Washington State Health Care Authority
| Annual FTEs | General Fund State | Other Funds | Total Funds | |
|---|---|---|---|---|
| (Dollars in Thousands) | ||||
| Estimated Expenditures | 1,242.5 | 4,662,347 | 14,497,674 | 19,160,021 |
2017-19 Maintenance Other Changes |
||||
| Hospital Safety Net Assessment | 0.0 | 0 | 9,825 | 9,825 |
| CPE Hold Harmless Adjustment | 0.0 | 194 | 0 | 194 |
| Institution for Mental Diseases | 0.0 | 21,534 | 0 | 21,534 |
| Mandatory Caseload Adjustments | 0.0 | (22,942) | (81,097) | (104,039) |
| BHO Rate Adjustments | 0.0 | (10,047) | 18,530 | 8,483 |
| Utilization Changes | 0.0 | 7,068 | 63,546 | 70,614 |
| ACA Tax Moratorium | 0.0 | 12,843 | 34,637 | 47,480 |
| Disabled MC Rate Adjustment CY 2018 | 0.0 | 598 | 601 | 1,199 |
| Disabled MC Rate CY 2019 | 0.0 | 12,762 | 12,819 | 25,581 |
| Expansion MC Rate Adjust CY 2018 | 0.0 | 1,539 | 23,174 | 24,713 |
| Expansion MC Rate CY 2019 | 0.0 | (324) | (4,341) | (4,665) |
| Family MC Rate Adjustment CY 2018 | 0.0 | 2,542 | 3,733 | 6,275 |
| Family MC Rate CY 2019 | 0.0 | 21,357 | 28,176 | 49,533 |
| Hepatitis C Treatment Adjustment | 0.0 | (1,594) | (3,611) | (5,205) |
| IMD Update | 0.0 | (1,312) | 0 | (1,312) |
| Interpreter Other | 0.0 | 390 | 589 | 979 |
| Medicare Part D Clawback | 0.0 | 2,402 | 0 | 2,402 |
| 2017-19 Maintenance Other Changes Total | 0.0 | 47,010 | 106,581 | 153,591 |
| Total Maintenance Changes | 0.0 | 47,010 | 106,581 | 153,591 |
| 2017-19 Maintenance Level | 1,242.5 | 4,709,357 | 14,604,255 | 19,313,612 |
2017-19 Policy Other Changes |
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| Healthier WA Savings Restoration | 0.0 | 29,648 | 37,501 | 67,149 |
| Pharmacy Savings Restoration | 0.0 | 6,628 | 18,233 | 24,861 |
| Dental Savings Restoration | 1.4 | 6,016 | 10,194 | 16,210 |
| PEBB Administrative Fees | 0.0 | 0 | 187 | 187 |
| Low Income Health Care/I-502 | 0.0 | (2,699) | 2,699 | 0 |
| Behavioral Health Grants | 3.7 | 0 | 15,247 | 15,247 |
| Medicaid Fraud Account | 0.0 | 9,390 | (9,390) | 0 |
| 2017-19 Policy Other Changes Total | 5.1 | 48,983 | 74,671 | 123,654 |
| Total Policy Changes | 5.1 | 48,983 | 74,671 | 123,654 |
| 2017-19 Policy Level | 1,247.6 | 4,758,340 | 14,678,926 | 19,437,266 |
Policy Changes
Hospital Safety Net Assessment
The Hospital Safety Net Assessment program (HSNA) allows the Health Care Authority (HCA) to collect assessments from Washington state hospitals and use the proceeds for payments to hospitals. Funding is adjusted to align with forecasted enrollment increases for the program.
CPE Hold Harmless Adjustment
The Certified Public Expenditure (CPE) program allows the state of Washington to use public hospital expenditures, including government-operated hospitals that are not critical access or state psychiatric hospitals, to earn federal funds. It is the state's policy that a hospital will not be paid less under the CPE methodology than it would have been paid under the hospital payment methodology in place at the time services are provided. This is known as the hold-harmless provision. Funding is provided for hold-harmless payments to hospitals that participate in the CPE program.
Institution for Mental Diseases
The Centers for Medicare and Medicaid Services (CMS) issued a rule that disallows Medicaid reimbursement when an individual is receiving inpatient care in an institution for mental diseases (IMD) facility for longer than 15 days in a consecutive 30-day period. Funding is adjusted to reflect current inpatient IMD utilization.
Mandatory Caseload Adjustments
Appropriations are adjusted based on the expected impact of changes in the November 2018 caseload forecast.
BHO Rate Adjustments
Under federal Medicaid law, Behavioral Health Organization (BHO) rates must be developed by an independent actuary and certified as being actuarially sound. Appropriations for BHOs are adjusted to reflect new actuarial rate ranges for behavioral health services.
Utilization Changes
Funding is adjusted to align costs with projected utilization changes of medical services for Medicaid-eligible clients as identified in the November 2018 Medical Assistance forecast.
ACA Tax Moratorium
The federal government suspended the Affordable Care Act (ACA) insurance tax for calendar year 2017. That tax applies to Medicaid-managed care plans. Funding is restored as the tax has been reinstated and is effective for calendar year 2018 and onward.
