Transcript Highlights:

• rule to address the directives in H.R.1, which limits state-directed payments.
• Poor care coordination, lack of access to care or financial resources, and inadequate quality of care
• When you care for Medicaid, not even half of those births are getting adequate prenatal care.
• care.
• care clinician.

Summary: The Senate Health and Long-Term Care Committee met on July 30, 2026, to hear two main briefings. The first, from the Health Care Authority, focused on implementation of federal H.R. 1 Medicaid changes and Washington’s rural health transformation funding. HCA said the state is preparing for major eligibility changes, including the October 1 loss of Medicaid coverage for about 14,000 lawfully present non-citizens and January 1, 2027 work requirements, six-month renewals, and reduced retroactive coverage for roughly 600,000 Medicaid expansion adults. Officials described outreach efforts, new automated verification systems, a verification hub, and plans to use available data sources to reduce manual paperwork, while noting that about one-third of the affected population may still need manual processing. They also said H.R. 1 will limit state-directed payments over time, with an estimated long-term impact of up to $1.5 billion in hospital reimbursements. On rural health transformation, HCA said it is moving quickly to obligate its $181 million federal award through contracts and competitive grants for rural hospitals, workforce, behavioral health, technology, and tribal and community partners. Committee members asked about the impact on rural providers, community service as a work-requirement pathway, emergency Medicaid, tribal and federal reimbursement issues, and whether the state would submit comments on the federal work-requirement rule. HCA said it would file comments, that emergency Medicaid coverage for certain services remains available, and that it is working with tribes and other agencies to avoid erroneous terminations and to move eligible people into other coverage where possible. Members also raised concerns about the administrative burden on families and providers and the need for congressional attention on issues such as TRICARE reimbursement. The second briefing addressed maternal health and the Department of Health’s Maternal Mortality Review Panel report. DOH said maternal mortality in Washington increased for the first time in the report series, but most pregnancy-related deaths remain preventable. Nearly half were linked to behavioral health conditions, especially overdose deaths, with suicide, cardiovascular disease, and COVID-19 also significant causes; most deaths occurred postpartum rather than during delivery. The report found higher mortality rates among American Indian and Alaska Native, Black, Native Hawaiian, Pacific Islander, multiracial, rural, and Medicaid-covered populations, and identified lack of access to care, financial hardship, housing instability, discrimination, bias, and systemic inequities as major contributors. DOH highlighted existing state actions such as one-year postpartum coverage, doula reimbursement, inpatient substance use treatment coverage for birthing people, and vaccine coverage requirements, and offered 12 legislative recommendations focused on affordable and high-quality care, basic needs and community supports, and equitable, culturally responsive services. Presenters from the Suquamish Tribe and Kitsap OBGYN described how the tribe acquired and stabilized a threatened OB-GYN practice to preserve regional access amid provider shortages and hospital service losses. They said rural obstetric care is difficult to sustain because of thin margins, workforce shortages, long travel distances, and higher-risk patients, and emphasized that tribal health systems can offer stronger reimbursement and integrated family-centered care. The Foundation for Healthcare Quality and the Bree Collaborative then outlined statewide maternity-care quality efforts, including work on perinatal behavioral health, care coordination, postpartum screening, doula support, and better-aligned payment models. They said Washington has strengths in innovation but still needs more OB-GYN capacity, better transitions of care, and more culturally responsive, trauma-informed maternal and Native health services.

Transcript Highlights:

• , the child care innovation pilot.
• The other thing about our child care services program is the direct benefit it has to employers.
• Senator West asked what is going to be needed to take care of the child care crisis.
• They need child care to work but they can't afford to find the care.
• Senator Kochhorst for submitting the bill for child care for a child care caregivers to be at the top

Bills: SB1, SB 1

Keywords: appropriations, budget, state funding, education, healthcare, infrastructure, campground safety, youth camp regulations, flood safety, emergency evacuation, health and safety standards, 1185, senate, all

Transcript Highlights:

• For the past two years, her care has been provided through Missouri's self-directed services program.
• if they lose their self-directed care staff?
• And, of course, we have gone over the Our self-directed care staff.
• Home health care is a care model where staff takes care of those needs.
• Beyond daily expenses for Cameron's direct care, this is the financial cost to our family.

