There have been many bill hearings as the Legislature sprinted toward the opposite house policy cutoff on March 29th and the opposite house fiscal cutoff earlier this week on April 4th. Now we’re in the final stretch for bills to make it out of the Rules Committee and receive a vote on the floor before the next April 12th deadline. 

In addition to bills, the Legislature has now turned its attention to the 2023-25 biennial budget. The Senate and House have both released and voted on their operating budget proposals. Both budgets account for the Spring Quarterly Economic & Revenue Forecast, which showed a roughly billion dollar downward trend in state revenue and budget projections over the next four years. To give an idea of scale, the 2021-23 state budget was ~$65 billion. While the recent state Supreme Court decision to uphold the capital gains tax will bring in about $500 million in new revenue, these funds have already been allocated. 

Both budget proposals allocate roughly $70 billion, including $5 billion in new spending on each side, but there are major differences in how the chambers would allocate these funds, including differences in spending that affect NoHLA priorities. The Legislature will face difficult decisions in the weeks ahead about how to fund key priorities, such as major investments in behavioral health and housing supports. Budget negotiations will begin this week, with a goal of finalizing the budget by April 23rd. 

These are the key items we’re watching in the budget negotiations that includes funding for Health Equity for Immigrants, funding the “QMB” Medicare Savings Program, expanding Apple Health benefits and many more. 

• Health Equity for Immigrants: The House included ~$99M (Million) in new funds for immigrant health coverage, including a Medicaid-comparable program as requested by community leaders, while the Senate only included ~$19M in new funds for Exchange premium assistance. Both budgets would start the new health coverage assistance in January 2024. 
• Medicare Affordability Cliff: The House, but not the Senate, included nearly $11M in new funds to expand eligibility for the “QMB” Medicare Savings Program. Starting in April 2024, the House would expand this program to cover premiums and cost-sharing for Medicare enrollees with income up to 120% of the federal poverty level. This smart investment would draw down federal matching funds to help more than 25,000 low-income elders and people with disabilities. 
• Apple Health benefits: Both budgets would expand benefits for adults enrolled in Apple Health, including acupuncture, chiropractic, cochlear implants, and the number of allowable periodontal treatments. The Senate would start some of these services sooner in 2024, while the House would delay until 2025. 
• Cascade Care Savings premium assistance: Both budgets maintain an existing $100M appropriation for Cascade Care Savings premium assistance with an additional $10M now that the 1332 waiver has been approved, which helps make Exchange coverage more affordable, and also provide funds to implement the state’s new 1332 waiver. 
• Public Health Emergency wind-down: Both budgets would carry forward and expand funds to allow the Exchange to conduct outreach to people losing Apple Health coverage as the federal “continuous coverage” pandemic protections begin to wind-down this spring. 
• Reproductive health care: Both budgets add new funds to support abortion care, including funds to support workforce retention and recruitment. The Senate budget would also fund implementation of ESSB 5580, which would expand eligibility for Apple Health Pregnancy and Pregnancy After Care from 193% FPL to 210% FPL. 
• Difficult to discharge patients: Both budgets would add over $250M in new funds to address patients who no longer need hospital-level care but have been unable to find community or nursing facility placements, but there are differences in the funding level and specific investments. 

Health workforce: Both budgets would make substantial investments in the health care workforce. The House funds a 15% rate increase for Medicaid behavioral health providers, while the Senate funds a 7% rate increase. The proposals would also increase rates for home care and nursing home providers, kidney dialysis providers, and ground ambulance providers, among others.

What’s helping to pay for all these investments? The Legislature is evaluating a revised Hospital Safety Net Assessment program. This long-standing program allows the state to tax Washington hospital revenue, draw down federal funds, and use the proceeds for supplemental payments to hospitals. Under a set of new companion bills (HB 1850/SB 5764), the program would be reauthorized in 2025. Hospitals are expected to retain approximately $2.6 Billion in additional funding a biennium. While the deal also raises substantial new state general funds, NoHLA and other advocates have raised questions about whether there’s sufficient transparency about whether the funds are meeting their goal: to improve Medicaid access for patients. 

