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Home » Budget » State budgets » 2023-25 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

  Average Annual FTEs Near General Fund State Other Funds Total Funds
  (Dollars in Thousands)
Current Budget 2,526.8 3,393,737 5,193,918 8,587,655
2023-25 Maintenance Level 2,633.9 3,996,576 5,110,603 9,107,179
Difference from 2023-25 Original 107.1 602,839 (83,315) 519,524
% Change from 2023-25 Original 4.2% 17.8% (1.6%) 6.0%

2023 Policy Other Changes

Adult Abuse Registry 0.90 525 215 740
Acute Care Hospital Rapid Response 0.0 17,400 17,400 34,800
Transitional Care Center of Seattle 1.0 41,059 41,061 82,120
Institutional Transitions 16.7 10,895 2,058 12,953
Personal Protective Equipment 0.0 353 295 648
Adjust CDE Rates (11.7) 194,073 247,010 441,083
Translation Service Rates 0.0 594 524 1,118
Agency Parity 0.0 49,927 63,542 113,469
CDE Administrative Component 0.0 6,053 7,703 13,756
Residential PNA 0.0 1,464 733 2,197
Kinship Navigator 0.50 601 66 667
LTSS Operations 22.9 0 12,663 12,663
LTSS Technology 17.0 0 13,118 13,118
Medicaid Program Integrity 8.1 1,061 1,061 2,122
Medicaid Provider Rates 0.0 80,575 73,146 153,721
Skilled Nursing Facility Rates 0.0 55,380 55,382 110,762
Assisted Living Provider Rates 0.0 69,164 76,822 145,986
Medicare-Medicaid Integration Grant 1.2 0 443 443
Residential Complaints & Licensing 7.1 860 1,052 1,912
Traumatic Brain Injury Facility 0.0 1,518 1,435 2,953
Medical Escort Settlement 0.0 425 542 967
Facility One-time Costs 0.0 1,954 1,632 3,586
2023 Policy Other Changes Total 63.7 533,881 617,903 1,151,784

2023 Policy Comp Changes

Adult Family Home Award/Agreement 0.0 132,942 160,579 293,521
State Employee Benefits 0.0 127 105 232
WFSE General Government 0.0 21,406 17,601 39,007
Rep Employee Health Benefits 0.0 465 380 845
Non-Rep Recruitment/Retention 0.0 312 258 570
Non-Rep General Wage Increase 0.0 3,780 3,130 6,910
SEIU 1199 General Government 0.0 6,900 5,759 12,659
PERS & TRS Plan 1 Benefit Increase 0.0 272 223 495
Vaccine Booster Incentive 0.0 270 224 494
2023 Policy Comp Changes Total 0.0 166,474 188,259 354,733
Total Policy Changes 63.7 700,355 806,162 1,506,517
2023-25 Policy Level 2,697.6 4,696,931 5,916,765 10,613,696
Difference from 2021-23 170.8 1,303,194 722,847 2,026,041
% Change from 2023-25 Original 6.8% 38.4% 13.9% 23.6%

Policy Changes

Adult Abuse Registry

Funding is provided to implement proposed legislation to create a process to remove names from the vulnerable adult abuse registry. Currently, there is no provision that allows a provider's case to be reviewed or removed from this registry. (General Fund - Medicaid Federal, General Fund - State, General Fund - Cash, other funds)

Acute Care Hospital Rapid Response

This item will continue the rapid response nursing team program in fiscal year 2024. This program provides staffing teams for long-term care facilities facing workforce shortages and helps address hospital capacity issues that have affected the health sector during the COVID-19 pandemic. (General Fund - Cash, General Fund - State, General Fund - Medicaid Federal, other funds)

Transitional Care Center of Seattle

Funding is provided for the ongoing operation and projected cost increases of nursing facility services in Transitional Care Center of Seattle (TCCS). One FTE position is provided for complex transition planning to help TCCS residents transition to home and community-based settings. (General Fund - Medicaid Federal, General Fund - State, General Fund - Local CRC Oregon, other funds)

