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 | 2,787.1 | 4,583,690 | 5,917,399 | 10,501,089 |
| 2025-27 Maintenance Level | 2,960.7 | 5,314,655 | 6,680,968 | 11,995,623 |
| Difference from 2025-27 Original | 173.6 | 730,965 | 763,569 | 1,494,534 |
| % Change from 2025-27 Original | 6.2% | 15.9% | 12.9% | 14.2% |
2025 Policy Other Changes |
||||
| Forecast Cost AL/ARC Rebase | 0.0 | 19,284 | 21,956 | 41,240 |
| CMS HCBS Access Rule | 17.0 | 2,803 | 2,805 | 5,608 |
| OAA Requirements | 1.0 | 157 | 157 | 314 |
| Multi-Sector Plan on Aging | 2.0 | 746 | 0 | 746 |
| Duals Integration and PACE | 1.0 | 145 | 145 | 290 |
| WA Cares Operations | 323.4 | 0 | 145,229 | 145,229 |
| WA Cares IT | 7.0 | 0 | 24,848 | 24,848 |
| Federal Funding Adjustment | 0.0 | 0 | 12,000 | 12,000 |
| Nursing Home Rate Increase | 0.0 | 35,562 | 38,902 | 74,464 |
| Transitional Care Center of Seattle | 0.0 | 24,577 | 24,577 | 49,154 |
| Nursing Home to Community Support | 0.0 | 12,914 | 7,285 | 20,199 |
| NH2C NH Caseload Reduction | 0.0 | (12,343) | (12,600) | (24,943) |
| Adjust CDE Rates | 0.0 | 103,637 | 130,571 | 234,208 |
| AFH Bargaining | 0.0 | 118,509 | 147,644 | 266,153 |
| Agency Parity | 0.0 | 28,112 | 35,418 | 63,530 |
| CMS Eligibility Changes | 14.5 | 2,177 | 2,178 | 4,355 |
| Assisted Living Rate Increase | 0.0 | 45,800 | 52,199 | 97,999 |
| Competency Evaluation Underspend | 0.0 | (4,000) | (2,600) | (6,600) |
| ESF Underspend | 0.0 | (200) | 0 | (200) |
| General Admin Underspend/Savings | 0.0 | (4,000) | 0 | (4,000) |
| NFQ Fund Transfer | 0.0 | (15,000) | 15,000 | 0 |
| Savings- Administrative | (3.0) | (456) | (372) | (828) |
| Senior Nutrition Program | 0.0 | 27,964 | 0 | 27,964 |
| APS Federal Regulation Changes | 3.0 | 619 | 345 | 964 |
| Agency Provider Admin Rate | 0.0 | 5,562 | 7,007 | 12,569 |
| Facility One-Time Costs | 0.0 | 511 | 0 | 511 |
| 2025 Policy Other Changes Total | 365.9 | 393,080 | 652,694 | 1,045,774 |
2025 Policy Comp Changes |
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| WFSE General Government | 0.0 | 22,045 | 15 | 22,060 |
| Non-Rep General Wage Increase | 0.0 | 5,495 | 31 | 5,526 |
| Non-Rep Targeted Pay Increases | 0.0 | 14 | 0 | 14 |
| SEIU 1199 General Government | 0.0 | 5,860 | 0 | 5,860 |
| Updated PEBB Rate | 0.0 | (879) | (2) | (881) |
| PERS & TRS Plan 1 Benefit Increase | 0.0 | 415 | 0 | 415 |
| Pension Benefit Amortization | 0.0 | (1,505) | (4) | (1,509) |
| 2025 Policy Comp Changes Total | 0.0 | 31,445 | 40 | 31,485 |
| Total Policy Changes | 365.9 | 424,525 | 652,734 | 1,077,259 |
| 2025-27 Policy Level | 3,326.6 | 5,739,180 | 7,333,702 | 13,072,882 |
| Difference from 2023-25 | 539.5 | 1,155,490 | 1,416,303 | 2,571,793 |
| % Change from 2025-27 Original | 19.4% | 25.2% | 23.9% | 24.5% |
Policy Changes
Forecast Cost AL/ARC Rebase
Additional funding is necessary to support the increased cost and utilization of assisted living and adult residential care services anticipated in fiscal year 2027. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
CMS HCBS Access Rule
Center for Medicare and Medicaid Services (CMS) issued the Ensuring Access to Medicaid Services Final Rule in April 2024 to improve access to care, quality, and health outcomes and better address health equity issues in the Medicaid program. The rule seeks to increase transparency and accountability, standardize data and monitoring, and create opportunities for states to promote active beneficiary engagement in their Medicaid programs. This funding provides staff dedicated to overseeing ALTSAs transition and compliance. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
OAA Requirements
Funding is provided to comply with new federal regulations under the Older Americans Act 2024 Final Rule. This new regulation will support the partnership and authority of the State Unit on Aging with Area Agencies on Aging statewide in the provision of services to older adults, individuals with disabilities, and caregivers. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Multi-Sector Plan on Aging
Washingtons significant demographic shift includes increasing life expectancy, a growing proportion of individuals age 65 and over, and a quadrupling of the population of those 85 years and older. A multisector plan for aging (MPA) is a cross-sector, state-led resource that will identify, link, and leverage opportunities, infrastructure, and services for a rapidly aging population, benefiting people with disabilities to achieve quality of life. Resources are provided to begin development of a MPA on aging, engage communities, and hold a biennial summit on aging. (General Fund - State)
Duals Integration and PACE
One new staff member is provided to manage the growing work to improve care and reduce costs through Advancing Medicare and Medicaid Integration, including the Program for All-Inclusive Care for the Elderly, and continue to improve ALTSAs ability to discharge patients from acute care hospitals in a more timely manner. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
WA Cares Operations
Beginning July 2026, this program will provide WA Cares Fund benefits to qualified individuals who have been assessed as needing assistance with activities of daily living. Staff are provided to continue implementation of the WA Cares Fund Program, as directed by chapter 50B.04 RCW. (Long-Term Servs & Sup Trust Account - State)
