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 |
| 2019-21 Maintenance Level | 1,440.2 | 5,858,952 | 15,880,691 | 21,739,643 |
| Difference from 2017-19 | 197.7 | 1,196,605 | 1,383,017 | 2,579,622 |
| % Change from 2017-19 | 15.9% | 25.7% | 9.5% | 13.5% |
2019-21 Policy Other Changes |
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| Healthier WA Savings Restoration | 0.0 | 54,973 | 65,210 | 120,183 |
| Restore Pharmacy Savings | 0.0 | 14,245 | 35,477 | 49,722 |
| Tribal Evaluation Treatment Center | 0.0 | 150 | 0 | 150 |
| Trueblood Settlement Agreement | 2.0 | 25,996 | 3,702 | 29,698 |
| Doula Services | 1.0 | 4,597 | 7,131 | 11,728 |
| Benefit Education and Communication | 0.0 | 0 | 150 | 150 |
| Suicide Prevention | 3.0 | 1,614 | 1,466 | 3,080 |
| Newborn Screening Pompe and MPS-1 | 0.0 | 300 | 518 | 818 |
| Newborn Screening X-ALD | 0.0 | 60 | 102 | 162 |
| SUD Peer Support | 0.0 | 1,843 | 7,296 | 9,139 |
| Gun List Incident Report | 1.0 | 114 | 61 | 175 |
| Benefits Staff - Employee & Retiree | 9.0 | 0 | 1,899 | 1,899 |
| SEBB Dependent Verification | 4.0 | 0 | 512 | 512 |
| Centers of Excellence | 0.0 | 0 | 2,368 | 2,368 |
| SEBB TPA Payments | 0.0 | 0 | 17,286 | 17,286 |
| PEBB Administrative Fees | 0.0 | 0 | 6,035 | 6,035 |
| Medicare Retirees Portfolio | 3.9 | 0 | 1,500 | 1,500 |
| Evaluation Pay 1 Replacement | 0.0 | 0 | 300 | 300 |
| Tribal Affairs | 5.0 | (426) | 1,462 | 1,036 |
| Low Income Health Care/I-502 | 0.0 | (6,003) | 6,003 | 0 |
| Bi-Directional Rate Increase | 0.0 | 9,105 | 27,721 | 36,826 |
| Behavioral Health Grants | 10.9 | 0 | 45,111 | 45,111 |
| Dental Savings Restoration | 0.0 | 12,203 | 17,648 | 29,851 |
| Hepatitis C Virus Elimination | 0.0 | 3,693 | 3,693 | 7,386 |
| Intensive BH Treatment Facilities | 0.0 | 8,018 | 6,421 | 14,439 |
| Eliminate Medicaid Rate Increase | 0.0 | (49,352) | (116,834) | (166,186) |
| Finance Staffing | 6.0 | 622 | 880 | 1,502 |
| Assertive Community Treatment | 0.0 | 6,021 | 12,577 | 18,598 |
| Community Long-Term Inpatient Beds | 0.0 | 36,961 | 41,680 | 78,641 |
| Mental Health Drop-In Facilities | 0.0 | 2,361 | 2,662 | 5,023 |
| Intensive Outpatient Treatment | 0.0 | 13,850 | 23,582 | 37,432 |
| BHO Reserve Savings | 0.0 | (5,000) | 0 | (5,000) |
| Secure Withdrawal Vendor Rate | 0.0 | 10,792 | 14,904 | 25,696 |
| Discharge Wraparound Services | 0.0 | 2,816 | 5,938 | 8,754 |
| Federal IV&V Requirements | 0.0 | 0 | 558 | 558 |
| System Integrator Reprocurement | 0.0 | 0 | 2,946 | 2,946 |
| Language Access Providers CBA | 0.0 | 531 | 797 | 1,328 |
| Primary Care Rate Increase | 0.0 | 56,637 | 142,946 | 199,583 |
| Opioid Package: Diversion Grants | 0.0 | 686 | 4,534 | 5,220 |
| Opioid Package: Same Day Visit | 0.0 | 1,168 | 0 | 1,168 |
| Opioid Package: Start Up Funds | 0.0 | 1,270 | 0 | 1,270 |
| Public Option | 0.0 | 500 | 0 | 500 |
| Tort Recovery FTEs | 1.0 | (1,376) | (3,384) | (4,760) |
| Community and Rural Hospitals | 0.0 | 2,786 | 6,994 | 9,780 |
| Chiropractic Care for Spinal Pain | 0.0 | 5,063 | 5,090 | 10,153 |
| 2019-21 Policy Other Changes Total | 46.8 | 216,818 | 404,942 | 621,760 |
2019-21 Policy Comp Changes |
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| State Public Employee Benefits Rate | 0.0 | 51 | 76 | 127 |
| WFSE General Government | 0.0 | 1,528 | 3,318 | 4,846 |
| State Rep Employee Benefits Rate | 0.0 | 29 | 59 | 88 |
| Non-Rep General Wage Increase | 0.0 | 2,768 | 4,348 | 7,116 |
| Non-Rep Premium Pay | 0.0 | 4 | 10 | 14 |
| Non-Rep Targeted Pay Increases | 0.0 | 213 | 337 | 550 |
| PERS & TRS Plan 1 Benefit Increase | 0.0 | 100 | 171 | 271 |
