Washington State Health Care Authority
| Average Annual FTEs | Near General Fund State | Other Funds | Total Funds | |
|---|---|---|---|---|
| (Dollars in Thousands) | ||||
| Current Budget | 1,416.2 | 5,779,026 | 15,466,879 | 21,245,905 |
| 2019-21 Maintenance Level | 1,419.8 | 6,104,059 | 16,148,483 | 22,252,542 |
| Difference from 2017-19 | 3.6 | 325,033 | 681,604 | 1,006,637 |
| % Change from 2017-19 | 0.25% | 5.6% | 4.4% | 4.7% |
2019-21 Policy Other Changes |
||||
| ProviderOne - Operation/Maintenance | 0.0 | 758 | 2,131 | 2,889 |
| Restore Program Integrity Savings | 0.0 | 32,030 | 92,966 | 124,996 |
| MQIP Payments | 0.0 | 0 | 238,982 | 238,982 |
| Medicaid Transformation Project | 0.0 | 0 | (56,524) | (56,524) |
| Mental Health Drop-in Center Pilot | 0.0 | 582 | 657 | 1,239 |
| Low Income Health Care I-502 | 0.0 | (23,929) | 23,929 | 0 |
| PACT Ramp Up | 0.0 | 221 | 0 | 221 |
| Health Homes Rate Increase | 0.0 | 1,423 | 1,343 | 2,766 |
| Public Option | 0.70 | 558 | 0 | 558 |
| Drug Price Transparency Implement | 1.0 | 298 | 0 | 298 |
| K-12 Non-Medicare Retiree Risk Pool | 0.70 | 0 | 15 | 15 |
| Enrollment Process - PEBB | 6.4 | 0 | 1,942 | 1,942 |
| Newborn Screening | 0.0 | 70 | 113 | 183 |
| Diabetes Management | 0.0 | 0 | 150 | 150 |
| Ambulance Cost for Secure Detox | 0.0 | 328 | 0 | 328 |
| Tribal E&T Planning | 0.0 | 200 | 0 | 200 |
| CHIP coverage | 2.5 | 991 | 991 | 1,982 |
| DSH Delay | 0.0 | (54,500) | 168,825 | 114,325 |
| ASO Non-Medicaid Funding | 0.0 | 6,145 | 0 | 6,145 |
| Crisis Stabilization Start-up | 0.0 | 380 | 0 | 380 |
| UW DECOD Clinic Federal Funds | 0.0 | 0 | 500 | 500 |
| APM4 FQHC Reconciliation | 0.0 | 3,479 | 7,894 | 11,373 |
| Federal Match for DOH LIMS | 0.0 | 0 | 2,051 | 2,051 |
| Medicaid Fraud Penalty Account | 0.0 | 220 | (220) | 0 |
| 2019-21 Policy Other Changes Total | 11.3 | (30,746) | 485,745 | 454,999 |
2019-21 Policy Comp Changes |
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| PERS & TRS Plan 1 Benefit Increase | 0.0 | 15 | 26 | 41 |
| Adjust PEBB Funding Rate | 0.0 | 0 | 85 | 85 |
| 2019-21 Policy Comp Changes Total | 0.0 | 15 | 111 | 126 |
2019-21 Policy Transfers Changes |
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| Transfers Between Agencies | 0.0 | 500 | 0 | 500 |
| 2019-21 Policy Transfers Changes Total | 0.0 | 500 | 0 | 500 |
2019-21 Policy Central Services Changes |
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| Archives/Records Management | 0.0 | 1 | 2 | 3 |
| Audit Services | 0.0 | 46 | 79 | 125 |
| Attorney General | 0.0 | 28 | 48 | 76 |
| Administrative Hearings | 0.0 | 1 | 1 | 2 |
| DES Central Services | 0.0 | 7 | 13 | 20 |
| OFM Central Services | 0.0 | 121 | 206 | 327 |
| 2019-21 Policy Central Services Changes Total | 0.0 | 204 | 349 | 553 |
| Total Policy Changes | 11.3 | (30,027) | 486,205 | 456,178 |
| 2019-21 Policy Level | 1,431.1 | 6,074,032 | 16,634,688 | 22,708,720 |
| Difference from 2017-19 | 14.9 | 295,006 | 1,167,809 | 1,462,815 |
| % Change from 2017-19 | 1.1% | 5.1% | 7.6% | 6.9% |
Policy Changes
Audit Services
Adjustments are made to reflect each agency’s anticipated share of state government audits from the State Auditor’s Office. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
Attorney General
Adjustments are made to reflect each agency's anticipated share of legal service charges from the Attorney General’s Office. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State)
Administrative Hearings
Adjustments are made to reflect each agency's anticipated share of administrative hearings charges from the Office of Administrative Hearings. (General Fund - Federal, General Fund - State)
DES Central Services
Adjustments are made to reflect each agency’s anticipated share of charges from the Department of Enterprise Services (DES) for campus rent, utilities, parking, and contracts; capital project surcharges; financing cost recovery; public and historic facilities; real estate services; risk management services; personnel service rates; the Perry Street child care center; small agency services; and the department’s enterprise applications. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
OFM Central Services
Adjustments are made to reflect each agency’s anticipated share of charges from the Office of Financial Management (OFM) for statewide financial applications, One Washington, and other OFM central services. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
Transfers Between Agencies
General Fund State expenditure authority is transferred from the University of Washington School of Dentistry. These funds, combined with increased federal authority, will be used for a rate increase for education and clinical training for dental professionals and students who treat people with disabilities. (General Fund - State)
ProviderOne - Operation/Maintenance
Funding is provided to address increased costs to continue to operate and maintain the current ProviderOne Medicaid Management Information System (MMIS). (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 on delivering high-quality, necessary care and on preventing fraud and waste. The savings assumed in the current budget will not be realized in fiscal year 2020. Funding is provided to restore assumed savings in fiscal year 2020. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - State, other funds)
