All eyes are on the final biennial operating budget this week, which is due out any day now. Here at NoHLA, we’ll be watching for budget funding to expand affordable health care, including the launch of expanded access to health coverage for undocumented immigrants that could start as soon as January 2024. It is clear that the Senate and House have very different ideas of how to fund health coverage for over 100,000 Washingtonians. The House budget included ~$99 Million (M) in new funds including a Medicaid-comparable program, while the Senate’s significantly lower ~$22M in new funds comes in only the form of premium assistance through the Exchange. 

As funding for health coverage for immigrants makes its way through the budgetary process, NoHLA Policy Analyst Lee Che P. Leong explained the importance of this funding to KNKX’s Lilly Ana Fowler: “This is really about fairness. Immigrants make up a fifth of Washington’s workforce, but they don’t have equal access to health care and health coverage. And that puts our communities, our economy and our families at stake.”

While we’re waiting for budget news, here’s a list of bills impacting health access that have passed, in order of bill number:

• HB 1128, Personal needs allowance – (Passed, pending Governor action) This Dept. of Social and Health Services request bill will increase the personal needs allowance for clients in medical institutions or residential settings to $100 per month in 2023 and indexed thereafter, allowing Medicaid long-term care clients to keep more funds for basic necessities. 
• HB 1134, 988 system – (Passed, pending Governor action) This NAMI-WA priority bill will support the state’s new 988 behavioral health crisis hotline by laying the groundwork for crisis response teams and increasing public awareness.
• HB 1155, Consumer health data – (Passed, pending Governor action) The House concurred with the advocate-preferred Senate version of this Attorney General and abortion & gender justice coalition priority, which will prohibit selling consumer health data without the person’s authorization, making it harder for entities like period-tracking apps or crisis pregnancy centers to share sensitive reproductive health data. 
• HB 1188, Individuals with developmental disabilities – (Passed, pending Governor action) This Arc of WA priority bill will require the Caseload Forecast Council to forecast Developmental Disability Administration waiver slots for people with intellectual and developmental disabilities who are also receiving certain child welfare services, and will require DSHS to apply for a new Medicaid waiver to serve children and youth with developmental disabilities involved in certain child welfare services. 
• HB 1222, Hearing instruments coverage – (Passed, pending Governor action) This patient-led bill would require state-regulated large group plans to provide coverage for hearing instruments and would require the Office of the Insurance Commissioner (OIC) to include hearing instruments the next time it updates the Essential Health Benefits package for individual and small group plans.
• HB 1238, Free school meals – (Passed, pending Governor action) This priority from new House Health Care & Wellness Committee Chair Riccelli will provide free breakfast and lunch to public schools serving K-4 to any students that request the meals, beginning in schools with higher poverty levels. 
• HB 1260, Stability for people with work-limiting disability – (Passed, pending Governor action) This Statewide Poverty Action Network priority bill will improve eligibility for safety-net financial assistance programs ABD, HEN, and PWA, which in turn qualifies people for the Medical Care Services program. 
• HB 1357, Modernizing prior authorization – (Passed, pending Governor action) This WA State Medical Association priority bill will standardize prior authorization timelines and processes for state-regulated health plans and Medicaid managed care organizations. Prior authorization refers to health insurers’ decisions whether or not they agree to cover a person’s health care service. 
• HB 1407, Maintaining developmental disability services – (Passed, pending Governor action) This Arc of WA priority bill prevents DSHS from terminating eligibility for developmental disabilities services solely due to age when a child has been determined eligible on or after the child’s third birthday. 
• HB 1469, Reproductive and gender-affirming treatment access – (Passed, pending Governor action) This reproductive coalition priority would shield providers of sensitive health services like abortion from criminal proceedings and extradition to other states. 
• HB 1515, Behavioral health medical assistance contracting – (Passed, pending Governor action) This King County priority bill would require the Health Care Authority to make changes to the Medicaid managed care organization procurement and contracting process for behavioral health services, including statewide behavioral health network adequacy standards. 
• HB 1626, Colorectal screening tests – (Passed, pending Governor action) This bill requires Apple Health to cover preventive colorectal cancer screening tests, as well as follow-up colonoscopies after a positive test result. 
• HB 1678, Expanding dental therapy – (Passed, pending Governor action) This Dental Access Coalition priority will authorize dental therapists to practice in FQHCs and look-alikes.
• HB 1745, Clinical trials diversity – (Passed, pending Governor action) This Patient Coalition of WA priority bill will require state universities, hospitals, and agencies that receive federal funding for prescription drug or medical device clinical trials to take steps to recruit participants from underrepresented demographic groups. This bill is similar, but not identical, to SB 5388, which died in House Rules. 
