Washington State Health Care Authority
| Average Annual FTEs | Near General Fund State | Other Funds | Total Funds | |
|---|---|---|---|---|
| (Dollars in Thousands) | ||||
| Current Budget | 1,721.6 | 8,924,197 | 29,108,901 | 38,033,098 |
| 2025-27 Maintenance Level | 1,721.6 | 9,275,890 | 29,399,196 | 38,675,086 |
| Difference from 2025-27 Original | 0.0 | 351,693 | 290,295 | 641,988 |
| % Change from 2025-27 Original | 0.0% | 3.9% | 1.00% | 1.7% |
2026 Policy Other Changes |
||||
| 1915i CBHS Services | 0.0 | 11,505 | 7,702 | 19,207 |
| AHE Caseload change | 0.0 | (59,758) | 0 | (59,758) |
| AHE Service Delivery Change Cost | 0.0 | (2,091) | (2,091) | (4,182) |
| Administrative Reduction | 0.0 | (3,020) | 0 | (3,020) |
| B247 Enrollment File Functionality | 0.0 | 0 | 3,600 | 3,600 |
| CMS Eligibility Solution | 0.0 | 632 | 2,772 | 3,404 |
| Cannabis Revenue Distributions | 0.0 | 58,122 | (58,122) | 0 |
| Cert Comm BH Clinic Implementation | 1.3 | 2,841 | 8,523 | 11,364 |
| Changes to Federal Medicaid Laws | 49.4 | 3,142 | 7,481 | 10,623 |
| Community Beds at OHBH | 0.0 | (7,682) | (3,457) | (11,139) |
| Fed Eligibility & Managed Care Chgs | 3.9 | 1,264 | 2,594 | 3,858 |
| HBE-Cascade Care Savings | 0.0 | 0 | 25,000 | 25,000 |
| HBE-Lead Organization M&O Increase | 0.0 | 8 | 343 | 351 |
| HCMACS Enterprise EHR | 0.0 | (8,573) | (59,060) | (67,633) |
| HR 1 Fed Reductions | 0.0 | 10,774 | 0 | 10,774 |
| HR1 Rural Transformation Program | 0.0 | 0 | 150,000 | 150,000 |
| Health Homes Continuation | 0.0 | 6,346 | 12,147 | 18,493 |
| Indian Health Investment Account | 0.0 | 0 | 50 | 50 |
| Interops & Prior Auth Requirements | 6.0 | 1,347 | 2,855 | 4,202 |
| Long-term Civil Commitment Beds | 0.0 | (21,517) | (11,174) | (32,691) |
| MTP 2.0: Long Term Supports Srvcs | 0.0 | 0 | (25,707) | (25,707) |
| MTP 2.0: Reentry Capacity Bldg Prgm | 0.0 | (707) | (39,987) | (40,694) |
| Master Person Index | 0.0 | (1,179) | 2,262 | 1,083 |
| Maternal Outcomes Underspend | 0.0 | (1,340) | (2,143) | (3,483) |
| Medicaid Access Program | (3.0) | 0 | (98,285) | (98,285) |
| Medicaid Quality Improvement Prgm | 0.0 | 0 | 85,986 | 85,986 |
| Medicaid Transformation Prjct 2.0 | 0.0 | 0 | 17,120 | 17,120 |
| Mobile Opioid Treatment Fund Shift | 0.0 | (6,510) | 6,510 | 0 |
| Newborn Screening Fee Increase | 0.0 | 74 | 204 | 278 |
| Opioid Awareness Fund Shift | 0.0 | (2,000) | 2,000 | 0 |
| Outreach/Intensive Case Management | 0.0 | (1,960) | 0 | (1,960) |
| PAL Carrier Assessment | 0.0 | (282) | 282 | 0 |
| Pharmacy Service shift to FFS | 0.0 | (7,500) | (13,000) | (20,500) |
| Pub Hlth Disp Machines Fund Shift | 0.0 | (600) | 600 | 0 |
| Restore Program Integrity Savings | 0.0 | 71,000 | 159,000 | 230,000 |
| Same Day Visit Fund Shift | 0.0 | (2,336) | 2,336 | 0 |
| Site Neutral Payment | 0.0 | (11,000) | (27,000) | (38,000) |
| Stanwood Commitment Facility Beds | 0.0 | 2,289 | (206) | 2,083 |
| Street Medicine Fund Shift | 0.0 | (2,650) | 2,650 | 0 |
| Thurston County ITA Judicial Costs | 0.0 | 85 | 0 | 85 |
| Tribal Fentanyl Summit | 0.0 | 0 | 600 | 600 |
| UW 90/180 Beds | 0.0 | 0 | 78,554 | 78,554 |
| Work Requirement IT Project | 3.3 | 6,050 | 36,392 | 42,442 |
| 2026 Policy Other Changes Total | 60.9 | 34,774 | 277,331 | 312,105 |
2026 Policy Central Services Changes |
||||
| Administrative Hearings | 0.0 | 34 | 32 | 66 |
| Audit Services | 0.0 | 6 | 10 | 16 |
| DES Central Services | 0.0 | 54 | 92 | 146 |
| GOV Central Services | 0.0 | 26 | 43 | 69 |
| Legal Services | 0.0 | 20 | 26 | 46 |
| OFM Central Services | 0.0 | 2,510 | 536 | 3,046 |
| Self-Insurance Liability Premium | 0.0 | 236 | 385 | 621 |
| WTS Central Services | 0.0 | 84 | 138 | 222 |
| 2026 Policy Central Services Changes Total | 0.0 | 2,970 | 1,262 | 4,232 |
| Total Policy Changes | 60.9 | 37,744 | 278,593 | 316,337 |
| 2026 Policy Level | 1,782.5 | 9,313,634 | 29,677,789 | 38,991,423 |
| Difference from 2025-27 Original | 60.9 | 389,437 | 568,888 | 958,325 |
| % Change from 2025-27 Original | 3.5% | 4.4% | 2.0% | 2.5% |
Policy Changes
1915i CBHS Services
Funding is provided to support the increasing caseload for the Community Behavioral Health Supports program. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
AHE Caseload change
