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Published on Friday, March 4, 2016

Senate budget language potentially hampers efforts to support Medicaid programs, including housing and homelessness initiatives

The Senate’s proposed 2016 supplemental budget contains language that could hamper the Health Care Authority’s (HCA) efforts to support Washington’s efforts in transforming our health care delivery system through the Healthier Washington Initiative.

Upon adoption of the Affordable Care Act, Washington’s Apple Health Care program (Medicaid) extensively expanded its reach in coverage. Today it now covers 1 in 4 Washingtonians. Before, it covered mostly children. Adults are now the largest group served, and therefore the program includes more individuals with mental health and substance abuse disorders. This population requires a whole new set of medical care and long-term services and support. As a result, in August 2015 the HCA applied for a Medicaid Transformation Waiver with the federal government. The waiver, known as the “Section 1115 waiver”, provides an opportunity to accelerate the strides we are making through Healthier Washington to meet the unique needs of this growing, and changing Medicaid population. The waiver is a contract between the federal government and the state that “waives” some of the federal rules for Medicaid spending, allowing states to “reform the delivery system.” Washington’s goals include improving population health and reducing the use of intensive services and settings.

The 1115 waivers are not grants, and the state cannot spend any more federal dollars than would have been spent without the project. Waivers must show progress over a five-year demonstration period, be budget neutral for the federal government, be sustainable post-waiver, and include a comprehensive evaluation. Washington has asked for $3.5 billion over the five-year period.

Specifically, among its many objectives, the HCA proposes investments in a new supportive housing services Medicaid benefit investments in our long-term care system, the creation of health transformation projects that the newly created Accountable Communities of Health will be implementing, and an impact to the statewide behavioral and physical health integration efforts. The proposed investments will result in savings to the state budget, while also improving access to care and the health outcomes for vulnerable populations. Partners in this endeavor include local governments, managed care and behavioral health organizations, community services, and others.

Washington has not yet been granted the waiver and is awaiting direction from the federal government.

The proposed Senate budget includes language that prohibits the HCA from accepting or expending any federal funds received under the waiver until the Legislature appropriates it. If this language moves forward, the state waiver cannot go into effect and Washington risks losing the opportunity to realize significant improvements to our Medicaid program. The hold-up will affect the state and our communities’ efforts to bring desperately needed support services to our chronically homeless populations. This also becomes problematic with the timeline established by the HCA. If Washington is granted the waiver, it needs to start immediately on its efforts – there is a five-year timeline with the federal government.

AWC is tracking this issue and will continue to keep you apprised of developments.

Categories: Human services
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