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Washington State Health Care Authority

  Average Annual FTEs Near General Fund State Other Funds Total Funds
  (Dollars in Thousands)
Current Budget 1,578.5 7,482,625 22,300,172 29,782,797
2023-25 Maintenance Level 1,578.5 7,800,467 23,209,111 31,009,578
Difference from 2023-25 Original 0.0 317,842 908,939 1,226,781
% Change from 2023-25 Original 0.0% 4.2% 4.1% 4.1%

2024 Policy Other Changes

Doula Reimbursement 0.0 332 491 823
Upper Payment Limit 0.0 376 (562) (186)
AFH Tiered Rates 0.0 12,145 39,297 51,442
Young Adult Discharge Program 0.0 3,000 0 3,000
Cannabis Revenue Distributions 0.0 32,355 (32,355) 0
BH Comparison Rates Phase 3 0.0 500 0 500
Community Behavioral Health Clinics 0.0 5,000 0 5,000
OHBH Study 0.0 250 0 250
Community Information Exchange 0.0 0 9,159 9,159
Youth Stabilization Teams 0.0 6,504 3,700 10,204
CYBHWG Recommendations 0.0 2,405 0 2,405
Kooth Behavioral Health Application 0.0 1,122 368 1,490
Non-emergent Transports 0.0 3,324 5,032 8,356
New Journeys 0.0 500 4,500 5,000
CSFRF Fund Swap 0.0 (144,519) 144,519 0
Street Medicine Pilot 0.0 2,000 0 2,000
Trueblood Diversion Programs 0.0 8,000 0 8,000
WA Apple Health Redeterminations 0.0 1,495 2,638 4,133
HBE Apple Health Expansion 0.0 618 0 618
ACES M&O Costs 0.0 0 768 768
Maintain Software Capabilities 0.0 0 2,068 2,068
Apple Health Enrollment Growth 43.0 6,442 6,442 12,884
MTP Waiver Extension 4.4 0 (31,899) (31,899)
Eligibility for CHIP Ages 0-6 0.0 488 906 1,394
Reentry Services 0.0 128 121,716 121,844
LTSS Waiver Program 0.0 0 (56,107) (56,107)
Apple Health Expansion Admin Costs 3.5 4,719 218 4,937
Tribal Administration 2.0 628 304 932
Increase Rates for 90/180-day Beds 0.0 15,977 12,788 28,765
BH Data Collection & Management 5.2 2,311 335 2,646
MOUD in Jails Program 0.70 7,280 81 7,361
Community & School Prevention 0.0 6,100 0 6,100
Tribal Supports - Icelandic Model 0.0 670 330 1,000
Tribal Fentanyl Summit 0.0 0 750 750
Tribal Opioid Fentanyl Campaign 0.0 2,000 0 2,000
Health Engagement Hub Acceleration 0.0 0 1,000 1,000
Smart Health Machines 0.0 0 1,440 1,440
Sublocade Access 0.0 0 3,000 3,000
ORCA Center 0.0 1,500 0 1,500
Oxford House Expansion 0.0 0 750 750
Peer Bridger Expansion 0.0 1,848 0 1,848
Clinical Contract Cost Increases 0.0 258 146 404
Fee-for-service Prior Authorization 3.0 427 864 1,291
PEBB & SEBB Program Staff Resources 2.0 0 590 590
PACT Stabilization 0.70 7,031 9,414 16,445
IBHTF Operations 0.0 2,174 0 2,174
Health Care Cost Transparency Board 2.0 538 815 1,353
Pharmacy Dispensing Fee Settlement 0.0 6,840 7,728 14,568
WACares Program Implementation 1.5 0 563 563
MQIP Waiver Program 0.0 0 33,257 33,257
BH Personal Care Waiver 2.0 16,271 15,660 31,931
Restore Program Integrity Savings 0.0 106,900 237,900 344,800
Equifax Income Data Sources 0.0 412 1,238 1,650
Involuntary Treatment Staff 3.5 904 0 904
FCS Admin Capacity 1.0 0 (199,447) (199,447)
Long-term Civil Commitment Beds 0.0 (561) (43,509) (44,070)
2024 Policy Other Changes Total 74.5 126,692 306,896 433,588