Funding is reduced due to Apple Health Expansion caseload decrease. (General Fund - State)
AHE Service Delivery Change Cost
Funding is reduced to account for federal required move from managed care to fee for service. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Administrative Hearings
Adjustments are made for each agency's anticipated cost of administrative hearings from the Office of Administrative Hearings. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State)
Administrative Reduction
Funding is reduced to reflect a reduction in administrative services. (General Fund - State)
Audit Services
Adjustments are made for each agency's anticipated cost of audits performed by the Washington State Auditor. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
B247 Enrollment File Functionality
Funding is provided for project management and a reconfiguration of the state's Benefits 24/7 enrollment system to support the generation and distribution of EDI 834 enrollment files. (School Employees' Insur Admin Acct - State, St Health Care Authority Admin Acct - State)
CMS Eligibility Solution
Funding to upgrade Health Plan Finder to comply with Centers for Medicare and Medicaid Services (CMS) mitigation plan requiring Washington to streamline eligibility verification process. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Cannabis Revenue Distributions
Appropriations from the Dedicated Cannabis Account are adjusted pursuant to Chapter 169, Laws of 2022 (E2SSB 5796) and the November 2025 revenue forecast. (Basic Health Plan Trust Account - Non-Appropriated, Dedicated Cannabis Account - State, General Fund - State)
Cert Comm BH Clinic Implementation
Funding is provided for the Health Care Authority to identify two facilities to be certified as Certified Community Behavioral Health Clinics to participate in a federal demonstration program. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - State, other funds)
Changes to Federal Medicaid Laws
Funding is provided to comply with increased client eligibility verifications due to H.R. 1 rule changes. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Community Beds at OHBH
Contracting for community beds is delayed until fiscal year 2028. Funding is reduced reflect this delay. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
DES Central Services
Adjustments are made to reflect each agency's anticipated share of charges from the Department of Enterprise Services for Capitol Campus costs; real estate, risk management, and small agency services; the Perry Street and Capitol Campus child care centers; enterprise applications, and other items. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
Fed Eligibility & Managed Care Chgs
Funding is provided to comply with new CMS Managed Care rules. HCA is required to staff two client-focused committees, improve the Managed Care Quality Rating System and improve Medicaid Provider directory. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
GOV Central Services
Adjustments are made to reflect each agency's anticipated share of charges from the Office of the Governor for the Office of Equity. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
HBE-Cascade Care Savings
Funding is provided to continue premium assistance for qualified health plans for Washingtonians under 250% of the federal poverty limit, who are ineligible for Medicaid or Medicare. (State Health Care Affordability Acc - State)
HBE-Lead Organization M&O Increase
Funding is provided to support increased contract costs for the statewide network of Lead Organizations that help Washingtonians understand their health care options. (General Fund - Cash, General Fund - Medicaid Federal, Health Benefit Exchange Account - State, other funds)
HCMACS Enterprise EHR
Funding is reduced to align shifting HCMACs program from HCA to UW. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - State, other funds)
HR 1 Fed Reductions
Funding is provided to address the impacts of federal changes to Medicaid eligibility tied to immigration status. Beginning in October 2026, many lawfully residing non-citizens including refugees, asylees, and victims of human trafficking, will lose access to Medicaid. This provides funding for 500 additional non-citizens for clients currently receiving long-term care and developmental disability services. (General Fund - State)