| Non-Rep Salary Schedule Revision | 0.0 | 57 | 197 | 254 |
| 2019-21 Policy Comp Changes Total | 0.0 | 4,750 | 8,516 | 13,266 |
2019-21 Policy Transfers Changes |
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| Orca Transit Pass Funding Transfer | 0.0 | (2) | (2) | (4) |
| Health Coalition FSA Fund Transfer | 0.0 | (235) | (10) | (245) |
| 2019-21 Policy Transfers Changes Total | 0.0 | (237) | (12) | (249) |
2019-21 Policy Central Services Changes |
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| Electric Vehicle Infrastructure | 0.0 | 1 | 2 | 3 |
| Archives/Records Management | 0.0 | 2 | 2 | 4 |
| Audit Services | 0.0 | 31 | 51 | 82 |
| Legal Services | 0.0 | 150 | 252 | 402 |
| Administrative Hearings | 0.0 | 195 | 180 | 375 |
| CTS Central Services | 0.0 | (212) | (363) | (575) |
| DES Central Services | 0.0 | 33 | 60 | 93 |
| OFM Central Services | 0.0 | 390 | 663 | 1,053 |
| 2019-21 Policy Central Services Changes Total | 0.0 | 590 | 847 | 1,437 |
| Total Policy Changes | 46.8 | 221,921 | 414,293 | 636,214 |
| 2019-21 Policy Level | 1,487.0 | 6,080,873 | 16,294,984 | 22,375,857 |
| Difference from 2017-19 | 244.5 | 1,418,526 | 1,797,310 | 3,215,836 |
| % Change from 2017-19 | 19.7% | 30.4% | 12.4% | 16.8% |
Policy Changes
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.
Restore Pharmacy Savings
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.
Tribal Evaluation Treatment Center
One-time funding is provided for the Health Care Authority to build the infrastructure to develop and support a tribal evaluation and treatment facility that provides culturally appropriate services and coordinates with patients’ Indian health care providers.
Trueblood Settlement Agreement
A settlement agreement has been approved in the Trueblood et. al. v. Department of Social and Health Services lawsuit. Implementation of the agreement will occur in phases within different regions of the state with the first phase including Pierce and Spokane counties and the southwest region. The agreement outlines five key areas of investments: competency evaluations, competency restoration, crisis diversion and supports, education and training, and workforce development.
Doula Services
Funding is provided to include doula services through the Maternity Support Services (MSS) program.
Benefit Education and Communication
Funding is provided for the preparation and distribution of information to assist school employees enrolling in the School Employees' Benefits Board (SEBB) program.
Suicide Prevention
Funds are provided to implement the State Action Alliance for Suicide Prevention recommendations for the performance and administration of clinical services for suicide assessment, treatment, and management of suicide prevention grants to community groups and coalitions throughout Washington State.
Newborn Screening Pompe and MPS-1
The Washington State Board of Health added Pompe Disease (PD) and Mucopolysaccharidosis Type - I (MPS-I), both genetic disorders, to the mandatory newborn screening panel in 2017. The Department of Health has requested a fee increase to cover costs related to inclusion of these tests. Funding is provided for the fee increase for the mandatory newborn screening panels for all covered medical births.
Newborn Screening X-ALD
The Washington State Board of Health added X-linked adrenoleukodystrophy (X-ALD), a genetic disorder, to the mandatory newborn screening panel in 2018. The Department of Health has requested a fee increase to cover costs related to inclusion of this test. Funding is provided for the fee increase for the mandatory newborn screening panels for all covered medical births.
