Washington State Health Care Authority
| Annual FTEs | General Fund State | Other Funds | Total Funds | |
|---|---|---|---|---|
| (Dollars in Thousands) | ||||
| Estimated Expenditures | 1,431.0 | 6,047,285 | 16,296,030 | 22,343,315 |
| Total Maintenance Changes | 0.0 | 0 | 0 | 0 |
| 2019-21 Maintenance Level | 1,431.0 | 5,859,314 | 16,987,132 | 22,846,446 |
2019-21 Policy Other Changes |
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| Low-income Health Care - I-502 | 0.0 | (52,370) | 52,370 | 0 |
| Healthier WA Savings Restoration | 0.0 | 30,792 | 40,424 | 71,216 |
| 1115 IMD Waiver Costs | 0.50 | 395 | 3,555 | 3,950 |
| MQIP Increase | 0.0 | 0 | 22,263 | 22,263 |
| Clubhouse Programs | 0.0 | (1,428) | (4,050) | (5,478) |
| SSB 5181 - Firearms Restrictions | (0.3) | (18) | (18) | (36) |
| Tele-Health TPA Supplemental | 0.50 | 406 | 0 | 406 |
| MTP Initiative 1 | 0.0 | 0 | 38,484 | 38,484 |
| Assisted Outpatient Treatment | 0.0 | (225) | 0 | (225) |
| Secure Detoxification Facilities | 0.0 | (941) | (941) | (1,882) |
| Program Integrity | 0.0 | 71,000 | 159,000 | 230,000 |
| Health Homes - Tribal Affairs | 0.0 | 4 | 64 | 68 |
| Raise Tribal Residential SUD Rates | 0.0 | 0 | 6,957 | 6,957 |
| Primary Care Case Mgmt-Tribal | 0.0 | 13 | 116 | 129 |
| DSH Delay | 0.0 | 0 | 8,330 | 8,330 |
| Trueblood FTEs | 0.40 | 107 | 0 | 107 |
| Backfill Medicaid Fraud Account | 0.0 | 10,110 | (10,110) | 0 |
| Telemedicine Equipment | 0.0 | 1,200 | 0 | 1,200 |
| 2019-21 Policy Other Changes Total | 1.1 | 59,045 | 316,444 | 375,489 |
2019-21 Policy Comp Changes |
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| Agency Savings in FY 2021 | (1,312) | (2,248) | (3,560) | |
| General Wage Increase Savings | (423) | (607) | (1,030) | |
| 2019-21 Policy Comp Changes Total | 0.0 | (1,735) | (2,855) | (4,590) |
| Total Policy Changes | 1.1 | 57,310 | 313,589 | 370,899 |
| 2019-21 Policy Level | 1,432.1 | 5,916,624 | 17,300,721 | 23,217,345 |
Policy Changes
Mandatory Caseload Adjustments
Appropriations are adjusted based on the expected impact of changes in the February 2020 forecast by the Washington State Caseload Forecast Council.
FMAP Changes
The Families First Coronavirus Response Act that was signed into law April 13, 2020. This act enhances the federal financial participation in the Medicaid program by 6.2 percentage points. The enhancement is currently scheduled to end March 31, 2021.
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. The changes in rates are largely due to case mix and utilization factors.
Utilization Changes
Funding is adjusted to align costs with projected utilization changes of medical services for Medicaid-eligible clients as identified in the November 2020 Medical Assistance forecast.
CPE Hold Harmless Adjustments
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.
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 Hospital Safety Net Assessment program.
ACA Tax Moratorium
Mental Health IMD Waiver
The 2019-21 biennial budget directed the Health Care Authority (Authority) to apply for an 1115 Medicaid waiver to allow for full federal participation in mental health facilities classified as Institutions of Mental Diseases (IMDs). The Authority is unable to claim federal match for certain IMD stays during this interim period prior to waiver approval. Funding is provided to cover the gap between the original assumed approval date for the Mental Health IMD 1115 waiver and the anticipated actual approval date.
FCS DBHR Admin
Funding is provided to align with projected expenditures for Initiative 3 under the Medicaid Transformation Project (MTP), as approved by the Centers for Medicare and Medicaid Services.
Initiative 3 FCS
Funding is provided to align with projected expenditures for Initiative 3 under the Medicaid Transformation Project (MTP).
