waiver for BH respite care, and to develop an implementation plan to incorporate medical and psychiatric respite care as statewide Medicaid benefits and report by 1/15/22. 175200
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Youth Prevention ServicesNot funded in final. Sen had proposed funds to maintain and increase support for youth prevention services.00
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Rural Behavioral Health PilotFunds one-time grant to Island County for a pilot program to improve behavioral health outcomes for young people in rural communities.750750
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988 Crisis Response ImplementationSee E2SHB 1477 (National 988 System) for separate appropriation. House proposal had included funding.00
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BH NavigatorNot funded in final. House had proposed funds to contract for behavioral health navigators in two primary care settings for supportive services to children and youth with identified behavioral health needs. 00
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Telehealth StandardsFunds to contract with the WA State Behavioral Health Institute to make recommendations related to virtual behavioral health services to children (prenatal - age 25).410410
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Incarcerated Persons - MedicalFunds implementation of ESHB 1348 (incarcerated persons/medical), related to staff and IT changes to prohibit a person's Medicaid eligibility from being affected by the person's incarceration status for up to 29 days.169912
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Crisis Stabilization PilotOne-time funds to establish the Whatcom county crisis stabilization center as a pilot project for diversion from the criminal justice system to community based treatment.400400
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Jail MOUD TreatmentFunds to expand efforts to provide opioid use disorder medication in city, county, regional, and tribal jails.5,0005,000
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Law Enforcement Assisted DiversionsFunds to continue grants to Law Enforcement Assisted Diversion programs outside of King county established under Chapter 314, Laws of 2019 (SSB 5380).05,000
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BH Consumer AdvocacyReduces funds for ombuds services provided by Behavioral Health Administrative Services organizations pursuant to E2SHB 1086 (behavioral health consumers). Funding for non-Medicaid consumer advocacy services is shifted to the Dept. of Commerce. Medicaid MCOs will continue to directly pay for the services required by their enrollees.-610-610
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Expand MH Services and SupportsFunds to expand mental health services and supports, including treatment and recovery support services.020,600
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Expand SUD Services and SupportsFunds to expand substance use disorder services and supports including outreach, treatment, and recovery support services.6,60342,018
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Trauma Informed CareOne-time funds to contract with the North Sound BHASO to provide trauma informed counseling services to children and youth in Whatcom County schools.600600
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Children's Crisis Outreach ResponseFunds King County BHASO for Children's Crisis Outreach Response team that was previously budgeted under DCYF, with requirement to maximize federal funding for Medicaid-eligible children. 2,5002,500
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CLIP HMH FacilityFunds to contract for a 12-bed children's long-term inpatient program facility specializing in the provision of habilitative mental health services for children and youth with intellectual or developmental disabilities who have intensive behavioral health support needs. Start-up funding is provided in FY 2022 and ongoing operational funding is provided beginning in 7/22. HCA must report on utilization by 6/23. 3,2886,316
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Vancouver RTFFunds to contract with two providers to operate two 16-bed units for long-term involuntary treatment. (See also DSHS item below).2,8344,647
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Other HCA Programs
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Child Continuous EligibilityDirects HCA to assess the feasibility and fiscal impacts of an 1115 medicaid waiver to extend continuous eligibility for apple health covered children ages zero through five as a component of school readiness. Prior to submitting the waiver application, HCA shall provide a status update no later than 9/30/21. N/AN/A
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Primary Care InitiativeOne-time funding for contracting to further the development and implementation of the Washington Primary Care Transformation Initiative. 75150
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Child Assessment and DiagnosisFunds to implement 2SHB 1325 (behavioral health/youth) to provide up to five sessions of intake and assessment for children aged birth to 5 years old (particularly boys of color) in their own home or other natural setting. 1,0791,257
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Health Homes - Tribal AffairsFunds expansion of Health Homes services to the American Indian (AI) and Alaska Native (AN) populations, through incentives for lead organizations to contract with Indian Health Service providers.-3021,658