Summary: The committee first heard the State Auditor’s fiscal year 2027 budget request. Auditor Scott Fitzpatrick described rebuilding the office after staffing had fallen to a historic low, explaining that the office has grown from 92.5 to 119 FTE but still needs several years to reach full staffing, especially at the manager level. He said most of the budget is payroll, noted the office’s use of lapsing general revenue while staffing is rebuilt, and outlined requests including core operating funds, a small sports betting audit NDI, and a $290,000 increase to the CPA stipend to address recruitment and retention problems. Members also discussed the auditor’s authority to audit state agencies and subrecipients, the office’s role in performance audits, and the meaning of “E” appropriations and the auditor’s recent general revenue conditions report. The committee then moved to public testimony on House Bill 10, focusing on Department of Health and Senior Services and Department of Mental Health issues. One witness from the American Heart Association supported continued funding for cardiac emergency response planning in schools, citing AEDs, CPR training, and about 480 schools served. Another witness from the Alzheimer’s Association urged rejection of a proposed $1 million reduction to the Missouri caregiver program, arguing it supports families caring for people with dementia and helps avoid more expensive institutional care. Most of the testimony concerned proposed cuts to developmental disability services, especially day habilitation and self-directed supports (SDS). Providers, family members, and workers said the proposed reductions would force service cuts, reduce wages, and threaten community-based care that keeps people at home and out of more costly facilities. They argued the cuts would shift costs to emergency, residential, or institutional settings and asked the committee to preserve current funding levels. Several members asked questions about provider rates, the share of services delivered by private providers, and the cost difference between SDS and institutional care. The hearing ended with the chair apologizing for earlier tension, explaining the schedule, and recessing the committee to return later because of House floor obligations.

Transcript Highlights:

• I am a registered nurse appointed by Governor Newsom to serve on the board in a direct care provider
• Telehealth is also providing direct patient care, so a part of that can be counted towards that 500 hours
• Before they actually go in and can provide the direct care.
• That is for everybody, whether it's U.S., California, or international. 500 hours in direct patient care
• You can have a campus in L.A., but you can provide online coursework and direct patient care in Big Pine

Keywords: 988, house, all

Transcript Highlights:

• That kid deserves real help and holistic care.
• Health care. Item number six, AB 1876 with Addis. Health care coverage, non-discrimination.
• Affordable Care Act.
• or other gender-affirming care that the health care service plan would otherwise cover if the denial
• is, we consider it a health care access desert, really, but it's also becoming a dental care access

Keywords: 988, house, all

Transcript Highlights:

• And then the final piece, uh, with all the effective date changes, uh, deals with direct care and treatment
• It's Representative Nors' bill exempting assisted living providers from direct care staff compensation
• <00:03:26.319><c> Care</c><00:03:26.680><c> staff</c><00:03:27.120><c> compensation</c> Direct Care staff
• All of these sections update statutes to account for the new Direct Care and Treatment agency.
• These sections add Direct Care and Treatment and the Direct Care and Treatment executive board, or chief

Keywords: 1183, house

Transcript Highlights:

• dollars be dedicated to patient care and spent on direct care.
• Taxpayer dollars are being diverted away from direct resident care.
• go to direct resident care.
• When you look at, can they do direct care ratios and reviews, I mean, is it transparent?
• But does not apply the direct, we're trying not to. apply the direct care ratio to capital improvements

Keywords: 1185, senate, all

Transcript Highlights:

• </c> bill for Minnesota Care. bill for Minnesota Care.
• directed payment program for hospitals that participate in MA managed care. actually identical.
• Uh, this directs DHS to seek federal approval for MA to cover traditional health care practices.
• </c> health care in Minnesota. health care in Minnesota.
• </c> um we take care from a um healthc care um we take care from a um healthc care access<01:49:48.800

Bills: HF2435

Keywords: healthcare, dementia services, public health funding, opioid prevention, women's health, community health boards, mental health, 1183, house

Transcript Highlights:

• For fiscal year 27, hospital budgets allows the Green Mountain Care Board to direct an amount equal to
• It requires the Green Mountain Care Board to direct hospitals to provide information in their fiscal
• ><c> Care</c><00:20:22.080><c> Board,</c> directs the Green Mountain Care Board, directs the Green Mountain
• Care Board to direct the Green Mountain Care Board to direct hospitals<00:30:52.159><c> commercial</
• S.190 directs the Green Mountain Care Board to do this work.

Keywords: 926, house, all

Transcript Highlights:

• </c><00:02:41.040><c> center</c> Uh did the did the child care center Uh did the did the child care center
• </c> actions to assist uh new child care actions to assist uh new child care centers<00:04:52.880><c>
• in child care and um she was trapped in child care and um she was trapped between<00:07:22.000><c> the
• plan of care.
• Seeing none, Secretary, please call the roll. a directed plan of care uh but the a directed plan of care

Keywords: 958, all

Transcript Highlights:

• The CARES project will support a successful go-live of CWS CARES by providing implementation management
• facilities, children's residential facilities, child care facilities, home care organizations, continuing
• care contracts, the administrator certification program, and the registries for home care aides and
• in the future and will lead to more people needing emergency care and those higher levels of care in
• in the future and will lead to more people needing emergency care and those higher levels of care in

Keywords: 987, senate, all

Transcript Highlights:

• No one cares, nobody cares.
• I love it when students, oh wait, go Ducks, no one cares, nobody cares.
• OPD is prepared to staff the task force as directed in the bill.
• It directs study of delivery models and system design.
• And we know there is remaining input from the health care section.