Disabled MC Rate Adjustment CY 2018
Funding is adjusted for actuarially adjusted managed care (MC) rates, effective July 2018, for Medicaid-eligible groups for calendar year 2018. Rates were adjusted for multiple factors, the most significant being the carve-out of all outpatient pharmacy products as a result of the shift to HCA's statewide preferred drug list.
Disabled MC Rate CY 2019
Funding is provided for actuarially adjusted managed care (MC) rates, effective January 2019, for Medicaid-eligible groups. Funding is adjusted for the Apple Health Blind Disabled program base rates including a 7.8 percent increase for the general non-integrated and mid-adopter Apple Health regions and a 17.2 percent increase in the fully integrated southwest and northcentral Washington regions.
Expansion MC Rate Adjust CY 2018
Funding is provided for actuarially adjusted managed care (MC) rates, effective July 2018, for Medicaid clients enrolled as a result of Affordable Care Act expansion. Rates were adjusted for multiple factors, the most significant being the carve-out of all outpatient pharmacy products as a result of the shift to HCA's statewide preferred drug list.
Expansion MC Rate CY 2019
Funding is provided for actuarially adjusted managed care (MC) rates, effective January 2019, for Medicaid clients enrolled as a result of Affordable Care Act expansion. Funding is adjusted for the expansion population base rates including a 2.3 percent increase for the general non-integrated and mid-adopter Apple Health regions and a 9.4 percent increase in the fully integrated southwest and northcentral Washington regions.
Family MC Rate Adjustment CY 2018
Funding is provided for actuarially adjusted managed care (MC) rates, effective July 2018, for Medicaid-eligible groups. Rates were adjusted for multiple factors, the most significant being the carve-out of all outpatient pharmacy products as a result of the shift to HCA's statewide preferred drug list.
Family MC Rate CY 2019
Funding is provided for actuarially adjusted managed care (MC) rates, effective January 2019, for Medicaid-eligible groups. Funding is adjusted for the family composite program base rates, including a 13.4 percent increase for the general non-integrated and mid-adopter Apple Health regions and a 11.8 percent increase in the fully integrated southwest and northcentral Washington regions.
Hepatitis C Treatment Adjustment
Funding is reduced due to lower-than-anticipated treatment costs for the Hepatitis C virus (HCV). The decreased funding is due to falling drug costs as more treatment options enter the market.
IMD Update
The Centers for Medicare and Medicaid Services (CMS) issued a rule that disallows Medicaid reimbursement when an individual is receiving inpatient care in an institution for mental diseases (IMD) facility for longer than 15 days in a consecutive 30-day period. Funding is adjusted to reflect current inpatient IMD utilization.
Interpreter Other
Funding is adjusted for interpreter services based upon the interpreter collective bargaining agreement for the 2017-19 biennium.
Medicare Part D Clawback
States are financially responsible for their share of outpatient prescription drug costs for dual-eligible clients. This is known as Medicare Part D clawback. Based upon forecasted caseloads and expenditures from the November 2018 Medical Assistance forecast, funding is provided for an estimated Part D clawback inflation factor set at 1.9 percent.
Healthier WA Savings Restoration
Healthier Washington is a project that allows the Health Care Authority and the Department of Social and Health Services to establish integrated clinical models of physical and behavioral health care, thereby improving the effectiveness of health care purchasing and transforming the health care delivery system. As a result of delayed efforts to integrate these clinical models, savings assumed in the current budget will not be realized this biennium. Funding is provided to restore a portion of the assumed savings.
Pharmacy Savings Restoration
The Health Care Authority has implemented a single Medicaid preferred drug list. The savings assumptions in the current budget will not be achieved at the level or within the timeline originally anticipated. Funding is provided to restore a portion of the assumed savings.
Dental Savings Restoration
The Health Care Authority has named apparently successful bidders to transition dental services from fee for service to managed care. Savings from reduced emergency department utilization as a result were assumed in the current budget; however, the savings assumptions in the current budget will not be achieved at the level or within the timeline originally anticipated. Funding is provided to restore the assumed savings for fiscal year 2019.
PEBB Administrative Fees
This provides additional spending authority to cover projected costs in Flexible Spending Arrangement (FSA) and Dependent Care Assistance Program (DCAP) administration fees. These third party administrator costs would exceed authorized levels without the increase.
Low Income Health Care/I-502
Initiative 502 directed a portion of the revenue from taxes on the sale of marijuana into the Basic Health Trust Account. Those dollars are used in lieu of General Fund-State dollars for capitation payments for Medicaid clients enrolled in managed care plans. Funding is adjusted to reflect updated estimates of marijuana-related revenue.
Behavioral Health Grants
Federal expenditure authority is provided for multiple federal grant awards to address and combat substance use disorder.
Medicaid Fraud Account
The 2017-19 biennial budget included a one-time fund shift in fiscal year 2019 from the state general fund to the Medicaid Fraud Penalty Account. There is insufficient revenue in the Medicaid Fraud Penalty Account to support that fund shift. Funding is adjusted in a fund shift from the Medicaid Fraud Penalty Account to the state general fund.