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WRHAP Pilot Program EvaluationFunds program evaluation for the Washington Rural Health Access Preservation pilot, which includes 13 rural critical access hospitals that receive federally matched payments for achieving quality metrics in the delivery of behavioral and care coordination services. 60120
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Postpartum CoverageFunds extension of Apple Health for an additional ten months for postpartum persons who are eligible under pregnancy eligibility rules at the end of the 60-day postpartum period, to provide a total of 12 months postpartum coverage under SSB 5068 (postpartum period/Medicaid) and the American Rescue Plan Act. 297979
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Child Care Premium AssistanceFunds premium assistance program before 9/30/22 via an Exchange sponsorship pilot for eligible employees working in a licensed child care facility who are under 300% FPL and select a silver plan. Requires a report by 10/1/22. Note: A separate item not listed here funds $400,000 for a Child Care Navigator. 030,266
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Developmental Disabilities TrainingFunds the continuation of funding with the University of Washington for the Extension for Community Healthcare Outcome project for providers who deliver services to intellectually disabled/developmentally disabled clients.600600
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ABCD OutreachOne-time funds for the Office of Equity to collaborate with the statewide managing partner of the Access to Baby and Child Dentistry program for increased outreach and the support of local ABCD programs and providers. This was originally provided in the 2020 Supplemental budget but was delayed. 200400
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Dentist LinkOne-time funds to develop a public-private partnership with a state-based oral health foundation to connect Medicaid patients to dental services and reduce barriers to accessing care. This had been included in the 2020 Supplemental budget but was delayed. 500500
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PCAP ExpansionFunds to expand services to pregnant and parenting women in the Parent Child Assistance Program. 6871,374
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COFA MedicaidPass-through funds related to transitioning the COFA Islander program to Medicaid for: (1) a COFA community-led organization through a WA-based organization contract to provide additional supports to COFA community members statewide who are seeking access to health coverage and health care services, and (2) the lead navigator organization in the 4 regions with the highest concentration of COFA citizens to provide enrollment assistance to the COFA community beyond the scope of the current COFA program. (Numbers represent both HCA and HBE allocations. A separate maintenance item not detailed here relates to changes in funding resulting from the restoration of COFA Migrant eligibility for Medicaid.) 4721,200
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Emergency Medical Service Costs/ Non-Citizen Hospital SurgeFunds emergency medical costs related to an additional 20 noncitizen long-term care beds funded in the DSHS portion of the budget (see below). 923923
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Cascade CareFunds Exchange premium assistance for individuals with income up to 250% FPL, as well as system costs, outreach, enrollment and customer support, and verification and reconciliation of premium subsidies under ESSB 5377 (standardized health plans, "Cascade Care 2.0"). Numbers incorporate both HCA and HBE allocations. 28958,301
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Universal Health Care CommissionFunds staffing costs and actuarial support for the Universal Health Care Commission under ESSB 5399 (universal health care commission).950950
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Generic Prescription DrugsFunds staffing and contracting costs related to generic drug purchasing under ESSB 5203 (generic prescription drugs).1,5881,588
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Audio-only TelemedicineFunds implementation of ESHB 1196 (audio-only telemedicine) related to rulemaking and staff to review standards and collaborate with OIC on telemedicine recommendations.411459
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Uninsured and underinsured careFunds for one-time grants for rural health centers, federally qualified health centers, public hospital districts, behavioral health administrative service organizations or providers/facilities, free clinics, or community-based organizations to provide health care services for uninsured and underinsured patients under 200% FPL, regardless of immigration status.035,000
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Home Health Social WorkerFunds a social worker as part of the medical assistance home health benefit.5321,131
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Indian Health Improvement ReinvestmentFunds Indian Health Improvement Advisory Plan projects, programs, and activities as authorized by RCW 43.71B.030.018,669
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WSHIP AssessmentExtends funding for the WA State Health Insurance Pool, per HB 1096 (nonmedicare plans). 1,3504,280
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Reentry ServicesFunds implementation of ESSB 5304 (reentry services), providing staffing and one-time system costs to expand the Medicaid suspension policy.4731,276