Institutional Transitions

Funding is provided to help Medicaid patients transition from acute care hospitals, state hospitals and community psychiatric hospitals into settings in the community with more appropriate levels of care. (General Fund - Local CRC Oregon, General Fund - State, General Fund - Medicaid Federal, other funds)

Personal Protective Equipment

This funding will cover the increased costs incurred for personal protective equipment (PPE) during the COVID-19 pandemic. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - State, other funds)

Adjust CDE Rates

Funding is provided for a new rate for the consumer directed employer (CDE) contracted individual providers as set by the Consumer Directed Employer Rate Setting Board in accordance with RCW 74.39A.530. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - State, other funds)

Translation Service Rates

Funding is provided for contracted services that provide translation services to clients in federally required languages through a contracted vendor. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - State, other funds)

Agency Parity

This item provides homecare agency parity consistent with the rates set by the Consumer Directed Employer Rate Setting Board in accordance with RCW 74.39A.530. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - State, other funds)

CDE Administrative Component

This item covers administrative costs set by the Consumer Directed Employer Rate Setting Board in accordance with RCW 74.39A.530. (General Fund - Local CRC Oregon, General Fund - State, General Fund - Medicaid Federal, other funds)

Residential PNA

If proposed legislation is enacted, this item will increase the personal needs allowance (PNA) for clients residing in institutions and residential facilities from $75.36 to $100.00 per month. The PNA is an amount of their own income clients retain to pay for their personal needs, including clothing, personal hygiene supplies, cell phone data, non-covered facility activities, additional grooming, and small treats. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)

Kinship Navigator

This funding will be used to continue the case management kinship navigator pilot. Initial findings of a study, begun in 2018 in cooperation with the Department of Children, Youth, and Families and the University of Washington, show improved utilization of resources, client satisfaction, and health and well-being of pilot participants. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)

LTSS Operations

Funding is provided to continue implementation of the long-term services and supports (LTSS) trust program, now called WA Cares Fund, as directed by chapter 50B RCW. Beginning July 2026, this program will provide long-term services and supports benefits to qualified individuals who have been assessed as needing assistance with daily living activities. This investment will be funded solely from worker contributions to the Long-Term Services and Supports Trust Account. (Long-Term Servs & Sup Trust Account - State)

LTSS Technology

Funding is provided for technology solutions necessary to operate the WA Cares Fund program. This investment will be funded solely from worker contributions to the Long-Term Services and Supports (LTSS) Trust Account. (Long-Term Servs & Sup Trust Account - State)

Medicaid Program Integrity

This item will enable the department to meet reporting, auditing, and dispersal requirements of Medicaid funds used in Aging and Long-Term Support Administration (ALTSA) and Developmental Disabilities Administration (DDA) programs. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)

Medicaid Provider Rates

Funding is provided to increase rates for providers of home and community-based services who serve Medicaid clients. (General Fund - State, General Fund - Medicaid Federal, General Fund - Local CRC Oregon, other funds)

Skilled Nursing Facility Rates

This item will increase rates for skilled nursing facilities that serve Medicaid clients. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)

Assisted Living Provider Rates

Funds are provided to increase rates for assisted living facilities that serve Medicaid clients. (General Fund - Cash, General Fund - State, General Fund - Medicaid Federal, other funds)

Medicare-Medicaid Integration Grant

Expenditure authority is provided for the Advancing Medicare and Medicaid Initiative grant that was previously approved through the unanticipated receipt approval process. (General Fund - Private/Local, General Fund - Local)

Residential Complaints & Licensing

Funding is provided for complaint investigations and licensing efforts to keep up with the current and estimated future growth in the volume of complaints regarding care in long-term care facilities. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)