SUD Peer Support
A Medicaid Substance Use Disorder (SUD) peer service benefit and funding to maintain the training and certification program are provided.
Gun List Incident Report
Initiative 1639, related to firearm safety measures, was approved by voters in 2018. Funding is provided for the administration of enhanced background checks for the sale or delivery of semiautomatic assault rifles throughout Washington State.
Benefits Staff - Employee & Retiree
Resources are provided for additional staffing for the Public Employees' Benefits Board (PEBB) and School Employees' Benefits Board (SEBB) programs for customer service, contract management, and program and benefit support. This is in response to increasing enrollment and complexity in employee and retiree insurance programs.
SEBB Dependent Verification
Approximately 150,000 individuals who are dependents of school employees must be verified to confirm eligibility to be enrolled in the School Employees' Benefits Board (SEBB) insurance program. Funding is provided to complete this verification.
Centers of Excellence
Funding is provided for three components in the Centers of Excellence (COE) bundled payment program: an increase in the administrative rate for the total joint replacement COE, establishment of an ongoing administrative rate for a lumbar fusion bundle and evaluation of a possible third bundle, to include bariatric surgeries. The COE program is focused on improving outcomes and controlling costs by encouraging the use of selected, high performing service providers.
SEBB TPA Payments
Funding is provided for third party administrator fees for the new SEBB Program.
PEBB Administrative Fees
Cost increases in the third party administrator fees and administrator charges for the Uniform Medical Plan (UMP), Uniform Dental Plan (UDP), Flexible Spending Arrangement (FSA), and Dependent Care Assistance Program (DCAP) would cause projected expenditures to exceed the current level of spending authority. This provides additional spending authority to cover the cost increases.
Medicare Retirees Portfolio
During the 2017-19 biennium, the Health Care Authority studied several options for addressing rising prescription drug costs and retiree member premiums. To offer a more affordable benefit option to Medicare-eligible PEBB retirees, funding is provided to continue work on the recommended approach and secure one or more group "Medicare Advantage plus prescription drug plans."
Evaluation Pay 1 Replacement
Funding is provided to continue preparation for replacement of the Pay 1 information system through an independent analysis and evaluation of the options identified in an earlier feasibility study, including $50,000 to support assistance from the Office of the Chief Information Officer.
Tribal Affairs
In 2016, the Centers for Medicare and Medicaid Services (CMS) issued State Health Official Letter #16-002, clarifying that the Social Security Act enables states to achieve additional General Fund-State savings through 100 percent federal match for Medicaid services provided to American Indian/Alaska Native (AI/AN) clients by non-tribal facilities under contracts with the federal Indian Health Services (HIS) or tribes. Previously, 100 percent federal match was not available for services provided by non-tribal facilities. Funding and five FTEs are provided to partner with tribal governments to meet federal requirements that allow the state to receive 100 percent federal match on services currently provided to Medicaid recipients through contracts with non-tribal facilities.
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.
Bi-Directional Rate Increase
Funding is provided to increase bi-directional behavioral health rates for the health and behavior codes and psychotherapy codes that were identified through the stakeholder workgroup process required under Chapter 226, Laws of 2017 (SSB 5779).
Behavioral Health Grants
Federal expenditure authority is provided for multiple federal grant awards to address and combat substance use disorder.
Dental Savings Restoration
The Health Care Authority has named apparently successful bidders to transition 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 a portion of the assumed savings.
Hepatitis C Virus Elimination
Currently, an estimated 65,000 Washingtonians are living with chronic Hepatitis C Virus (HCV). Additionally, newly acquired HCV-infection reports show a 126 percent increase in Washington between 2013 and 2017 when compared to the prior five years. The Health Care Authority (HCA) shall lead and coordinate efforts with the Department of Health (DOH) and other agencies and purchasers to establish a comprehensive procurement strategy for the purchase of HCV medications that includes financing the needed public health interventions to affordably eliminate HCV by 2030.
Intensive BH Treatment Facilities
A new community facility type is created to address the need for additional discharge placements for individuals leaving the state psychiatric hospitals. Intensive behavioral health (BH) treatment facilities serve individuals who possess higher levels of behavioral challenges that existing alternative behavioral health facilities cannot accommodate. Funding is provided for four new facilities.
Eliminate Medicaid Rate Increase
Funding is removed for the 2 percent rate increase included in the Medicaid November 2018 forecast for calendar years 2020 and 2021 in the 2019-21 biennium.