MQIP Payments
The Medicaid Quality Improvement Program (MQIP) allows states to design quality improvement programs for the Medicaid population in ways that support the state's quality goals. In Washington, the MQIP will be used to support the Medicaid Transformation Waiver implemented in the 2017-19 biennial budget. Apple Health managed care organizations and their partnering providers will receive MQIP program payments as they meet designated milestones. Funding is provided to implement the MQIP program to support the transformation waiver. (General Fund - Local, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Medicaid Transformation Project
Funding is adjusted to align with expected expenditures under the Healthier Washington 1115 Demonstration Waiver. (General Fund - Local, General Fund - Local CRC Oregon, General Fund - Private/Local, other funds)
Mental Health Drop-in Center Pilot
Pursuant to Chapter 324, Laws of 2019, the Health Care Authority must stand up a pilot program to provide mental health drop-in center services. Drop-in centers are staffed 24/7 with a multidisciplinary team intended to divert individuals from inpatient commitments and reduce emergency department use. Funding is increased to cover the full estimated cost of the pilot and the implementation date is pushed to July 1, 2020. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Low Income Health Care I-502
Initiative 502 directed a portion of the revenue from taxes on the sale of marijuana into the Basic Health Trust Account. Those dollars are used in lieu of General Fund-State dollars for capitation payments for Medicaid clients enrolled in managed care plans. Funding is adjusted to reflect updated estimates of marijuana-related revenue. (Basic Health Plan Trust Account - Non-Appropriated, General Fund - State)
PACT Ramp Up
The 2019-21 biennial budget provided funding for eight additional Program for Assertive Community Treatment (PACT) teams across the state. Initial estimates did not take implementation ramp-up costs into account. Additional General Fund-State dollars are provided to cover the estimated time it will take to serve enough clients to cover the cost of Medicaid-eligible services provided by the PACT team. (General Fund - State)
Health Homes Rate Increase
The Health Homes program integrates care within existing systems for high-risk, high-cost adults and children, including clients that are dually-eligible for Medicare and Medicaid. Funding is provided for actuarial analysis in support of a rate increase for Health Home Lead and Care Coordination Organizations serving dually eligible Medicare-Medicaid clients. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Public Option
Funding and 1.0 full-time equivalent staff are provided to plan and administer a new annual procurement effort to secure new qualified health plans for the Health Benefit Exchange. This work begins January 2021 and requires ongoing actuarial support. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - State, other funds)
Drug Price Transparency Implement
Funding and 2.0 full-time equivalent staff are provided to develop, implement, and maintain the prescription drug price transparency program that was established in Chapter 334, Laws of 2019 (Engrossed Second Substitute House Bill 1224). (General Fund - State)
K-12 Non-Medicare Retiree Risk Pool
This funds additional actuarial services so the Health Care Authority can continue work on changes for non-Medicare eligible retirees who will retire as School Employees' Benefits Board (SEBB) members. This will allow those who retire while covered by SEBB insurance to remain in the SEBB program until they become eligible for Medicare. Currently, such K-12 retirees are enrolled in the Public Employees' Benefits Board (PEBB) coverage. (School Employees' Insur Admin Acct - State)
Enrollment Process - PEBB
The Health Care Authority will modernize the PEBB enrollment process. The recently created SEBB process is more efficient than the older PEBB version, and upgrading the PEBB version will increase efficiency by reducing manual work. (St Health Care Authority Admin Acct - State)
Newborn Screening
The Washington State Board of Health added spinal muscular atrophy to the list of diseases screened through the state's mandatory newborn screening panel in 2019. The Washington State Department of Health has requested a fee increase to cover costs related to inclusion of this test. Funding is provided for the fee increase for the mandatory newborn screening panels for all covered medical births. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Diabetes Management
The agency will conduct a request for information for a provider of a diabetes disease management program. (School Employees' Insur Admin Acct - State, St Health Care Authority Admin Acct - State, Uniform Dental Plan Benefits Admin - Non-Appropriated)
Ambulance Cost for Secure Detox
