Health Care Authority (HCA) 2025 Requests for Legislation & Funding Navigator In-Service Days
Explore the legislative priorities and funding requests for 2025 by the Health Care Authority (HCA), including initiatives like Medicaid Transformation Project (MTP) renewal, clinical quality investments, and enhancing maternal services. Dive into key bills, such as SB 1508, adjusting the Health Care Cost Transparency Board, and miscellaneous bills like SB 5213 and HB 1979 aimed at strengthening regulatory requirements for healthcare programs.
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Health Care Authority (HCA) 2025 requests for legislation & funding Navigator In-Service Days October 16, 2024
Agenda 2024 session recap 2025 budget priorities 2025 request legislation Next steps 2
2024 legislative priorities Ensuring and expanding access Behavioral health investments Medicaid Transformation Project (MTP) renewal (or 2.0) Investing in clinical quality Advancing equity Enhancing maternal services Rates, benefits, and operations 3
2024 session by the numbers 351 bills analyzed 21 one- time reports 24 new legislative reports 72 tracked legislative reports 188 fiscal notes 4
Apple Health Expansion The Legislature increased investment in the Apple Health Expansion program by over $25M for fiscal year (FY) 25 Bringing total projected program funds to over $72M for year one Program operating under a budget cap, limiting enrollment Applications and enrollments opened in June Program went live July 1, 2024 Program enrollment currently at capacity and capped 5
MTP 2.0 Community information exchange (CIE) Continuous eligibility (ages 0-6) Reentry supports Required coordination with Dept. of Corrections (DOC), tribes, other state agencies, and jail administrations. Pre-release services for all Medicaid-eligible individuals within 90 days of release from a state prison, jail, or youth correctional facility (pre-trial or post- conviction). HCA to define a pre-release care management model by March 31 for inclusion in the Implementation Plan submission to CMS, though the details of implementation may evolve over time. 6
Senate Bill (SB) 1508 Adjusts the structure of the Health Care Cost Transparency Board s (Cost Board s) Health Care Stakeholder Advisory Committee and directs new work. Required public hearing for entities subject to benchmark. New requirements: Underinsurance survey Survey of insurance trends Changes annual report date from Aug. 1 to Dec. 1. 7
Miscellaneous bills SB 5213: Modifies and strengthens regulatory requirements for pharmacy benefit managers (PBMs), including those PBMs utilized by our state purchased programs House Bill (HB) 1979: Requires health plans (including PEBB/SEBB) to cap the out-of-pocket cost of 30-day supply of inhalers/epinephrine autoinjectors at $35, starting Jan. 1,2025. SB 5986: Protects consumers from out-of-network health care services charges. HB 1957: Preserves coverage of preventive services without cost sharing. 8
2025 budget priorities Maintaining coverage and ensuring access Strengthening behavioral health, substance use disorder (SUD), and housing supports Improving health outcomes through enhanced rates and benefits Public and school employee benefits investments Critical agency staff supports Human services projects and IT investments 9
Apple Health Expansion funding Seeking funding to increase program budget by $84M Proposing increasing available slots in program by up to 14,000 Would bring total enrollment up to 26,000+ in program by 2027 Includes: Updated agency administrative costs Funding to reimbursement community members participating on community engagement committee Funding to continue development of an IT-based waitlist solution Funding to support additional outreach activities 10
Compliance with federal rules CMS adopted several new Medicaid rules over the past year HCA requesting funding for various compliance activities, including: Adjusting income compatibility thresholds and expanded continuous eligibility. Implementing IT interfaces to comply with federal and state interoperability and prior authorization requirements. Compliance with new managed care accountability and payment rules. Updating and aligning eligibility processes across Apple Health for Kids, MAGI, and Classic Medicaid. 11
Primary care investments Primary Care Infrastructure grants Seeking funding to offer grant funds to primary care providers (PCPs) to invest in infrastructure required to deliver whole-person care. Grants to be administered by Accountable Communities of Health (ACHs). Medicaid primary care rates Seeking funding to bring various pediatric and adult primary care fee schedules up to Medicare levels. 12
Resources More information on Agency Request Legislation and high-priority Decision Packages at hca.wa.gov/assets/program/2025-budget- legislation-proposals.pdf Additional detail on full list of Decision Packages at abr.ofm.wa.gov 13
Questions? Evan Klein Special Assistant for Legislative & Policy Affairs Evan.Klein@hca.wa.gov 14