2024 Policy Comp Changes

State Employee Benefits 0.0 44 76 120
Non-Rep General Wage Increase 0.0 0 1,570 1,570
Pension Rate Month of Death Bill 0.0 22 37 59
2024 Policy Comp Changes Total 0.0 66 1,683 1,749

2024 Policy Central Services Changes

Audit Services 0.0 5 8 13
Legal Services 0.0 10 13 23
Administrative Hearings 0.0 20 18 38
CTS Central Services 0.0 54 93 147
DES Central Services 0.0 1 3 4
OFM Central Services 0.0 1,752 223 1,975
GOV Central Services 0.0 7 12 19
2024 Policy Central Services Changes Total 0.0 1,849 370 2,219
Total Policy Changes 74.5 128,607 308,949 437,556
2024 Policy Level 1,653.0 7,929,074 23,518,060 31,447,134
Difference from 2023-25 Original 74.5 446,449 1,217,888 1,664,337
% Change from 2023-25 Original 4.7% 6.0% 5.5% 5.6%

Policy Changes

Audit Services

Adjustments are made for each agency's anticipated cost of audits performed by the State Auditor's Office. (General Fund - Federal, School Employees' Insur Admin Acct - State, General Fund - State, other funds)

Legal Services

Adjustments are made for each agency's anticipated cost of legal services provided by the Attorney General's Office. Because legal services expenditures are based on consumption, funding provided in the central service model is not all inclusive. The methodology to estimate consumption is a two-year average and allows for analysis to incorporate unique agency circumstances. (St Health Care Authority Admin Acct - State, General Fund - Federal, General Fund - State, other funds)

Administrative Hearings

Adjustments are made for each agency's anticipated cost of hearings performed by the Office of Administrative Hearings. (General Fund - State, General Fund - Federal)

CTS Central Services

Adjustments are made to reflect each agency's anticipated share of charges from Consolidated Technology Services (CTS) for the Office of the Chief Information Officer, Office of Cybersecurity, state network, enterprise and small agency IT services, enterprise architecture and data management, Microsoft 365 licenses, and other items. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)

DES Central Services

Adjustments are made to reflect each agency's anticipated share of charges from the Department of Enterprise Services (DES) for Capitol campus costs; real estate, risk management, and small agency services; the Perry Street and Capitol Campus child care centers; enterprise applications, and other items. (General Fund - Federal, General Fund - State)

OFM Central Services

Adjustments are made to reflect each agency's anticipated share of charges from the Office of Financial Management for existing statewide applications, the One Washington program, and other central services. See Chapter 11 of the 2023-25 OFM Budget Instructions for allocation methodologies. (General Fund - State, General Fund - Federal, St Health Care Authority Admin Acct - State, other funds)

Doula Reimbursement

Funding is provided to compensate birth doulas for services provided to Medical Assistance clients. (General Fund - Medicaid Federal, General Fund - State, General Fund - Cash, other funds)

Upper Payment Limit

Funding is provided to shift federal expenditures that were disallowed by the Centers for Medicare and Medicaid Services to state funds to cover the costs that exceed the Medicaid Inpatient Upper Payment Limit. (General Fund - State, General Fund - Federal)

AFH Tiered Rates

Funding is provided to implement the tiered rate structure included in the collective bargaining agreement with adult family homes (AFH) for personal care services. (General Fund - Medicaid Federal, General Fund - State, General Fund - Local CRC Oregon, other funds)

Young Adult Discharge Program

Funds are provided for a community residential program designed for young adults ages 18 to 25 exiting an inpatient behavioral health facility with risk of unaccompanied homelessness. Sufficient funding is provided for two 6-10 bed community residential programs, one on each side of the state. They will focus on continuing the benefits of inpatient treatment and identifying long-term housing and other services to reduce the chances of the young person returning to homelessness. (General Fund - State)

