As bill action wraps up over the next week, all eyes will turn to the 2024 supplemental budget. Budget activity kicked off last week with a positive start, as the Economic & Revenue Forecast Council released a slightly favorable quarterly update to its revenue forecast. Next, the Senate proposed its operating budget this past Sunday and the House proposed its operating budget this past Monday. In the coming days, the two chambers will finalize their budget proposals and then will enter negotiations on the final supplemental budget.  

Here are just a few of the many items related to health access, affordability, and equity we noticed in preliminary review of the proposed budgets and will be keeping an eye on:

• Immigrant health equity. The Senate and the House proposals took very different approaches to community-led calls for enhanced funding for undocumented immigrant health coverage expansions that are starting in 2024 but were underfunded in last session’s budget. While the House included ~$29.4 million in new funds for the Apple Health Expansion, including ~$27.5 million to expand enrollment capacity and $1 million for immigrant-led community education, the Senate only included ~$3.8 million in implementation funds. We hope to see the House approach in the final budget. 

• Apple Health coverage improvements. We were glad to see that both the Senate and the House proposals include policies to help lower-income people retain health coverage when their circumstances change, as both sides:
  • Appropriated ongoing funds related to ensuring orderly implementation of the post-pandemic Apple Health coverage “wind-down” process and transition to new coverage where needed. 
  • Assumed implementation of continuously-renewed Apple Health coverage for children up to age 6 in the Children’s Health Insurance Program, an expansion of last year’s policy to extend such continuous coverage to children in Medicaid. 
  • Prioritized addressing coverage gaps as people “churn” between Apple Health and Exchange coverage, including a study about ways to address this problem that disrupts care.

Disappointingly, neither budget took action to restore access to eyeglasses and contact lenses for adults in Apple Health. These essential benefits were cut during the Great Recession and still have not been restored a decade later, leaving lower-income people in our state without the vision care they need to thrive. 

• Medicare-Medicaid dual coverage expansion. Given our long-standing interest in solutions to the Medicare affordability cliff that harms many elders and people with disabilities, we are excited by a House budget proposal to study expansion of “dual” Medicaid coverage for more low-income Medicare enrollees. Shout out to our friends at Health Care for All – Washington for advocacy on this issue! 

• Health care affordability. The Senate and the House proposals agreed on the need to get to the bottom of what’s driving our health care affordability crisis, with studies to look at this issue. Both budget proposals included additional funds that would help the Health Care Cost Transparency Board and Office of the Insurance Commissioner accelerate their ongoing work to examine health care cost trends and policy options to improve health care affordability. We hope to see continued agreement in this area in the final budget. 

These have yet to be finalized – we’ll continue to keep you posted on what we’re watching as the budget process unfolds.