SEBB Spending Authority
The Health Care Authority (HCA) requests $ 6,474,000 in the 2021 supplemental budget to cover projected costs in School Employees Benefit Board (SEBB) administrative account. This request is directly related to the continuation of the mandatory Information Technology (IT) project for SEBB Implementation spanning into fiscal year (FY) 2021 and the increase of SEBB costs to the shared services cost allocation base.
PEBB and SEBB Spending Authority
The Health Care Authority (HCA) requests an increase of $1,939,000 in the fiscal year 2021 to cover projected costs in the School Employees Benefits Board (SEBB) Uniform Medical Plan (UMP), and Uniform Dental Plan (UDP) third party administrator (TPA) fees. Higher than projected enrollment in the self-insured UMP and UDP plans have caused projected expenditures that exceed the appropriation level.
ESF Intensive BH TX Facilities
HB1394 required the Department of Health (DOH) to create rules for a new facility type that will provide treatment for people in state hospitals but no longer benefiting from treatment and for whom there is no community placement. Capital funding was provided to build these new facilities in the 2019-21 biennium. The capital funds are being distributed, but construction will not be completed in fiscal year 2021. Additionally, the 2019-21 operating budget included funding to operate these facilities beginning in FY21. Funding is adjusted to reflect this shift in anticipated occupancy date.
COVID FMAP Increase
The Families First Coronavirus Response Act that was signed into law April 13, 2020. This act enhances the federal financial participation in the Medicaid program by 6.2 percentage points. The enhancement is currently scheduled to end March 31, 2021.
Comm. Long-Term Inpatient Bed Adj
Funding is adjusted to reflect anticipated utilization for services to individuals on long-term inpatient commitments in community settings.
DSH Adjustment
Federal funding is adjusted to align with available disproportionate share hospital funds.
PEBB Funding Rate Adjustment
Funding is provided to increase benefit rate at Health Benefit Exchange to align with PEBB funding rate for the 2019-2021 biennium.
Language Access Providers
Funding is adjusted for interpreter services based upon the interpreter collective bargaining agreement.
Medicare Parts A and B
Funding is provided for projected Medicare inpatient hospital (Part A) and physician and outpatient hospital (Part B) premiums paid by the state for dually eligible Medicaid and Medicare clients. Part A and Part B premiums are set by the Social Security Administration trustees and projected expenditures are based upon the November 2020 Medical Assistance forecast.
Disabled Managed Care 2021 Adj
Funding is adjusted for actuarially adjusted rates, effective January 2021, for Medicaid eligible groups for calendar year (CY) 2021.
Expansion Managed Care 2021 Adj
Funding is adjusted for actuarially adjusted rates, effective January 2021, for Medicaid eligible groups for calendar year (CY) 2021.
Family Managed Care 2021 Adj
Funding is adjusted for actuarially adjusted rates, effective January 2021, for Medicaid eligible groups for calendar year (CY) 2021.
Medicaid Fraud Penalty Acct Adj
Funding is adjusted to remove Medicaid Fraud Penalty Account expenditure authority from the Community Behavioral Health program. This program does not spend from this account.
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 2020 Medical Assistance forecast, funding is provided for an estimated Part D clawback inflation factor set at 2.8 percent.