Traumatic Brain Injury Facility

This item will fund one 16-bed facility in a community-based residential setting. This facility will provide specialized medical behavioral supports, specialized inpatient care, and long-term residential services to individuals experiencing a traumatic brain injury with complex medical and behavioral needs so they can reside in Washington. The Health Care Authority will also help fund the service delivery in this new program. (General Fund - Cash, General Fund - State, General Fund - Medicaid Federal, other funds)

Medical Escort Settlement

Funds are provided for the unfair labor practice settlement in the case of the Adult Family Home Council v. Office of Financial Management. If the settlement agreement is not reached by June 30, 2024, the funds shall lapse. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - State, other funds)

Facility One-time Costs

Funding is provided for one-time relocation costs and projects that support the DSHS Six-Year Facilities Plan that supports 106 leased offices and client service centers statewide. (General Fund - State, General Fund - Medicaid Federal, General Fund - 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 for the 2023-25 biennium. (General Fund - Medicaid Federal, General Fund - State, General Fund - Cash, 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 $1,160 per employee per month for fiscal year 2024 and $1,233 per employee per month for fiscal year 2025. (General Fund - State, General Fund - Federal, General Fund - Medicaid Federal, other funds)

WFSE General Government

Funding is provided for a general wage increase of 4%, effective July 1, 2023; a general wage increase of 3%, effective July 1, 2024; targeted job classification base range increases; recognition and retention lump sum payments for employees employed on or before July 1, 2022 and continuously employed through July 1, 2023; shift premium increase for eligible shifts from $1 to $2.50 per eligible hour; a COVID-19 booster incentive of $1,000; supplemental shift premium increases for nurse classifications; 5% premium pay for employees who are assigned to a facility that provides direct care to residents, patients and/or clients and whose duties are required to be performed on location; and an increase of $250 to the annual lump sum payment for Labor and Industries risk classes 7200/7201. (General Fund - Federal, General Fund - State, General Fund - Medicaid Federal, other funds)

Rep Employee Health Benefits

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 $1,160 per employee per month for fiscal year 2024 and $1,233 per employee per month for fiscal year 2025. (General Fund - Federal, General Fund - State, General Fund - Medicaid Federal, other funds)

Non-Rep Recruitment/Retention

Funding is provided for recognition and retention lump sum payments for employees employed on or before July 1, 2022 and continuously employed through July 1, 2023. (General Fund - Federal, General Fund - State, General Fund - Medicaid Federal, other funds)

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 4 percent, effective July 1, 2023 and a general wage increase of 3 percent, effective July 1, 2024. This item includes both general government and higher education workers. (General Fund - State, General Fund - Federal, General Fund - Medicaid Federal, other funds)

SEIU 1199 General Government

Funding is provided for a general wage increase of 4%, effective July 1, 2023; a general wage increase of 3%, effective July 1, 2024; targeted job classification base range increases; recognition and retention lump sum payments for employees employed on or before July 1, 2022 and continuously employed through July 1, 2023; shift premium increase for eligible shifts from $1 to $2.50 per eligible hour; and a COVID-19 booster incentive of $1,000. The agreement includes supplemental shift premium increases for nurse classifications; 5% premium pay for employees who are assigned to a facility that provides direct care to residents, patients and/or clients and whose duties are required to be performed on location; and an ARNP ANCC Board certification incentive of $2,500. In addition, this agreement includes preceptor premium pay increase, increase in training dollars, additional retention incentive of $1,500, and $500 annual lump sum payment for L&I codes 7200/7201. (General Fund - State, General Fund - Medicaid Federal, General Fund - Federal, other funds)

PERS & TRS Plan 1 Benefit Increase

For eligible Public Employees' and Teachers' Retirement Systems Plan 1 members, this item provides an increase of 3%, up to a maximum of $110 per month. (General Fund - Federal, General Fund - Medicaid Federal, General Fund - State, other funds)

Vaccine Booster Incentive

Funding is provided for a $1,000 lump sum COVID-19 booster incentive for non-represented employees. This funding does not cover institutions of higher education. (General Fund - Medicaid Federal, General Fund - Federal, General Fund - State, other funds)