Cannabis Revenue Distributions

Appropriations from the Dedicated Cannabis Account are adjusted pursuant to Chapter 169, Laws of 2022 and the November 2023 revenue forecast. (Dedicated Cannabis Account - State, General Fund - State, Basic Health Plan Trust Account - Non-Appropriated)

BH Comparison Rates Phase 3

Funding is provided to continue actuarial work funded in prior budgets that the Authority needs to develop behavioral health (BH) comparison rates related to regional and service level variations. (General Fund - State)

Community Behavioral Health Clinics

Funds are provided for Certified Community Behavioral Health Clinics (CCBHCs) that received grants from the federal Substance Abuse and Mental Health Services Administration. This funding will allow them to continue their operations when sufficient federal funding is no longer available and while HCA pursues a state demonstration waiver to be implemented by fiscal year 2027. (General Fund - State)

OHBH Study

The Authority will use this funding to evaluate options for operating Olympic Heritage Behavioral Health (OHBH), including an analysis of how to best maximize non-General Fund-State funding. A report is due on June 30, 2025. (General Fund - State)

Community Information Exchange

The agency will implement the community information exchange program, which will assist providers with closed loop referrals and ensure clients receive services provided under the 1115 Medicaid Transformation Project waiver. (General Fund - Private/Local, General Fund - Medicaid Federal, General Fund - Local, other funds)

Youth Stabilization Teams

Funding is provided to increase support of youth stabilization teams in the state's crisis system. Support is also included for rural crisis stabilization and withdrawal management facilities. (General Fund - State, General Fund - Medicaid Federal, General Fund - Cash, other funds)

CYBHWG Recommendations

Funds are provided for the Children and Youth Behavioral Health Work Group to update the statewide strategic plan and cover increased contracting costs. It will coordinate this effort with work being done by the Joint Legislative and Executive Committee on Behavioral Health and add targeted issue-driven engagement and learning cycles through 2024. (General Fund - State)

Kooth Behavioral Health Application

Funding is provided for a behavioral health pilot program for 50,000 school-aged children. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)

Non-emergent Transports

Funding is provided to increase rates paid to non-emergent transportation brokers and to compensate non-emergent ambulance transportation over 25 miles, each direction, for the return trip. Currently, non-emergent ambulance transportation is paid only when clients are transported, not the unloaded return trip. (General Fund - Medicaid Federal, General Fund - State, General Fund - Local CRC Oregon, other funds)

New Journeys

Funding is provided to offset provider administrative costs and to cover prescription costs for non-Medicaid participants. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - Cash, other funds)

CSFRF Fund Swap

The General Fund-State appropriation in the 2023-25 budget is replaced with Coronavirus State Fiscal Recovery Funds (CSFRF). (Coronavirus St Fiscal Recovery Fund - Federal, General Fund - State)

Street Medicine Pilot

Funding is provided for two pilot programs of health care professionals that will assess and address the acute and chronic physical and behavioral health needs of people living homeless in encampments and on the streets of Seattle and Spokane. (General Fund - State)

Trueblood Diversion Programs

The Trueblood Diversion Program was launched in 2018 to provide assessments, mental health services, substance abuse treatment, case management, employment assistance, and social services to reduce recidivism and improve the lives of the Trueblood class members. Funding is provided to continue these diversion programs. (General Fund - State)

WA Apple Health Redeterminations

This item supports increased costs resulting from Medicaid redeterminations and an anticipated increase in year-round utilization of the customer support center. (General Fund - Medicaid Federal, Health Benefit Exchange Account - State, General Fund - State, other funds)

HBE Apple Health Expansion

Funds are provided to implement the expansion of the Apple Health Expansion medical assistance program mandated by the Legislature. (General Fund - State)

ACES M&O Costs

Funding is provided to the Health Benefit Exchange to pay for its share of increased costs associated with DSHS' Automated Client Eligibility System (ACES). (Health Benefit Exchange Account - State)

Maintain Software Capabilities

This item supports the increased costs of essential software used by the Health Benefit Exchange. (General Fund - Cash, Health Benefit Exchange Account - State, General Fund - Medicaid Federal, other funds)

