2021-2023 state operating budget includes significant investments in supporting health equity

Monday, May 10, 2021

By Sue Birch, Director
Washington State Health Care Authority

The 2021 legislative session is finished, and the 21-23 state operating budget awaits Gov. Jay Inslee’s signature. When the session began, no one was sure what the revenue picture would look like and how much we could invest in supporting healthy individuals and communities.

I’m pleased to say the budget includes significant investments in enhancing our state health care delivery system, particularly to support health equity and access to high-quality services.

Highlights include:

Health care programs and services
  • Postpartum coverage: Funding is provided for extending health care coverage for an additional 10 months for postpartum persons who are eligible under pregnancy eligibility rules at the end of the 60-day postpartum period, to provide a total of 12 months postpartum coverage.
  • Opioid overdose medication: Funding is provided to implement Senate Bill 5195, which supports use of and education about opioid overdose reversal medication.
  • Medicaid Transformation Project: The 1115 waiver is extended for an additional year due to the pandemic.
  • Cascade Care: Funding is provided for premium assistance for individuals with income up to 250 percent of the federal poverty level and for system costs, outreach, enrollment and customer support, and verification and reconciliation of premium subsidies.
  • Apple Health adult dental: Funding is provided to increase rates for adult dental services.
  • Apple Health provider rates: Funding is provided to increase provider rates for certain primary care and behavioral health services to Apple Health clients.
  • Medical and psychiatric respite care: Funding is provided to develop an implementation plan to incorporate medical and psychiatric respite care as statewide Medicaid benefits and report by January 15, 2022.
  • Primary care initiative: One-time funding is provided for contracting to further the development and implementation of our primary care transformation effort.
  • Health Homes - Tribal Affairs: The Health Homes program integrates care within existing systems for high-risk, high-cost adults and children, including clients who are dually eligible for Medicare and Medicaid. Funding is provided to expand Health Home services to the American Indian (AI) and Alaska Native (AN) populations.
  • Primary care case management for tribal members: Primary Care Case Management payments are used by tribal providers to coordinate and monitor Medicaid services. Funding is provided to increase the Primary Care Case Management rate.
  • Uninsured and underinsured care: One-time grants are provided for rural health centers, federally qualified health centers, public hospital districts, behavioral health administrative service organizations, or free clinics to provide health care services for uninsured and underinsured patients, regardless of immigration status.
  • Family planning clinic rates: Funding is provided to increase provider rates for Title X family planning clinics.
  • Non-emergency medical transportation: Funding is provided to increase the non-emergency medical transportation broker administrative rate to ensure access to health care services for Apple Health clients.
Technology solutions
  • Interoperability: One-time funding is provided for a technology solution to meet patient health record access requirements as defined by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology in final interoperability rules published in March 2020.
  • Pharmacy point of sale: Funding is provided for a modular replacement of the ProviderOne pharmacy point of sale (POS) system.
HCA administrative budget

The budget directs HCA to achieve some administrative savings “by reducing and eliminating some contracts, supplies, equipment, vacancies, and trainings.” HCA leadership will review the proposed savings options we put forward last year as part of the pandemic response to determine next steps in achieving these savings.


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