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. (General Fund - State, Basic Health Plan Trust Account - Non-Appropriated)
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 to improve the effectiveness of health care purchasing and delivery. Savings assumed in the current budget will not be realized this biennium. Funding is provided to restore a portion of the assumed savings. (General Fund - Medicaid Federal, General Fund - Cash, General Fund - State, other funds)
1115 IMD Waiver Costs
The federal Centers for Medicare & Medicaid Services requires significant health information technology (HIT) commitments to meet milestones associated with the 1115 Institutions for Mental Disease (IMD) waiver. There also are reporting and evaluation costs related to the waiver. To ensure all required assessment, HIT, budget neutrality and evaluation elements are met, funding is provided for increased HIT costs necessary for implementation of the waiver. (General Fund - Medicaid Federal, General Fund - Cash, General Fund - Local CRC Oregon, other funds)
MQIP Increase
The Medicaid Quality Improvement Program (MQIP) allows states to design quality improvement programs for the Medicaid population in ways that support the state's quality goals. In Washington, the MQIP will be used to support the Medicaid Transformation Waiver. Apple Health managed care organizations and their partnering providers will receive MQIP program payments as they meet designated milestones. Funding is provided to increase the appropriation for the MQIP program as the transformation waiver is extended for one year. (General Fund - Local, General Fund - Federal, General Fund - Private/Local)
Clubhouse Programs
Funding is adjusted to align with savings due to a delay in the expansion of Clubhouse programs, effective July 1, 2020. (General Fund - Medicaid Federal, General Fund - Cash, General Fund - Local CRC Oregon, other funds)
SSB 5181 - Firearms Restrictions
Substitute Senate Bill 5181, enacted in the 2019 legislative session, imposed restrictions on firearms possession by individuals receiving involuntary behavioral health treatment, which created work for the Health Care Authority's firearms compliance unit. The actual workload has been less than anticipated in the enacted budget. Funding is reduced to align with projected expenditures. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - Cash, other funds)
Tele-Health TPA Supplemental
Funding is provided to the agency to implement and administer a carrier assessment to fund the Partnership Access Line (PAL) and the Psychiatric Consultation Line (PCL). (General Fund - State)
MTP Initiative 1
Funding is provided to align with projected expenditures for Initiative 1 of the 1115 Demonstration Waiver of the Medicaid Transformation Project (MTP). (General Fund - Federal, General Fund - Local, General Fund - Private/Local)
Assisted Outpatient Treatment
Funding is adjusted to align with projected expenditures. (General Fund - State)
Secure Detoxification Facilities
Operating expenses for two new Secure Withdrawal Management and Stabilization facilities were included in the Medicaid rates and payments to administrative service organizations. Facilities anticipated to open in fiscal year 2021 have been delayed and will not open until the 2021-23 biennium. Funding is adjusted to reflect savings from the delay in opening these facilities. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Program Integrity
Program integrity activities help ensure that state and federal dollars are spent appropriately on delivering high-quality, necessary care and on preventing fraud and waste. The savings assumed in the current budget will not be realized in fiscal year 2021. Funding is provided to restore these assumed savings. (General Fund - Medicaid Federal, General Fund - State, General Fund - Cash, other funds)
Health Homes - Tribal Affairs
Funding is provided to expand the Health Home services to the American Indian (AI) and Alaska Native (AN) populations. This will be achieved through incentives for lead organizations to contract with Indian Health Service providers. By engaging IHSS providers, the Health Home program can help mitigate the health disparities afflicting the AI/AN populations. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - Cash, other funds)
Raise Tribal Residential SUD Rates
Apple Health reimburses all substance use disorder (SUD) resident treatment facilities (RTFs) for adults and youth intensive inpatient resident treatment at rates that do not cover the cost of the treatment and support provided by tribal RTFs to Indian Health Service-eligible American Indian and Alaska Native Medicaid clients. Higher, cost-based rates can be negotiated with the Centers for Medicare & Medicaid Services (CMS). (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal)
Primary Care Case Mgmt-Tribal
Primary Care Case Management payments are used by tribal providers to coordinate and monitor Medicaid health care services for the population assigned to their care. Funding is provided to increase the Primary Care Case Management rate from $3.00 to $6.00. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - Local CRC Oregon, other funds)
DSH Delay
Under the Affordable Care Act, disproportionate share hospital (DSH) funding was scheduled to be reduced beginning in 2014. The federal government has extended this reduction to federal fiscal year 2021. Funding is adjusted for both the certified public expenditure hold harmless payment and federal DSH appropriation in anticipation of another federal extension. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - Cash)
Trueblood FTEs
Funding is provided to support the data reporting, contracts, and fiscal work required in the Trueblood settlement agreement. (General Fund - State)
Backfill Medicaid Fraud Account
Expenditures from the Medicaid Fraud Penalty Account are shifted to the general fund to align with available revenues. (General Fund - State, Medicaid Fraud Penalty Account - State)
Telemedicine Equipment
Funding is provided for the agency to pay off and shut off the cell phones provided to Medicaid clients during the early stages of the public health emergency to get access to physical and behavioral health during the governor's stay at home order. (General Fund - State)
Agency Savings in FY 2021
Agency savings were achieved by implementing the governor's directive to furlough staff. (School Employees' Insur Admin Acct - State, Flexible Spending Admin Account - Non-Appropriated, Medicaid Fraud Penalty Account - State, other funds)
General Wage Increase Savings
Agency savings were achieved by implementing the governor's directive to withhold the general wage increase scheduled for July 1, 2020. (Medical Aid Account - State, Dedicated Marijuana Acct - State, Flexible Spending Admin Account - Non-Appropriated, other funds)