WA Cares IT
Beginning July 2026, this program will provide WA Cares Fund benefits to qualified individuals who have been assessed as needing assistance with activities of daily living. The program requires technology solutions to manage and track benefits. (Long-Term Servs & Sup Trust Account - State)
Federal Funding Adjustment
Federal expenditure authority is necessary for agencies to utilize awards and grants. Current Older Americans Act grants exceed the agencys current authority. (General Fund - Federal, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Nursing Home Rate Increase
This rate add-on to be applied to the nursing facility rate for fiscal year 2026 and 2027. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Transitional Care Center of Seattle
The Transitional Care Center of Seattle was purchased by DSHS during the COVID-19 pandemic to transition individuals out of acute care settings and into community settings or nursing facilities. Funding is necessary to maintain current bed capacity of nursing facility services in the Transitional Care Center of Seattle. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Nursing Home to Community Support
Rental subsidies to expand in-home options are necessary to transition individuals with lower acuity currently residing in nursing facilities out of these acute care settings. Affordable housing options are limited, and this rental subsidy is intended to bridge the economic barriers between transitioning out of a nursing home and receiving federal rental assistance. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
NH2C NH Caseload Reduction
This corresponding reduction to the Nursing Home to Community program is to reflect the reduction in cost to ALTSA when an individual moves from the more costly nursing home setting to an in-home placement with personal care services. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Adjust CDE Rates
Additional funding is necessary to support the proposed Consumer Directed Employer (CDE) Rate Setting Board labor and admin rates. This provides adequate funding to pay the 46,000 Individual Providers wages and benefits and administrative duties to ensure that in-home care remains a viable option to allow Medicaid clients to live in their community rather than more restrictive and costly alternatives. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
AFH Bargaining
Additional funding is necessary to implement the collective bargaining agreement reached between the state of Washington and the Adult Family Home Council under the provisions of chapter 41.56 RCW for the 202527 biennium. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Agency Parity
Additional funding is necessary to support the parity step for agency providers (AP) associated with the proposed CDE Rate Setting Board rates. This provides adequate funding to keep AP rates in alignment with CDE labor rates. This will ensure in-home care remains a viable option to allow Medicaid clients to live in their community rather than more restrictive and costly alternatives. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
CMS Eligibility Changes
The new federal CMS requirements intended to streamline Medicaid enrollment aims to simplify basic Medicaid programs by reducing coverage disruptions, streamlining the process, increasing enrollment and retention, and protecting beneficiaries. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Assisted Living Rate Increase
Currently, assisted living facility (ALF) rates are funded below the estimated cost of providing long-term care services and at a lower percentage of estimated costs than rates for long-term care provided in similar settings. This underfunding, combined with recent inflation and the unprecedented workforce shortage, has created a threat to the viability of the ALF provider network. This rate increase is intended to support the viability of assisted living providers. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Competency Evaluation Underspend
This program was established to ensure individuals found incompetent to stand trial due to an intellectual or developmental disability, traumatic brain injury, or dementia receive services and supports in community-based settings. Current program utilization is lower than first estimated, and this reduction reflects the true operating costs. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
ESF Underspend
Enhanced Service Facility Program is not expected to reach full capacity until fiscal year 2027. This one-time reduction reflects the true costs of the program. (General Fund - State)
General Admin Underspend/Savings
This represents savings from from various program underspends. This reduction does not intend to impact direct services. (General Fund - State)
NFQ Fund Transfer
The Nursing Facility Quality Assessment Fund has an excess fund balance that can be used for eligible general Fund State expenditures. (General Fund - State, Skilled Nursing Facility Net Trust - State)
Savings- Administrative
Funding and FTE staff are reduced to reflect position vacancy administrative savings. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Senior Nutrition Program
