Department of Social and Health Services - Long Term Care
| Annual FTEs | General Fund State | Other Funds | Total Funds | |
|---|---|---|---|---|
| (Dollars in Thousands) | ||||
| Estimated Expenditures | 2,428.3 | 2,800,766 | 3,646,665 | 6,447,431 |
| 2021-23 Maintenance Level | 2,375.9 | 3,164,806 | 4,039,609 | 7,204,415 |
| Difference from 2019-21 | (52.4) | 364,040 | 392,944 | 756,984 |
| % Change from 2019-21 | (2.2%) | 13.0% | 10.8% | 11.7% |
2021-23 Policy Other Changes |
||||
| In-Home Provider PPE | 17.8 | 15,285 | 14,559 | 29,844 |
| Children's SOLA | 0.80 | 117 | 118 | 235 |
| Rental Subsidies | 5.0 | (9,360) | (13,148) | (22,508) |
| Staff Costs | 0.0 | (2,630) | (1,100) | (3,730) |
| Adult Family Home Award/Agreement | 0.0 | 9,865 | 11,054 | 20,919 |
| Agency Provider Agreement-Parity | 0.0 | 8,996 | 11,448 | 20,444 |
| In-Home Care Provider Agreement | 0.0 | 27,304 | 34,749 | 62,053 |
| Behavioral Health Transitions | 11.1 | 8,435 | 8,436 | 16,871 |
| Nursing Home Rate Methodology | 0.0 | 11,460 | 11,460 | 22,920 |
| TBI Council Projects | 0.0 | 0 | 1,042 | 1,042 |
| Personal Needs Allowance | 0.0 | 68 | 30 | 98 |
| LTSS Trust Staff/Infrastructure | 12.5 | 0 | 8,095 | 8,095 |
| Transitional Care Center of Seattle | 0.0 | 22,989 | 23,231 | 46,220 |
| Infection Control & Client Services | 88.1 | 22,974 | 19,686 | 42,660 |
| Personal Protective Equipment | 0.0 | 230 | 184 | 414 |
| Shared Benefit Adjustment | 0.0 | 90,738 | 115,488 | 206,226 |
| Facility One-time Costs | 0.0 | 1,222 | 973 | 2,195 |
| 2021-23 Policy Other Changes Total | 135.3 | 207,693 | 246,305 | 453,998 |
2021-23 Policy Comp Changes |
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| Pension Adjustments, nonrate | 0.0 | 231 | 180 | 411 |
| State Employee Benefits | 0.0 | (89) | (70) | (159) |
| WFSE General Government | 0.0 | (8,422) | (6,537) | (14,959) |
| Temporary Layoffs and Other Savings | 0.0 | (2,443) | (1,921) | (4,364) |
| Rep Employee Health Benefits | 0.0 | (431) | (337) | (768) |
| Non-Rep General Wage Increase | 0.0 | (2,090) | (1,826) | (3,916) |
| SEIU 1199 General Government | 0.0 | (1,716) | (1,365) | (3,081) |
| 2021-23 Policy Comp Changes Total | 0.0 | (14,960) | (11,876) | (26,836) |
| Total Policy Changes | 135.3 | 192,733 | 234,429 | 427,162 |
| 2021-23 Policy Level | 2,511.2 | 3,357,539 | 4,274,038 | 7,631,577 |
| Difference from 2019-21 | 82.9 | 556,773 | 627,373 | 1,184,146 |
| % Change from 2019-21 | 3.4% | 19.9% | 17.2% | 18.4% |
Policy Changes
In-Home Provider PPE
Funding and 17.8 FTEs are provided to purchase personal protective equipment (PPE) for in-home caregivers who provide personal care for clients who are at a greater mortality risk from COVID-19 and who themselves are in a high risk category. (General Fund - Medicaid Federal, General Fund - State, General Fund - Cash, other funds)
Children's SOLA
Funding and 0.8 FTE are provided for an additional 15 beds in a total of five facilities in a certified State-Operated Living Alternative (SOLA) program for children and youth (age 20 and younger). The additional capacity is needed to divert young people with developmental disabilities and behavioral health challenges from unneeded acute care hospitals, single night foster home placements, hotel stays, or out-of-state services due to the lack of available facilities in Washington. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - State, other funds)
Rental Subsidies
The COVID-19 pandemic is requiring nursing facilities to move as many clients who no longer need nursing levels of care into community settings. The cost of the state-only rental subsidies, in-home services, and the ALTSA staff requires less GF-State funding than the state portion of the nursing home Medicaid rate, if clients continued to wait in nursing facilities. Savings are achieved utilizing state-only rental subsidies of no more than $750/month. To support this effort, 3.3 FTE staff are provided. (General Fund - Medicaid Federal, General Fund - Cash, General Fund - Local CRC Oregon, other funds)
Staff Costs
Savings are achieved by holding vacancies in the Office of Deaf and Hard of Hearing (ODHH) and by implementing equipment and travel freezes. (General Fund - Local CRC Oregon, General Fund - Cash, General Fund - Medicaid Federal, other funds)
Adult Family Home Award/Agreement
Funding is provided for implementation of an agreement reached between the governor and the Adult Family Home Council under the provisions of chapter 41.56 RCW. (General Fund - Medicaid Federal, General Fund - State, General Fund - Cash, other funds)
Agency Provider Agreement-Parity
Funding is provided for a wage and benefit increase for workers who provide in-home personal care services and are employed by private agencies. The increase corresponds to the salary and wage component of the in-home care agreement for individual providers. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - State, other funds)
In-Home Care Provider Agreement
Funding is provided for an agreement with individual providers of in-home personal care services, which includes salary increases and changes to years of service for former agency providers. (General Fund - State, General Fund - Medicaid Federal, General Fund - Local CRC Oregon, other funds)