Want more budget details? Check out the House budget summary and the Senate budget summary, as well as comparison summaries from the Arc of Washington, WA State Hospital Association, and the Statewide Poverty Action Network. 

Here’s an update on the rest of the bills we’re watching. All of these bills have passed out of one chamber and are under consideration in the second chamber.

Spoiler Alert: several have passed both houses and some are awaiting the Governor’s signature!

• HB 1128, Personal needs allowance – In the Rules Committee (“Rules”), this Dept. of Social and Health Services agency request bill would 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 – In Rules, this NAMI-WA priority bill would 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 by both chambers, this Attorney General and abortion & gender justice coalition priority would prohibit selling consumer health data without the person’s authorization with the effect of 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 – In Rules, this Arc of WA priority bill would 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 would 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 by both chambers, 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 – In Rules, this priority from new House Health Care & Wellness committee Chair Riccelli would provide free breakfast and lunch to K-4 students beginning in public schools with higher poverty levels. 
• HB 1260, Stability for people with work-limiting disability – In Rules, this Statewide Poverty Action Network priority bill would 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 – In Rules, this WA State Medical Association priority bill would 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 – In Rules, 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 – In Rules, this reproductive coalition priority would shield providers of sensitive health services like abortion from criminal proceedings in and extradition to other states. 
• HB 1515, Behavioral health medical assistance contracting – In Rules, 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. 
• ESHB 1678, Expanding dental therapy – Pending in the Senate, this Dental Access Coalition priority would authorize dental therapists to practice in FQHCs and look-alikes.
• HB 1745, Clinical trials diversity – In Rules, this Patient Coalition of WA priority bill would 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 is also referred to Rules in the opposite chamber. 
• SB 5103, Difficult to discharge Medicaid patients – In Rules, this WA State Hospital Association priority bill would 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 – In Rules, this NAMI-WA priority bill would 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 – In Rules, 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 – Awaiting the Governor’s signature, this End of Life WA priority bill would 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 – In Rules, this SEIU 1199 NW priority bill would set staffing loads and working conditions to support frontline healthcare workers. It was voted out of the House Labor & Workplace Standards committee.
• SB 5242, No abortion cost-sharing – In Rules, this abortion & gender justice coalition priority would eliminate cost-sharing for abortion services in state-regulated private health plans. 
• SB 5300, Behavioral health drug continuity of care – Pending in the House, this NAMI-WA priority bill would 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 both chambers, this Interpreters United union priority bill would 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 both chambers, this bill directs the Office of the Insurance Commissioner to review the state’s essential health benefits and determine whether to request federal approval to update those benefits.
• SB 5580 and SB 5581, Maternity care access – This bill duo would expand access to maternity care services. SB 5580, in Rules, would increase the income limit for pregnancy/postpartum Apple Health from 193% FPL to 210% FPL and expand other perinatal and postpartum care services. SB 5581, in Rules, would require OIC to develop strategies to reduce cost-sharing for maternity care services in state-regulated private health plans. 
• SB 5700, Health Care Authority statute modernization – Awaiting the Governor’s signature, this Health Care Authority priority bill would make technical “clean-up” amendments to HCA statutes, including provisions related to Apple Health, PEBB/SEBB, and the Health Care Cost Transparency Board. 

The bills we were watching that did not make it past cutoff and are now dead for this session include:

• SB 5632 (striking worker premium assistance), which would require the Health Benefit Exchange to administer a premium assistance program for employees who lose employer-sponsored health insurance as a result of a labor dispute, didn’t make it out of Appropriations; and
• SB 5486/HB 1473 (wealth tax), which would raise new revenue by establishing a 1% tax on financial intangible assets in excess of $250 million, didn’t make it out of committee. However, the recent court decision affirming a capital gains tax has supporters hopeful that there will be more momentum for next session.