One-time funding is provided for Area Agencies on Aging to administer programs which address food insecurity. These programs target those in greatest economic and social need and support the continuation of vital meal services, nutrition education, and other nutrition services. (General Fund - State)
APS Federal Regulation Changes
Resources are provided to ensure alignment of federal Department of Health and Human Services regulations, which took effect June 7, 2024 (CFR part 1324 subpart D). The new federal rule will require Adult Protective Services (APS) to modify policies, current statute, train staff, and make system enhancements. To meet the federal deadline, APS requires funding for additional staff in the upcoming biennium. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Agency Provider Admin Rate
Additional funding is necessary to support the proposed CDE Rate Setting Board Agency admin rates. This increase will provide adequate funding to keep AP rates in alignment with the administrative cost growth. This will ensure in-home care remains a viable option to allow Medicaid clients to live in their community rather than more restrictive and costly alternatives. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Facility One-Time Costs
Funding is required to complete the closure of the Airport Way Adult Protective Services office. The lease has ended, and the space must be cleared out. (General Fund - State)
WFSE General Government
Funding for bargaining includes a 3%/2% general wage increase, targeted job classification increases, wildfire disaster leave, expanded bereavement leave, and paid vaccine travel time during pandemic emergencies. The agreement also includes: an additional $1 per hour supplemental shift premium for eligible employees who are assigned to a facility that provides direct care to residents, patients, and/or clients and whose duties are performed on location on evenings and weekends; 5% premium pay for employees who are assigned to a 24/7 facility that provides direct care to residents, patients, at-risk youth, and/or clients and whose duties are required to be performed on location, which will be in effect for the 2025–27 biennium; three additional steps on the nurse salary schedule; and an increase to the annual lump-sum payment for employees in LNI risk codes 7200/7201 from $500 to $750. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - State, other funds)
Non-Rep General Wage Increase
Funding is provided for wage increases for state employees who are not represented by a union or are not under a bargaining agreement that is subject to financial feasibility determination. It is sufficient for a general wage increase of 3%, effective July 1, 2025, and a general wage increase of 2%, effective July 1, 2026. This item includes both general government and higher education workers. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - State, other funds)
Non-Rep Targeted Pay Increases
Funding is provided for classified state employees who are not represented by a union or not covered by a bargaining agreement subject to financial feasibility determination, for pay increases in specific job classes in alignment with other employees. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
SEIU 1199 General Government
Funding for bargaining includes a 3%/2% general wage increase, targeted job classification increases, wildfire disaster leave, expanded bereavement leave, and paid vaccine travel time during pandemic emergencies. The agreement also includes: an additional $1 per hour supplemental shift premium for eligible employees who are assigned to a facility that provides direct care to residents, patients, and/or clients and whose duties are performed on location on evenings and weekends; a 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, which premium pay will be in effect for the 2025–27 biennium; three additional steps on the nurse salary schedule; an increase to the annual lump-sum payment for employees in LNI risk codes 7200/7201 from $500 to $750; a 5% assignment pay for RN2s and RN3s at DCYF, Juvenile Rehabilitation Institutions; and $100 standby rate for ARNP and ARNP leads. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Updated PEBB Rate
This item adjusts the employer funding rate for public employee insurance benefits to reflect policy-level decision packages. It increases the rate by $8 per month in the first fiscal year and decreases the rate by $34 per month in the second fiscal year, compared to the maintenance-level update, for a total rate of $1,315 in the first year and $1,355 in the second year. (General Fund - Local, General Fund - Private/Local, Traumatic Brain Injury Account - State, other funds)
PERS & TRS Plan 1 Benefit Increase
An adjustment is made for pension contribution rates, including to fund a benefit increase of 3%, up to a maximum of $110 per month for eligible Public Employees' and Teachers' Retirement Systems Plan 1 members. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Pension Benefit Amortization
An adjustment is made to the base pension rates, as set out in a proposed bill addressing the calculation of the base rate for the 2025–27 biennium, as well as amortization of Plan 1 benefit increases. (General Fund - Local, General Fund - Private/Local, Traumatic Brain Injury Account - State, other funds)