Finance Staffing
Staffing and funding are provided to address critical staff and skill shortfalls in the financial services division.
Assertive Community Treatment
Funding is provided for eight additional Assertive Community Treatment (ACT) teams statewide. ACT teams provide evidence-based, recovery-oriented intensive outreach services in the community to divert individuals from more intensive levels of care. Currently there are 14 Program for Assertive Community Treatment (PACT) teams across the state and a Flexible Assertive Community Treatment (FACT) team being piloted in the Great Rivers Behavioral Health Organization.
Community Long-Term Inpatient Beds
Services for individuals on 90-day and 180-day commitments are traditionally provided in the state hospitals. Funding is provided for nearly 130 community beds in the 2019-21 biennium.
Mental Health Drop-In Facilities
Five mental health drop-in facilities are funded across the state to divert individuals from crisis services and an inpatient level of care. Mental health drop-in facilities are run by peers and serve individuals in need of voluntary, short-term, non-crisis services that focus on recovery and wellness in a trauma-informed environment.
Intensive Outpatient Treatment
Funding is provided to expand intensive outpatient treatment programs (IOPs) and partial hospitalization programs (PHPs) to Medicaid clients. These evidence-based programs are provided by acute or psychiatric hospitals and are tailored to individual patient treatment needs once they are discharged from inpatient psychiatric facilities. PHPs serve patients up to eight hours per day, five days a week and IOPs serve patients up to three hours per day, up to three days per week.
BHO Reserve Savings
Effective January 1, 2020, all regions of the state are required to transition to fully integrated physical and behavioral health care, meaning funding for these services will shift from Behavioral Health Organizations (BHOs) to fully integrated managed care contracts. The current BHOs are required to return state and federal Medicaid reserves remaining after termination of their contract, resulting in a one-time savings.
Secure Withdrawal Vendor Rate
Provider rates for secure withdrawal management and stabilization facilities across the state are increased by 12 percent. Secure withdrawal management and stabilization facilities provide up to 17 days of withdrawal management and substance use treatment for adults and adolescents over 13 years of age, who present a likelihood of serious harm to themselves or others.
Discharge Wraparound Services
Intensive wraparound services for adults discharging from the state psychiatric hospitals into alternative community placements is funded. These wraparound services help ensure discharge placements to the community are successful.
Federal IV&V Requirements
The Health Care Authority (HCA) must meet new federal requirements for enterprise-wide Independent Validation and Verification (IV&V) contracted services. Funding is added to the Health Benefit Exchange to support the enterprise-wide IV&V processes, independent contractor quality and risk mitigation services.
System Integrator Reprocurement
Funding in state fiscal years 2020 and 2021 is provided to cover projected costs associated with procuring and implementing a system integrator to support the Healthplanfinder (HPF) maintenance and operations activities and enhancement services.
Language Access Providers CBA
Funding is adjusted for interpreter services based upon the language access providers' collective bargaining agreement for the 2019-21 biennium.
Primary Care Rate Increase
Funding is provided to increase adult and pediatric primary care rates for the same set of evaluation and management and vaccine administration codes that were included in the temporary rate increase provided by the federal Patient Protection and Affordable Care Act.
Opioid Package: Diversion Grants
This step is part of a multi-agency package to expand treatment and prevention services across the state to prevent opioid-related overdose deaths. King County's Law Enforcement Assisted Diversion (LEAD) allows law enforcement officers to divert low-level offenders engaged in drug or prostitution activity to community services, instead of jail or prosecution. One-time funding is provided for grants to establish two new LEAD diversion programs for jurisdictions outside of King County.
Opioid Package: Same Day Visit
This step is part of a multi-agency package to expand treatment and prevention services across the state to prevent opioid-related overdose deaths. Funding is provided for transport and an incentive payment to providers to hold appointments so that individuals releasing from jail have no disruption in access to medication-assisted treatment for opioid use disorder, effective July 1, 2019. This will ease transition from jail and ensure access to treatment for individuals with opioid use disorder.
Opioid Package: Start Up Funds
This step is part of a multi-agency package to expand treatment and prevention services across the state to prevent opioid-related overdose deaths. One-time funding is provided for start-up costs for four new 16-bed pregnant and parenting women (PPW) Residential Treatment sites that will allow parent and child to reside together.
Public Option
In order to contract with an insurance carrier to offer at least one plan in all counties in Washington State, funding is provided for consulting and contract management activities.
