Washington’s legislative session has come to a close, and thanks to persistent advocacy we are celebrating significant advances for health equity! 

Governor Inslee has signed legislation protecting consumers from surprise medical bills (E2SHB 1688), expanding statewide charity care standards (SHB 1616) and preserving and expanding a pregnant person’s ability to access abortion (HB 1851) as well many other bills addressing health. Our analysis can be found below, with details of all health access bills in our Bill Summary and Budget Analysis, but let’s begin with NoHLA’s top two priorities followed by highlights of other important health legislation:

Addressing the Medicare affordability cliff 

Washington will begin to address the “Medicare Affordability Cliff” by eliminating the onerous asset test that prevents people on Medicare from accessing assistance with health care costs through Medicare Savings Programs (MSPs) if they have modest savings. MSPs are programs offered through the Health Care Authority that pay Medicare premiums, and sometimes cost-sharing, for low-income individuals. Until now, these programs were only available to people with very limited assets. These limits will be removed in 2023, though income thresholds will still apply. We applaud this first step toward addressing disparities in affordability that older adults and persons with disabilities experience compared to younger, non-disabled adults who qualify for full Medicaid coverage or less costly Exchange coverage, at comparatively higher income limits and without regard to assets.  

The 2022 budget also includes funding for a comprehensive study of options the state could take to further expand Medicare affordability assistance programs with help from federal funds. The study will look at steps 34 other states have taken to enable more older adults and people with disabilities to qualify for help.

 Justice in Aging, a national advocacy organization working to protect and improve the rights of low-income older adults, featured NoHLA’s work in their national overview of these challenges in their recent issue brief (page 4). 

Advancing health equity for immigrants

We are excited that budget spending has been finalized to create a pathway to new coverage for immigrants, a major priority of NoHLA’s. Beginning in 2024, a “Medicaid equivalent” program for those with incomes up to 138% FPL will become available, administered by the Health Care Authority. In addition, a Health Benefit Exchange-based health insurance program will include subsidies for people just above that income level. The Spokesman-Review recently featured Washington’s effort to launch programs for future health coverage for uninsured adults regardless of their immigration status. Sen. June Robinson also highlighted this advance in her article about mending Washington’s safety net this session. 

While development of these programs can now proceed, the Legislature must still allocate funding for the program costs in the next biennial budget, which will require advocates to push hard. Stay tuned!

Other improvements for low-income Washingtonians

Before diving into the Bill Summary and Budget Analysis in full, here are some additional bills we want to highlight:

The Legislature provided additional support to Washington residents in need of care and those faced with medical bills, and they took steps toward further reforms. Here are some key bills:

·         Low-income residents receiving in-home long-term care will now be able to keep significantly more of their income through a large increase in the Personal Needs Allowance, enabling them to cover housing, food and basic necessities. (SSB 5745)

·         With the passage of HB 1748, Victims of Human Trafficking will be eligible for financial and medical support through programs already available to citizens and other immigrants.

·         “Apple Health and Homes” (ESHB 1866) is a new initiative to create permanent supportive housing and community support services for low-income individuals with medical or behavioral health risk factors. This bill recognizes the positive impact that stable housing can have on medical and behavioral health conditions, and is an effort to create such housing for vulnerable individuals. It was championed by outgoing Representative and former Speaker of the House Frank Chopp and applies to individuals eligible for Apple Health and those who would qualify but for their immigration status.

·         SHB 1616 revised the minimum requirements for hospitals to provide charity care to low-income persons, enabling more consumers to avoid crushing medical debt. Larger hospitals must write off all charges for those with income up to 300% of the federal poverty level (FPL), with partial write-offs up to 400% FPL. For smaller hospitals, full charity care must be provided to 200% FPL and partial write-offs up to 300% FPL. The bill also excludes certain assets from consideration for partial write-offs.

·         The state’s surprise billing law has been revised to strengthen consumer protections against high health care prices. E2SHB 1688 builds on state law and incorporates new federal protections from the No Surprises Act. The amendments will protect consumers from out-of-network bills for emergency behavioral health services, post-emergency stabilization services, and air ambulance services.

·         2SSB 5532 creates a state prescription drug affordability board to oversee prescription drug price increases. Although it is limited in authority, we hope it will be strengthened in the future to have an impact on prices.

·         SSB 5729 created a good cause exception to request a public benefits hearing, allowing an extension beyond the 90-day limit for those requests when there are extenuating circumstances.

In other news, the Washington Cares Fund – the new long-term care program – was delayed until July 2023, and a bill that would have required minimum customer service standards for DSHS was vetoed. We are watching these issues closely. 

These are just a few of the many changes our Legislature made this session. Our final Bill Summary and Supplemental Budget Summary include many more bills and budget outlays that relate to health care access and related policies. 

A sincere thanks to the legislative champions who worked hard to achieve these wins, and to our advocacy and community partners who campaigned to expand health access and improve health equity in the years to come.

Here are the full summaries of final enacted bills and supplemental budget provisions that relate to health care access. 

A sincere thanks to the legislative champions who worked hard to achieve these wins, and to our advocacy and community partners who campaigned to expand health access and improve health equity in the years to come.