Summary: The Civil Rights and Judiciary Committee heard testimony on several bills. On SB 5906, the SAFE Act, staff and Sen. Hansen described protections limiting immigration enforcement access to non-public areas in schools, early learning settings, higher education, health care facilities, adult family homes, and ballot-processing areas, and restricting collection of immigration-status information. Supporters said the bill would clarify and strengthen existing Keep Washington Working policies, while some witnesses requested amendments to better define health care facilities, clarify adult family home and election-related provisions, and keep Section 6 on ballot security. Some members questioned the factual basis for reported ICE activity near schools and daycares and the distinction between judicial and administrative warrants. The committee also heard SB 5886 on personality rights and forged digital likenesses. Staff explained that the bill would add digitally created or modified likenesses to the Personality Rights Act, raise civil penalties, and allow recovery of actual and non-economic damages in forged-digital-likeness cases. The sponsor and supporters said the bill is intended to address AI deepfakes and identity misuse while preserving satire and fair use; student and advocacy witnesses supported the measure as a way to protect students and victims of digital impersonation. The committee then heard SB 5169, which expands child hearsay and closed-circuit testimony rules to older children and additional offenses. Prosecutors and forensic interviewers supported the bill as necessary in trafficking and child abuse cases, while defense advocates opposed it as an overbroad expansion that could raise confrontation-clause issues and create legal challenges. Additional hearings included SB 5865, which would move garnishment form updates from statute to the Washington Pattern Forms Committee; judges supported it as a way to fix a wage-withholding calculation error and allow future updates without legislation. SB 5912 would reinstate the Indigent Defense Task Force to study statewide public defense delivery and recommend sustainable reforms; counties, the Office of Public Defense, and defense groups supported it. SB 6009 would make permanent the current process for direct review of administrative decisions by the Court of Appeals and retain land-use transfer provisions; a Court of Appeals judge supported the bill. SB 6087 would extend limited liability for donations of children’s items to religious organizations and add strollers and car seats, with support from Zero Waste Washington. The committee did not take final votes on these bills during the hearing.

Transcript Highlights:

• And then there's your consumer-directed care, which is where the client or the patient actually hires
• According to a letter of direction issued by the Health Care Authority in July 2025, the recommended
• And then there's your consumer directed care, which is where the client or the patient actually hires
• to the letter of direction issued by the Health Care Authority, the Health Care Authority serves at the
• It says here that there's a fiscal intermediary... ...or directed personal care services.

Keywords: 996, all

Transcript Highlights:

• </c><01:02:40.640><c> Care</c><01:02:40.920><c> staff</c> that are considered Direct Care staff that
• Senate File 1810 understands that direct care is direct care, and if we are going to have a list of direct
• </c><01:03:38.920><c> Care</c> temporary travel that other Direct Care temporary travel that other Direct
• </c><01:03:59.400><c> Care</c> file 1810 understands that Direct Care file 1810 understands that Direct
• 04:03.039><c> staff</c> have a list of Direct Care staff have a list of Direct Care staff services<01

Keywords: 1187, senate, all

Transcript Highlights:

• There is a whole suite of bills directed towards community-based care oversight.
• There is a suite of bills directed towards community-based care oversight.
• their own attendant and direct their own care with assistance from a financial services agency.
• support professional, or as I still call them direct care staff, that is just so deflating.
• care staff taking people out in the community or direct care staff specializing more on activities,

Keywords: 1184, house, all

Transcript Highlights:

• I am a registered nurse appointed by Governor Newsom to serve on the board in a direct care provider
• Telehealth is also providing direct patient care, so a part of that can be counted towards that 500 hours
• care.
• Before they actually go in and can provide the direct care.
• That is for everybody, whether it's U.S., California, or international. 500 hours in direct patient care