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HCA Provider Rates
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Tribal Residential SUD RatesAssumes federal payment of higher cost-based rates for substance use disorder treatment at tribal resident treatment facilities to Indian Health Service-eligible American Indians and Alaska Native Medicaid clients. 015,733
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Primary Care Case Mgmt - TribalFunds to increase the Primary Care Case Management rate from $3.00 to $6.00. These payments are used by tribal providers to coordinated Medicaid health services. 0258
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Family Planning Rate EnhancementEnhanced family planning rates for Title X providers. 5,21016,081
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Primary Care Provider Rate Increase Funds to increase primary care rates for the same set of evaluation and management and vaccine administration codes that were included in the temporary rate increase provided by the Affordable Care Act. 45,882123,878
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Behavioral Health Provider Rate IncreaseIncreases rates for behavioral health providers. 6,50017,509
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Non-Emergency Med Transport RateFunds increase in the non-emergency medical transportation broker administrative rate to ensure access to health care services for Medicaid patients.1,3093,463
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Sole Community HospitalOne-time funds to increase the rates paid to rural hospitals that were certified by CMS as Sole Community Hospitals as of 1/1/2013 with fewer than 150 acute care licensed beds in FY 2011 to 150% of the hospital's fee-for-service rate. 3,51910,166
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Adult Dental ServicesSen: Funds increased rates for fee-for-services adult Medicaid dental services by up to 100% of 2019 rates. 21,39076,046
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Dental Health Aid TherapistsNot funded in final. Sen & House had proposed funds to reimburse dental health aid therapists for services performed in tribal facilities for Medicaid clients. HCA must leverage any federal funding that may become available. 00
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MCO Behavioral Health Rate IncreaseFunds to continue a 2% increase to Medicaid reimbursement for community behavioral health providers contracted through Medicaid MCOs that was effective in April 2021. 17,01655,041
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Behavioral Health Provider ReliefOne-time funds for HCA to provide assistance payments to behavioral health providers that serve Medicaid and state-funded clients and have experienced revenue loss or increased expenses as a result of COVID-19. 031,000
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MCO Wrap-Around ServicesFunds MCOs to increase provider rates by 2% for non-Medicaid wraparound services, effective 7/2021.840840
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BHASO FundingFunds 2% rate increases for providers serving Behavioral Health Administrative Service Organization (BHASO) clients, effective 7/1/21, and for increases in other operating costs including local court costs for involuntary treatment hearings.6,7806,780
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PCAP Rate IncreaseFunds 2% percent rate increase for Parent Child Assistance Program providers, effective 7/1/21.234402
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CLIP Rate IncreaseFunds 2% rate increase for Children's Long-Term Inpatient Program providers, effective 7/1/21.228246
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Health Benefit Exchange - note that some items related to HBE are represented elsewhere in the HCA budget
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Facilitating EnrollmentWithin amounts appropriated, directs HBE to explore opportunities for enrollment of Washington residents who do not qualify for non- emergency Medicaid or federal affordability programs in a state-funded program no later than plan year 2024.N/AN/A
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HBE Sponsorship Program ImprovementEnhances the Exchange's sponsorship program to expand access to sponsored third-party premium or cost-sharing payments and improve customer service.0908
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Modernizing HealthplanfinderFunds improvements to Healthplanfinder IT system, including a modular health coverage application that can be more easily changed. 04,064
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HBE Business and Worker OutreachFunds enhanced Exchange support/outreach when owners and employees face a potential loss of employer-based health insurance coverage.0600
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Integrated Eligibility StudyFunds for the Exchange in cooperation with the Human Services Enterprise Coalition to develop a report on an integrated eligibility solution.146700
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Child Care NavigatorsPass-through funds for one or more lead navigator organizations to promote access to health services through outreach and insurance plan enrollment assistance for licensed child care facility employees.0400
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DEPARTMENT OF SOCIAL AND HEALTH SERVICES