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Home » Budget » State budgets » 2021-23 Gov. Inslee's proposed budgets » Agency recommendation summaries » Agency recommendation summaries » Department of Social and Health Services - Long Term Care

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

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)