Summary: The joint Assembly and Senate Business and Professions sunset oversight hearing focused first on the Board of Registered Nursing (BRN), with committee chairs emphasizing oversight, consumer protection, workforce access, and economic mobility. BRN leaders reported improvements since the last review, including faster licensing timelines, streamlined enforcement, higher consumer satisfaction, growth in pre-licensure enrollment, and expanded data collection. Members questioned the board about nurse practitioner scope and supervision, international and military pathways to licensure, online nursing education and clinical requirements, rural workforce shortages, and the 30-unit LVN-to-RN option. BRN staff explained California’s tiered advanced practice system, the NCLEX and certification requirements, English proficiency rules, clinical hour standards, and the board’s role in approving programs and supporting schools through nursing education consultants. Several members and the board president also discussed the need to retain new graduates, improve diversity in the workforce, and better support nontraditional students and rural placements. Public comment on the BRN sunset review was extensive and largely supportive of the board, while also urging policy changes. Nurse practitioner, nurse anesthetist, nurse midwife, and nursing education groups generally supported the BRN report and especially backed clarification of APRN-to-RN delegation authority under issue 13. Other commenters asked for clearer implementation of AB 890, more flexibility for clinical nurse specialists, streamlined renewals for nurse midwives, and changes to federal loan limits affecting graduate nursing education. Higher education representatives and private nursing schools raised concerns about duplicative BRN documentation, clinical placement bottlenecks, and barriers faced by out-of-state and online programs seeking to serve California students. The California Medical Association and some physician groups opposed easing transition-to-practice requirements for out-of-state nurse practitioners and cautioned against changes to specialty and delegation rules, while the California Nurses Association and others stressed the importance of community college pathways, new graduate support, and workforce retention. The hearing then moved to the Physical Therapy Board of California. Board leadership reported that the board oversees more than 41,000 active licensees, has seen about 15% growth since 2021, and continues to maintain high exam pass rates among California physical therapy and physical therapist assistant programs. The board described its mission as consumer protection through licensing, enforcement, continuing competency oversight, and stakeholder engagement. The vice president’s remote testimony encountered technical problems, so the executive officer continued with a brief overview of the board’s work and its commitment to efficient service and public protection. No votes or formal actions were taken in the portion of the meeting provided.

Transcript Highlights:

• Um, please keep caring. And everywhere. Um, please keep caring.
• </c> care system and preserve access to care. care system and preserve access to care.
• A directed payment program can offer stability needed to preserve access to care for underserved communities
• A directed payment program can offer stability needed to preserve access to care for underserved communities
• A directed payment program can offer stability needed to preserve access to care for underserved communities

Keywords: 1187, senate, all

Transcript Highlights:

• It is for community care. It is to kids. It is for community care.
• care.
• levels of care.
• than ICFID care andor nursing facility<00:57:22.160><c> care.
• </c> childc care facilities. childc care facilities.

Keywords: 958, all

Summary: The committee met with a quorum and first heard brief presentations on Kentucky’s 2025 Preventive Health and Health Services Block Grant and Title V Maternal and Child Health Block Grant. Department for Public Health staff explained that the preventive health block grant provides about $2.3 million annually and supports programs such as accreditation and performance improvement, local health department grants, community health workers, prescription assistance, asthma and COPD programs, workforce development, and a sexual assault programs set-aside. They said the Title V block grant provides about $11.7 million, with 35% directed to children and youth with special health care needs and 65% to maternal and child health populations, largely through local health departments and a five-year needs assessment process. After no questions, a motion was made and seconded to approve both block grants. The roll call vote passed 19-0, and the two block grants were approved. The committee then approved the minutes from the prior meeting. The next item was a discussion of the child waiver created in House Bill 6. Committee members raised concerns that the proposed 1915(c) waiver did not match the legislature’s intent, which they said was to move children from the Michelle P. waiver to free slots for adults. Cabinet officials from DCBS, behavioral health, and Medicaid described the proposed “Community Health for Improved Lives and Development” waiver as a targeted home- and community-based program for children under 21 with severe behavioral health or developmental needs, including those stepping down from inpatient or residential care or at risk of out-of-home placement. They said the waiver is designed for about 100 slots, uses a standardized needs-based assessment, and includes case management, community living supports, home modifications, respite, supervised residential care, and clinical therapeutic services. Officials said the public comment period ended July 15, responses are being compiled for August submission to CMS, and the waiver is part of the broader Families First initiative.

Transcript Highlights:

• </c><00:04:18.600><c> care</c> enjoy more comprehensive care care enjoy more comprehensive care care
• advance care through developing new care models.
• care through developing<00:09:37.440><c> new</c><00:09:37.640><c> care</c> developing new care developing
• </c> Health Care rather than less health care Health Care rather than less health care but<00:26:20.559
• health care.

Keywords: 1187, senate, all

Transcript Highlights:

• ><c> primary</c><00:13:16.200><c> care</c> framework for direct primary care framework for direct primary
• I think the concept of direct primary care is one that we should discuss and explore.
• care is one concept of direct primary care is one that<00:13:46.480><c> we</c><00:13:46.640><c> should
• </c><00:13:57.240><c> And</c> of a direct primary care agreement.
• And of a direct primary care agreement.

Keywords: 1187, senate, all