Apple Health Enrollment Growth

This item covers the administrative costs to unwind the growth of Apple Health enrollment that occurred during the COVID-19 pandemic. (General Fund - State, General Fund - Medicaid Federal, General Fund - Cash, other funds)

MTP Waiver Extension

The federal government approved and extended Washington state's 1115 Medicaid Transformation Project (MTP) waiver. Funding is provided to align appropriation authority with anticipated expenditures. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - Cash, other funds)

Eligibility for CHIP Ages 0-6

Funding is provided to implement continuous enrollment for Medicaid-eligible children ages zero to six with income at or below 312 percent of the federal poverty level or $45,500 in annual income for a single household. Funding is contingent upon an 1115 waiver approval from the Centers for Medicare and Medicaid Services. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)

Reentry Services

The reentry capacity building program will fund the infrastructure that prepares communities and facilities (prisons, jails, and juvenile rehabilitation centers) to implement the limited pre-release and reentry services authorized by the Centers for Medicare and Medicaid Services. (General Fund - Local, General Fund - Medicaid Federal, General Fund - Private/Local, other funds)

LTSS Waiver Program

Funds are provided to align federal spending authority to support the Long-Term Support and Services (LTSS) waiver program, which is authorized by the Centers for Medicare and Medicaid Services through the 1115 MTP waiver. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - Cash, other funds)

Apple Health Expansion Admin Costs

Funding is provided for the Health Benefit Exchange to support outreach for the Apple Health Expansion medical assistance program. (General Fund - State, General Fund - Cash, General Fund - Medicaid Federal, other funds)

Tribal Administration

Additional staffing resources are provided to assist Urban Indian Health Service providers with removing barriers in the Apple Health delivery system. (General Fund - State, General Fund - Federal)

Increase Rates for 90/180-day Beds

Funding is provided to enhance two reimbursement rates paid to 90- and 180-day involuntary civil commitment bed providers. The first proposed increase improves access to involuntary services for complex, difficult-to-place individuals with extensive needs. The second proposed rate increase eliminates the existing discrepancy between the fee-for-service and managed care daily bed reimbursement rates paid to free-standing evaluation and treatment providers. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)

BH Data Collection & Management

Funding is provided to improve behavioral health (BH) data collection, validation, and reporting abilities. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)

MOUD in Jails Program

The Health Care Authority supports Medications for Opioid Use Disorder (MOUD) programs in 19 city, county and tribal jails. Funding is provided to expand that support to all city, county and tribal jails. HCA has received approval from the federal Centers for Medicare and Medicaid Services to cover MOUD for individuals covered by Medicaid residing in jails, but federal funds will not be available for two years. This funding will both act as a bridge until the federal funds become available and can also provide MOUD treatment for individuals who do not qualify for Medicaid. (General Fund - State, General Fund - Medicaid Federal, General Fund - Local CRC Oregon, other funds)

Community & School Prevention

The Community Prevention and Wellness Initiative (CPWI) is an evidence-based model for effective community and school-based prevention services that is in 95 high-risk, high-need, and diverse sites across the state. Prevention services include youth education and skill building, parenting education, public education and awareness, and student prevention/intervention services that create healthy communities and promote well-being for youth and families. Funding is provided to expand these services to other areas and to stabilize those currently servng Washington youth, families and communities. (General Fund - State)

Tribal Supports - Icelandic Model

The Icelandic Prevention Model focuses on the four domains of youth life: family, peer group, school and leisure time. It is based on the idea that substance use is primarily a social and environmental problem, rather than an individual problem. It was designed to support community-based efforts to reduce substance use and improve the health and well-being of young people by reducing the risk and protective factors that influence youth health. Because the model has had significant positive effects on youth health, funding is provided to expand its use to tribal communities. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)

Tribal Fentanyl Summit

Funding is provided for a summit to bring Tribal leaders, the governor, and state agency leaders together to discuss the impact of the opioid crisis on Native communities across Washington State. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, Opioid Abatement Settlement Account - State, other funds)