HR1 Rural Transformation Program
Federal authority is provided to implement the Rural Transformation Program provided for under H.R.1. (General Fund - Federal)
Health Homes Continuation
Funding is provided to continue the Health Homes program through calendar year 2027. The Health Homes program provides case management services to the Medicaid and dual Medicaid/Medicare populations to improve health outcomes and manage resources. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Indian Health Investment Account
Funding for the Indian Health Improvement Account. Funding generated from additional federal financial participation due to signed care coordination agreements between tribes and medical providers. (Indian Health Improvement Rein Acct - Non-Appropriated)
Interops & Prior Auth Requirements
Funding is provided to comply with CMS rule CMS-0057-F. This rule requires states to improve electronic exchange of health care data and streamline processes related to prior authorization. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Legal Services
Adjustments are made for each agency's anticipated cost of legal services provided by the Office of the Attorney General. Funding provided in the central service model is not all inclusive, as legal services expenditures are based on consumption. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
Long-term Civil Commitment Beds
Funding is adjusted to align with projected expenditures for individuals on 90-day to 180-day civil commitment orders who are served in community settings. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
MTP 2.0: Long Term Supports Srvcs
Funding is provided through MQIP to align appropriation authority with anticipated MTP spending for long-term-care supports. (General Fund - Federal, General Fund - Local, General Fund - Private/Local)
MTP 2.0: Reentry Capacity Bldg Prgm
Funding is provided through MQIP to support infrastructure for communities, prisons, jails, and juvenile rehabilitation centers to implement the limited pre-release and reentry services authorized in the MTP by CMS. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - State, other funds)
Master Person Index
Funding is provided to improve the Master Person Index that will allow the state to comply with CMS mitigation plan requiring Washington to streamline eligibility verification and assist with implementation of community engagement verification hub. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Maternal Outcomes Underspend
Funding is shifted between fiscal years due to delays in implementation of Maternal Outcomes legislation from the 2025 legislative session. The Health Care Authority (HCA) intends to begin implementation as of July 2026. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Medicaid Access Program
Funding is reduced due to federal law changes on provider taxes that do not allow for the Medicaid Access Program to be implemented (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Medicaid Quality Improvement Prgm
The Medicaid Quality Improvement Program (MQIP) will be used to support the 1115 Medicaid Transformation Project (MTP) waiver. Apple Health managed care organizations and their partnering providers will receive MQIP payments as they meet designated milestones. Funding is adjusted to reflect anticipated program expenditures. (General Fund - Federal, General Fund - Local, General Fund - Private/Local)
Medicaid Transformation Prjct 2.0
Funding is provided through MQIP to align appropriation authority with anticipated MTP expenditures for the health-related social need program. (General Fund - Federal, General Fund - Local, General Fund - Private/Local)
Mobile Opioid Treatment Fund Shift
Funding for mobile opioid treatment services is shifted from General Fund-State to the Opioid Abatement Settlement Account. (General Fund - State, Opioid Abatement Settlement Account - State)
Newborn Screening Fee Increase
Funding to pay for $15 newborn screening fee assessed by DOH for Medicaid births. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
OFM Central Services
Adjustments are made to reflect each agency's anticipated share of charges from the Office of Financial Management for existing statewide applications, the One Washington program, and other central services. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