Individuals detained under Ricky's Law must be safely transported to a secure withdrawal management and stabilization facility for treatment. Medicaid rates do not cover the down time while the ambulance crews wait for clients to be transported or the return trip after drop off. Funding is provided to be added to the Behavioral Health Administrative Service Organization contracts to cover this down time. (General Fund - State)
Tribal E&T Planning
Funding is provided to continue the work of the Tribal Evaluation and Treatment (E&T) Work Group which includes maintaining a governance structure, developing policies and procedures, increasing responsibilities of crisis benefits and care coordination hub, and supporting the feasibility of a tribal E&T facility. (General Fund - State)
CHIP coverage
The Children's Health Insurance Program provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In Washington, CHIP covers kids from families with incomes between 133 percent of the federal poverty level (FPL) to 300 percent of the FPL. Funding is provided to maintain CHIP coverage as secondary payer for eligible child dependents of employees eligible for school employee or public employee benefit coverage. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
DSH Delay
Under the Affordable Care Act, disproportionate share hospital (DSH) funding was scheduled to be reduced beginning in 2014. The federal government has extended this reduction to federal fiscal year 2020. Funding is adjusted for both the certified public expenditure hold harmless payment and federal DSH appropriation in anticipation of another federal extension. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
ASO Non-Medicaid Funding
A 5 percent increase is provided to Administrative Service Organizations (ASO) for persons and services not covered by the Medicaid program. These flexible, non-Medicaid funds will be used for court costs related to persons committed under the Involuntary Treatment Act, community inpatient services, crisis and commitment services and residential services. The Health Care Authority must continue to coordinate with Behavioral Health Administrative Service Organizations to assess the funding gaps for non-Medicaid services and payment models. (General Fund - State)
Crisis Stabilization Start-up
Funding is provided for support of the Island County crisis stabilization center. This funding may be used to provide support for the non-Medicaid costs associated with operating the facility. The Health Care Authority must continue to coordinate with crisis stabilization providers and behavioral health entities to identify funding gaps for non-Medicaid services and payment models that reflect the unique needs of these types of facilities. (General Fund - State, Pension Funding Stabilization Acct - State)
UW DECOD Clinic Federal Funds
Federal expenditure authority is provided to use in combination with transferred state funds for a rate increase for education and clinical training for dental professionals and students who treat people with disabilities. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal)
APM4 FQHC Reconciliation
Federally Qualified Health Centers (FQHCs) are community-based health care providers that provide primary care services in underserved areas. In return for serving all patients regardless of ability to pay, the centers receive cost-based reimbursement for their Medicaid patients. On July 1, 2017, the Health Care Authority launched alternative payment methodology 4 (APM4), which ties payment to a per-member, per-month amount rather than an encounter rate, with 16 participating FQHCs. Amounts owed to participating APM4 clinics exceeded original expectations. Funding is provided to reconcile with clinics for costs reported for 2017 and 2018 and reported and estimated through 2019. (General Fund - Cash, General Fund - Medicaid Federal, General Fund - State, other funds)
Federal Match for DOH LIMS
Federal authority is provided for the Lab Information Management System (LIMS) at the Department of Health (DOH) which will automatically generate case reports in the Washington Disease Reporting System. This item is eligible for 90/10 federal match, and the state funds are in DOH. (General Fund - Cash, General Fund - Local CRC Oregon, General Fund - Medicaid Federal)
Medicaid Fraud Penalty Account
Funding is shifted from the Medicaid Fraud Penalty Account to the state general fund on a one-time basis. (General Fund - State, Medicaid Fraud Penalty Account - State)
PERS & TRS Plan 1 Benefit Increase
For eligible Public Employees' and Teachers' Retirement Systems Plan 1 members, this item provides an increase of 1.5 percent, up to a maximum of $22 per month. (General Fund - Federal, General Fund - State, St Health Care Authority Admin Acct - State, other funds)
Adjust PEBB Funding Rate
While Health Benefit Exchange employees are not public employees, they receive public employee benefits through the Public Employees' Benefits Board. Funding is provided to continue coverage at the new benefit rates for fiscal year 2020 and fiscal year 2021. (General Fund - Cash, General Fund - Medicaid Federal, Health Benefit Exchange Account - State, other funds)
Archives/Records Management
Adjustments are made to reflect each agency’s anticipated share of state archiving and state records center costs from the Secretary of State’s Office. (General Fund - Federal, General Fund - State)