Tribal Opioid Fentanyl Campaign

Funds are provided for For Native Lives, a campaign to inform and educate tribal communities about opioid misuse prevention, overdose response, and treatment. The campaign, geared to multiple age groups including youth, provides Tribes with education on using naloxone, finding drug treatment, helping people who are in recovery, and preventing addiction. (General Fund - State)

Health Engagement Hub Acceleration

The Health Care Authority is set to launch two health engagement hubs in fiscal year 2024. Funding is provided to add one additional health engagement hub in fiscal year 2025, one health engagement hub in fiscal year 2026, and two health engagement hubs in fiscal year 2027. This will provide six health engagement hubs across the state by June 2027 that will serve as all-in-one locations where people who use drugs can access a range of medical, harm reduction, and social services. (Opioid Abatement Settlement Account - State)

Smart Health Machines

Smart Health machines are public health vending machines that can be used to distribute a variety of items. In their most basic form they can provide access to naloxone, fentanyl test strips and other public health supplies. They also have touch screen and video conferencing capabilities that allow the machines to be used in the future to provide telehealth services in certain settings. HCA will pilot these machines with jails, behavioral health administrative service organizations, local health departments, harm reduction programs, and others that may be interested in partnering with HCA to utilize a Smart Health machine. Funding is provided for 20 machines across the state in areas identified as high risk for opioid overdose activity. (Opioid Abatement Settlement Account - State)

Sublocade Access

Sublocade is a long-acting injectible version of Medications for Opioid Disorder (MOUD). Funding is provided to increase access to sublocade and could be used for as many as 2,300 doses of sublocade. (Opioid Abatement Settlement Account - State)

ORCA Center

Funding is provided to support a new Opioid Recovery and Care Access (ORCA) Center dedicated to post-overdose medical stabilization, preventing subsequent overdoses and providing rapid initiation of evidence-based Medications for Opioid Use Disorder (MOUD), including methadone and buprenorphine. Naloxone and harm reduction services will be offered onsite to create an open door for service engagement and improve survival rates. The ORCA Center is a project of the Downtown Emergency Service Center (DESC), partnering with the University of Washington’s Addictions, Drug, and Alcohol Institute (ADAI), Public Health-Seattle and Public Health Seattle-King County. It will be located in the Pioneer Square neighborhood of downtown Seattle. (General Fund - State)

Oxford House Expansion

Oxford Houses of Washington State is a group of self-run, self-supported recovery houses that provide an opportunity for every recovering individual to learn a clean and sober way of life. Funding is provided to open six additional homes with up to 50 beds. (General Fund - Cash, Opioid Abatement Settlement Account - State, General Fund - Medicaid Federal, other funds)

Peer Bridger Expansion

Funding is provided to increase the number of peer bridgers from 27 to 35, increase the rates paid to peer bridgers, and backfill federal Mental Health Block Grant funding. (General Fund - State)

Clinical Contract Cost Increases

Increased funding is provided to adjust clinical contracts due to the increased demand for health care services and inflation. These contracts support the perinatal psychiatry consultation line, the Partnership Access Line carrier assessment, contractual activities to support pharmacy operations, and prior authorizations for orthodontic services. (General Fund - State, General Fund - Medicaid Federal, Ambulance Transport Fund - State, other funds)

Fee-for-service Prior Authorization

Funding is provided to implement new technology solutions to support modernization of the Apple Health prior authorization process for fee-for-service Medical Assistance clients, as required in Chapter 382, Laws of 2023. (General Fund - Medicaid Federal, General Fund - State, General Fund - Local CRC Oregon, other funds)

PEBB & SEBB Program Staff Resources

Funding is provided to the Health Care Authority to enhance the administration of the Public Employees Benefits Board and School Employees Benefits Board programs. The agency will increase responsiveness to retirees, improve customer and stakeholder satisfaction, and maintain critical program expertise. (St Health Care Authority Admin Acct - State)

PACT Stabilization

This funding will add two Program of Assertive Community Treatment (PACT) teams for a total of 16 full teams and seven half-teams. This item will also increase rates paid to PACT teams and provide start-up funding to help PACT teams become fully staffed. (General Fund - State, General Fund - Cash, General Fund - Medicaid Federal, other funds)