Opioid Awareness Fund Shift
Funding for opioid awareness marketing is shifted from General Fund-State to the Opioid Abatement Settlement Account. (General Fund - State, Opioid Abatement Settlement Account - State)
Outreach/Intensive Case Management
Funding for Recovery Navigator Program services is reduced by 10%. (General Fund - State)
PAL Carrier Assessment
Washington operates four Partnership Access Lines that provide support to primary care providers and patients and their families to manage psychiatric needs. Funding is shifted from general fund state to the Telebehavioral Health Account for administrative costs to support the program. (General Fund - State, Telebehavorial Health Access Accoun - State)
Pharmacy Service shift to FFS
Funding is reduced to assume savings from shifting pharmacy benefit from managed care to fee for service. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Pub Hlth Disp Machines Fund Shift
Funding for public health dispensing machines is shifted from General Fund-State to the Opioid Abatement Settlement Account. (General Fund - State, Opioid Abatement Settlement Account - State)
Restore Program Integrity Savings
Funding is provided to back fill savings assumed in the 2025–27 biennial budget that are already captured in the agency’s base budget. This will restore funding for fiscal year 2026 only. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Same Day Visit Fund Shift
Funding for the Same Day Visit program is shifted from General Fund-State to the Opioid Abatement Settlement Account. (General Fund - State, Opioid Abatement Settlement Account - State)
Self-Insurance Liability Premium
Adjustments are made to reflect each agency's share of actuarially projected costs of the self-insurance liability premium. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
Site Neutral Payment
Funding is reduced to assume savings related to requiring HCA to pay for clinic services at the same rate regardless of hospital affiliation. Currently, hospital-based clinics are compensated at a higher rate. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Stanwood Commitment Facility Beds
Under a tax sharing compact between the Tulalip Tribes and the state, a civil commitment facility was developed in Stanwood. Funding is adjusted based on updated utilization estimates for this facility. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - State, other funds)
Street Medicine Fund Shift
A portion of the funding for street medicince teams is shifted from General Fund-State to Medicaid because this program is now Medicaid eligible. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Thurston County ITA Judicial Costs
Funding is adjusted for the Thurston-Mason Behavioral Health Administrative Services Organization due to anticipated increases for Involuntary Treatment Act judicial costs for civil patients at the Department of Social and Health Services operated Maple Lane campus. This increase includes adjustments for the opening of the Baker Unit at Maple Lane. (General Fund - State)
Tribal Fentanyl Summit
Funding is continued for a summit that brings Tribal leaders, the governor, and state agency leaders together to discuss the impact of the opioid crisis on Native communities across Washington. (Opioid Abatement Settlement Account - State)
UW 90/180 Beds
Federal funding authority is adjusted to reflect current estimates of federal match available for services at the University of Washington Behavioral Health Teaching Facility based on the estimated case mix for 75 long-term civil commitment beds. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal)
WTS Central Services
Adjustments are made to reflect each agency's anticipated share of charges from Washington Technology Solutions for the Office of Cybersecurity, the state network, enterprise services, small agency IT services, enterprise architecture and data management, Microsoft 365 licenses, and other items. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
Work Requirement IT Project
Funding is provided to create a community engagement verification hub required by H.R.1. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)