Tort Recovery FTEs
Staffing is provided for tort recovery work, which will produce General Fund-State savings.
Community and Rural Hospitals
One-time funding is provided to the Health Care Authority (HCA) to sustain community and rural hospitals.
Chiropractic Care for Spinal Pain
This step is part of a multi-agency package to expand treatment and prevention services across the state to prevent opioid-related overdose deaths. A chiropractic care benefit for adults with spinal pain diagnoses is established, effective January 1, 2020.
State Public Employee Benefits Rate
Health insurance funding is provided for state employees who are not represented by a union, who are covered by a bargaining agreement that is not subject to financial feasibility determination, or who are not part of the coalition of unions for health benefits. The insurance funding rate is $977 per employee per month for fiscal year 2020 and $978 per employee per month for fiscal year 2021.
WFSE General Government
Funding is provided for a collective bargaining agreement with the Washington Federation of State Employees - General Government. The agreement includes a general wage increase of 3 percent, effective July 1, 2019; a general wage increase of 3 percent, effective July 1, 2020; premium, shift, and other special pay changes, and increases in targeted job classifications. Employee insurance included in the agreement is displayed in a separate item.
State Rep Employee Benefits Rate
This provides health insurance funding as part of the master agreements for employees who bargain for health benefits as part of a coalition of unions. The insurance funding rate is $977 per employee per month for fiscal year 2020 and $978 per employee per month for fiscal year 2021.
Non-Rep General Wage Increase
Funding is provided for wage increases for state employees who are not represented by a union or who are covered by a bargaining agreement that is not subject to financial feasibility determination. It is sufficient for a general wage increase of 3 percent, effective July 1, 2019, and a general wage increase of 3 percent, effective July 1, 2020. This item includes both general government and higher education workers.
Non-Rep Premium Pay
Funding is provided for increases in premium pay for state employees who are not represented by a union or who are covered by a bargaining agreement that is not subject to financial feasibility determination. Funding is sufficient to support changes in shift differential, call back and standby pay, as well as a 5 percent increase for employees working in King County.
Non-Rep Targeted Pay Increases
Funding is provided for classified state employees who are not represented by a union for pay increases in specific job classes in alignment with other employees.
PERS & TRS Plan 1 Benefit Increase
For eligible Public Employees' and Teachers' Retirement Systems Plan 1 members, this item provides a one-time, ongoing increase of 3 percent, up to a maximum of $62.50 per month.
Non-Rep Salary Schedule Revision
This funds a revised salary schedule for non-represented employees in information technology jobs, in alignment with other state employees.
Orca Transit Pass Funding Transfer
This moves funding for employee transit passes from agencies to WSDOT, which administers the program. The transfer includes both funding added in 2019-21 for expanded access, as well as funding that was provided in the 2017-19 budget.
Health Coalition FSA Fund Transfer
This moves funding for negotiated medical flexible spending arrangements (FSA) from individual agency budgets. It will be provided to the Health Care Authority, which will administer the benefit.
Electric Vehicle Infrastructure
Agency budgets are adjusted to reflect each agency’s estimated portion of increased fee for service charges from the Department of Enterprise Services to expand electric vehicle infrastructure for the state Motor Pool fleet.
Archives/Records Management
Agency budgets are adjusted to reflect each agency’s allocated share of charges for the state archives and state records center.
Audit Services
Agency budgets are adjusted to reflect each agency’s allocated share of charges for state government audits.
Legal Services
Agency budgets are adjusted to reflect each agency’s anticipated share of legal service charges.
Administrative Hearings
Agency budgets are adjusted to reflect each agency’s anticipated share of charges for administrative hearings.
CTS Central Services
Agency budgets are adjusted to reflect each agency’s allocated share of charges from the Consolidated Technology Services Agency (WaTech) for the Office of the Chief Information Officer, Office of Cyber Security, state network, security gateways, and geospatial imaging services.
DES Central Services
Agency budgets are adjusted to reflect each agency’s allocated share of charges from the Department of Enterprise Services (DES) for campus rent, utilities, parking, and contracts; a capital project surcharge; financing cost recovery; public and historic facilities; real estate services; risk management services; personnel service rates; the Perry Street child care center; and the department’s enterprise applications.
OFM Central Services
Agency budgets are adjusted to reflect each agency’s allocated share of charges from the Office of Financial Management (OFM) for the One Washington project and OFM enterprise systems.