IBHTF Operations

Ten intensive behavioral health treatment facilities (IBHTF) have received behavioral health facilities grants from the Department of Commerce. Funding is provided for start-up costs to support these new facilities. (General Fund - State, General Fund - Cash, General Fund - Local CRC Oregon, other funds)

Health Care Cost Transparency Board

The agency will import, analyze, and contextualize health care and financial data to allow agency leaders and state policymakers to make informed decisions about new and innovative policies to control health care costs. (General Fund - Medicaid Federal, St Health Care Authority Admin Acct - State, General Fund - State, other funds)

Pharmacy Dispensing Fee Settlement

Funding is provided to move to a tiered compensation structure for the pharmacy dispensing fee. (General Fund - State, General Fund - Federal)

WACares Program Implementation

Funds are provided to configure the ProviderOne payment system to pay Medical Assistance providers for WA Cares claims; track, authorize and coordinate benefits; and support WA Cares providers. (Long-Term Servs & Sup Trust Account - State)

MQIP Waiver Program

The Medicaid Quality Improvement Program (MQIP) will be used to support the Medicaid Transformation Project waiver. Apple Health managed care organizations and their partnering providers will receive MQIP payments as they meet designated milestones. Funding is adjusted to reflect anticipated program expenditures. (General Fund - Local, General Fund - Medicaid Federal, General Fund - Cash, other funds)

BH Personal Care Waiver

Funding is provided to include assisted living facilities in the tiered rate structure that was established in the collective bargaining agreement with adult family homes for personal care services. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)

Restore Program Integrity Savings

Program integrity activities help ensure that state and federal dollars are spent appropriately to deliver high-quality, necessary care and to prevent fraud and waste. Savings resulting from program integrity activities are built into rates and the additional savings adjustment assumed in the current budget will not be realized in the 2023-25 biennium. Funding is provided to restore assumed savings. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)

Equifax Income Data Sources

Funding is provided to pay a federal contractor for income verification services. This had been free during the public health emergency and is required by the Centers for Medicare and Medicaid Services to satisfy the new ex parte eligibility requirement. (General Fund - Local CRC Oregon, General Fund - State, General Fund - Medicaid Federal, other funds)

Involuntary Treatment Staff

Funds are provided to make temporary behavioral health positions into ongoing, permanent roles and to provide administrative assistance to existing activities. These staff are needed to continue to support the Stanwood Residential Treatment Facility project, the National 988 System project, and existing efforts surrounding the Involuntary Treatment Act and other crisis services. (General Fund - State)

FCS Admin Capacity

Funds are provided to build staff capacity for the Foundational Community Support (FCS) program. (General Fund - Local CRC Oregon, General Fund - Cash, General Fund - Private/Local, other funds)

Long-term Civil Commitment Beds

Funding is provided to align with projected expenditures for individuals on 90-day to 180-day civil commitment orders who are served in community settings. (General Fund - Cash, General Fund - State, General Fund - Local CRC Oregon, other funds)

State Employee Benefits

Funding is provided to increase the retiree health insurance subsidy, adjusting the cap from $183 to $193 per month and raising the base subsidy percentage from 50 percent to 60 percent. The insurance funding rates are set at $1,145 per month for fiscal year 2024 and $1,158 per month for fiscal year 2025. (General Fund - State, General Fund - Federal, St Health Care Authority Admin Acct - State, other funds)

Non-Rep General Wage Increase

Funding is provided to pay for a 4% general wage increase at the Health Benefit Exchange. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, Health Benefit Exchange Account - State, other funds)

Pension Rate Month of Death Bill

Funding is provided for contribution rate impacts associated with proposed legislation that ensures the continuation of benefit payments through the end of the month in which a retiree or beneficiary dies. (General Fund - State, General Fund - Federal, School Employees' Insur Admin Acct - State, other funds)

GOV Central Services

Adjustments are made to reflect each agency's anticipated share of charges from the Office of the Governor for the Office of Equity. (St Health Care Authority Admin Acct - State, General Fund - State, General Fund - Federal, other funds)