Behavioral Health Transitions
Funding and 11.1 FTEs are provided to increase dementia care capacity for civil patients in state and local psychiatric hospitals who are ready to transition to the community. (General Fund - State, General Fund - Medicaid Federal, General Fund - Local CRC Oregon, other funds)
Nursing Home Rate Methodology
Funding is provided for the annual rebase to the nursing facility daily Medicaid rates. (General Fund - Medicaid Federal, General Fund - State, General Fund - Cash, other funds)
TBI Council Projects
Appropriation authority is increased to allow for the expansion of programs for Educators Statewide, Safe Kids events, and Provider and Tribal Training. (Traumatic Brain Injury Account - Non-Appropriated)
Personal Needs Allowance
Funding is provided to increase the residential and institutional personal needs allowance (PNA). (General Fund - Medicaid Federal, General Fund - State, General Fund - Local CRC Oregon, other funds)
LTSS Trust Staff/Infrastructure
Funding and 12.5 FTEs are provided to continue implementation of the Long-Term Services and Supports (LTSS) Trust Program as directed by chapter 50B RCW. This program will provide long-term services and supports benefits to qualified individuals who have been assessed as needing a specified level of assistance with daily living activities. This investment will be funded solely from worker contributions to the Long-Term Services and Supports Trust Account. (General Fund - Medicaid Federal, General Fund - Cash, Long-Term Servs & Sup Trust Account - State, other funds)
Transitional Care Center of Seattle
Funding is provided for nursing home services and emergent building costs at the Transitional Care Center of Seattle (TCCS). As part of the COVID-19 response, DSHS purchased this building to provide care for difficult-to-place residents from acute care hospitals, creating more hospital capacity to treat COVID-19 patients. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Infection Control & Client Services
Funding and 88.1 FTEs are provided for costs related to the COVID-19 pandemic, including emergency planning and reporting, quality assurance nurses, Residential Care Services (RCS) complaint backlog reduction, telemedicine technology, Office of Deaf and Hard of Hearing (ODHH) technology, and the transition of patients from acute care hospitals to ALTSA community settings more quickly. (General Fund - Cash, General Fund - State, General Fund - Medicaid Federal, other funds)
Personal Protective Equipment
Funding is provided to reflect the increased costs incurred for personal protective equipment (PPE) as a result of the COVID-19 pandemic. (General Fund - Medicaid Federal, General Fund - State, General Fund - Cash, other funds)
Shared Benefit Adjustment
Funding is provided to cover the estimated claims for the variance between services provided under the shared benefit equation and the full amount of the benefit while rulemaking takes place. (General Fund - Medicaid Federal, General Fund - State, General Fund - Local CRC Oregon, other funds)
Facility One-time Costs
Funding is provided for one-time relocation and project costs to support the Department of Social and Health Services' leased facilities strategic plan. (General Fund - State, General Fund - Medicaid Federal, General Fund - Federal, other funds)
Pension Adjustments, nonrate
This funds the potential impact of Department of Retirement Systems request legislation on pension service credit and benefit calculation. It will prevent budget reductions such as temporary layoffs from negatively affecting employee retirement benefits. (General Fund - State, General Fund - Medicaid Federal, General Fund - Federal, other funds)
State Employee Benefits
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 $988 per employee per month for fiscal year 2022 and $1,018 per employee per month for fiscal year 2023. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
WFSE General Government
This adjustment reflects the impact of the 2021-23 collective bargaining agreement. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Temporary Layoffs and Other Savings
This item reflects savings achieved from temporary layoffs or similar actions. (General Fund - Medicaid Federal, General Fund - Cash, General Fund - Local CRC Oregon, other funds)
Rep Employee Health Benefits
This provides health insurance funding for the master agreement for employee benefits as part of a coalition of unions. The insurance funding rate is $988 per employee per month for fiscal year 2022 and $1,018 per employee per month for fiscal year 2023. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - Cash, other funds)
Non-Rep General Wage Increase
This reflects savings from the cancellation of the July 1, 2020 general wage increase for some non-represented, non-classified employees. (General Fund - Medicaid Federal, General Fund - Cash, General Fund - Local CRC Oregon, other funds)
SEIU 1199 General Government
This adjustment reflects the impact of the 2021-23 collective bargaining agreement. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - Cash, other funds)