• HB 1850, Hospital safety net program – (Passed House, pending in Senate but “necessary to implement the budget”) This WA State Hospital Association priority bill would revise the existing hospital safety net assessment to draw down additional federal funds, which are returned to hospitals and the general fund. 
• SB 5036, Audio-only telemedicine – (Passed and signed by Governor) This bill extends the existing law for provider reimbursement for audio-only telemedicine in certain circumstances until July 2024. 
• SB 5103, Difficult to discharge Medicaid patients – (Passed, pending Governor action) This WA State Hospital Association priority bill will increase reimbursement for Apple Health patients who no longer need acute inpatient care, but cannot be safely discharged for specific reasons. 
• SB 5120, 23-hour crisis relief centers – (Passed but final version in dispute) This NAMI-WA priority bill will direct the Dept. of Health to license 23-hour Crisis Relief Centers, a new type of crisis diversion facility to serve people regardless of behavioral health acuity instead of jails or hospitals. 
• SB 5130, Assisted outpatient treatment – (Passed but final version in dispute) This AOT petition bill reduces the burden of proof from “clear, cogent, and convincing” to a preponderance of the evidence and allows a behavioral health case manager to file the supporting declaration for an AOT petition. 
• SB 5179, Death with Dignity access – (Passed and signed by Governor) This End of Life WA priority bill will expand the types of providers authorized to perform the duties of the Death with Dignity Act and reduce waiting periods to request these services. 
• SB 5236, Safe & Healthy – (Passed, pending Governor action) This SEIU 1199 NW priority bill will set staffing loads and working conditions to support frontline healthcare workers and will impose penalties for violations of meal and rest breaks and overtime restrictions. 
• SB 5242, No abortion cost-sharing – (Passed, pending Governor action) This abortion & gender justice coalition priority would eliminate cost-sharing for abortion services in state-regulated private health plans. 
• SB 5263, Psilocybin services – (Passed, pending Governor action) This bill would establish various state bodies to develop a regulatory framework for access to clinical psilocybin, including a pilot program for psilocybin therapy at the U. of Washington. 
• SB 5300, Behavioral health drug continuity of care – (Passed, pending Governor action) This NAMI-WA priority bill will prohibit state-regulated health plans and Medicaid managed care organizations from changing their formulary or increasing cost-sharing mid-year for certain prescription drugs for serious mental illness. 
• SB 5304, Language access testing – (Passed and signed by Governor) This Interpreters United union priority bill will require the Dept. of Social and Health Services to administer language access provider testing that meets certain requirements and creates a new workgroup to make recommendations related to interpreter services. 
• SB 5338, Essential Health Benefits review – (Passed and signed by Governor) This bill directs the Office of the Insurance Commissioner to review the state’s essential health benefits by Dec. 2023 and determine whether to request federal approval to update those benefits.
• SB 5365, Minor vaping and tobacco use – (Passed, pending Governor action) This public health priority bill increases penalties for retailers that sell tobacco and vapor products to minors while modifying the approach to enforcement for minors that purchase or possess such products, with the goal of reducing police contact. 
• SB 5396, Breast exam cost-sharing – (Passed, pending Governor action) Starting January 2024, this bill will require state-regulated private health plans that cover supplemental and diagnostic breast exams to do so without cost-sharing. 
• SB 5497, Medicaid expenditures – (Passed, pending Governor action) This bill heightens Health Care Authority responsibilities in maintaining program integrity over health programs, including HCA contracts with Medicaid managed care organizations. 
• SB 5532, Enhanced rural hospital payment – (Passed, pending Governor action) This bill temporarily increases the Medicaid reimbursement rate for Astria Toppenish Hospital. 
• SB 5581, Maternity care access – (Passed, pending Governor action) This bill will require OIC to develop strategies to reduce cost-sharing for maternity care services in state-regulated private health plans. Unfortunately, a related bill SB 5580, died in House Rules–that bill would have raised the income limit for pregnancy/postpartum Apple Health from 193% FPL to 210% FPL and expanded other perinatal and postpartum care services. 
• SB 5729, Insulin cost-sharing cap – (Passed and signed by Governor) This diabetes patient priority bill makes permanent the existing law that requires state-regulated private health plans to limit enrollee cost-sharing for insulin to $35 for a 30-day supply. 
• SB 5768, Access to medication abortion – (Passed Senate, pending in House but “necessary to implement the budget”) This bill would authorize the Dept. of Corrections to purchase, dispense, and distribute medication abortion drugs.
• SB 5599, Youth protected health care services – (Passed, pending Governor action) This priority for youth-serving organizations allows a runaway/homeless shelter to avoid notifying the youth’s parents/guardians if the youth is seeking protected health services, such as reproductive or gender-affirming care. 
• SB 5700, Health Care Authority statute modernization – (Passed and signed by Governor) This Health Care Authority priority bill would make technical “clean-up” amendments to HCA statutes, including provisions related to Apple Health, public employees’ health benefits, and the Health Care Cost Transparency Board.