Transcript Highlights:

• at 100% of Medicare payment rates.
• It simplifies the payment plans by and large.
• H.R. 1 threatens the foundation of California's safety net systems.
• health care systems.
• payment error rate.

Transcript Highlights:

• We have a fantastic system. We are number one in the country.
• All families to verify continued eligibility prior to each payment.
• We do monthly payments, but we frontload and give a two-month payment on the front end to homeschooling
• Give a two-month payment on the front end to homeschooling families.
• of timely payment.

Transcript Highlights:

• Similarly, state-directed payments—new ones are really not allowed that exceed Medicare payments.
• So the state-directed payments are starting in 2028... ...state-directed payments are starting in 2028
• And these payments and taxes currently...
• , 'Hey, our IT system broke.
• ACES is one of those 34 systems.

Summary: The Ways and Means Committee held a work session to review how H.R. 1 (the One Big Beautiful Bill Act) could affect Washington’s Medicaid, long-term care, developmental disabilities, and food assistance programs, with a focus on implementation challenges, fiscal impacts, and likely coverage losses. Staff and agency officials explained Washington’s Medicaid financing structure, eligibility categories, caseload trends, and the role of the Health Care Authority and DSHS in administering Apple Health and related services. They also described how Medicaid expansion increased access to behavioral health services and how H.R. 1’s provisions are expected to affect the expansion population most directly. Health Care Authority and DSHS officials outlined several major H.R. 1 changes: new work and community engagement requirements for the Medicaid expansion population, six-month redeterminations instead of annual renewals, changes to immigrant eligibility, limits on provider taxes and state-directed payments, new cost-sharing requirements, reduced retroactive coverage, and changes affecting long-term care eligibility. They said Washington is still awaiting federal guidance on many details, but estimated that about 620,000 Apple Health expansion enrollees could be subject to work requirements, that roughly 30,000 immigrants could lose Medicaid eligibility under the new definition of qualified alien, and that some long-term care and developmental disability clients could be indirectly affected. Officials also said the state is working with other agencies to build shared verification systems and may seek a delay waiver, though they do not expect broad federal flexibility. The committee also heard that H.R. 1 immediately blocks Medicaid reimbursement for Planned Parenthood services for one year, with the state planning to backfill about $11 million to preserve access. In addition, officials warned that the law could reduce federal Medicaid revenue by billions over time and strain hospitals and emergency rooms as more people become uninsured. They noted that Washington’s rural health transformation grant application is due November 5 and could bring some funding, but not to offset coverage losses. No votes were taken; the session was informational only. The committee then heard a separate presentation on food assistance, where staff and DSHS described H.R. 1’s SNAP changes, including expanded work requirements, immigrant eligibility restrictions, higher state administrative costs, and a possible future state share of benefit costs tied to payment error rates. DSHS estimated a four-year fiscal impact of about $750 million for food assistance changes and said the state is working on system and policy changes across agencies before the new requirements take effect.

Transcript Highlights:

• We withhold 4% of payments based on the hospital or health systems' attributed members.
• So the two large systems still on the mainframe are the child welfare system...
• So the two large systems still on the mainframe are the child welfare system and the child support system
• systems?
• And then in Section 6, it requires that our premium payments, our capitation payments for Blue Cross

Committee: Senate Appropriations - Human Resources Division

Summary: The Senate Appropriations HR Division met with all members present to review the medical services portion of the HHS budget. Sarah Aker, Executive Director of Medical Services, walked the committee through several budget items, including HCBS cost-to-continue adjustments, the DD bed assessment, expansion of value-based purchasing, targeted rate increases for home health and QSP services, and the cross-disability waiver. Members generally supported the targeted increases for home health and QSP, and Aker explained that the cross-disability waiver funding would support startup work, service design, and infrastructure ahead of a planned July 1, 2028 implementation. The committee spent significant time on rate-setting and provider payment issues. Members discussed ambulance rate rebasing, with several senators expressing concern that the proposed increase was too high relative to peer states; the committee ultimately moved toward reducing that item to $1 million rather than zero so it could be revisited in conference committee. They also discussed a House-added critical access hospital networking grant and similarly leaned toward reducing it to $1 million. Aker explained the department’s value-based purchasing plans, including use of a vendor selected through RFP, and clarified how the department’s existing Medicaid managed care and hospital value-based programs work. A major portion of the meeting focused on long-term care and basic care payments, including a House-added extension of the $5 per day basic care add-on and a proposed shift in nursing facility incentive grants toward a withhold-based model. Senator Mathern indicated he would bring an amendment to delay or modify the withhold change, and Aker said the department would prefer language that directly addresses whether a withhold may be implemented. Members also discussed 1915(i) services, FMAP changes, the Medicaid legacy system modernization carryover, and a House-added legislative intent section on medical assistance. The committee adjourned for the morning with plans to return later to continue Human Services budget work and revisit unresolved items in conference committee.

Transcript Highlights:

• However, if a borrower makes payments during a forbearance plan, the payments must be applied to the
• I do not want lump-sum payments.
• I'm going to ask them about lump-sum payments, but assuming they're not lump-sum payments, I mean, there
• Usually at that point, there is a balloon payment.
• clear that it doesn't allow balloon payments, then it would be illegal to do a balloon payment, correct

Committee: House Banking and Finance

Transcript Highlights:

• That's the current<00:14:10.880><c> system.</c> current system. current system.
• </c> opportunity payment. opportunity payment.
• Some school districts have a local bus system; there's payments for that.
• </c><00:42:15.280><c> there's</c><00:42:15.599><c> payments</c><00:42:15.920><c> for</c> local bus system
• there's payments for local bus system there's payments for that.<00:42:16.800><c> Other</c><00:42:17.760

Transcript Highlights:

• What we can do is bring a mortgage and down payment assistance to get more people into homeownership
• DOWN PAYMENT ASSISTANCE TO HELP INDIVIDUALS AND FAMILIES WHO HAVE THE INCOME BUT NOT NECESSARILY THE
• DOWN PAYMENT ASSISTANCE AND WE ARE THE LARGEST SOURCE OF THAT ASSISTANCE IN THE STATE.
• MULTISECTOR SOLUTIONS AND ALLOW HARM TO PEOPLE PUBLIC SYSTEMS AND COMMUNITIES ACROSS MINNESOTA.
• SCAM IN MY OPINION AND THEN YOU HAVE TO PAY FOR THE BASELOAD SO YOU'RE PAYING FOR TWO SYSTEMS TWO SYSTEMS

Committee: Senate Housing and Homelessness Prevention

Transcript Highlights:

• health systems end up bearing a large share of the burden.
• Payments went up; monthly payments increased.
• We will have more payments because the payments are more affordable. That does make sense. Yes.
• I think it's a great first step for reforming our child support system. ...system.
• I, myself, am not part of the child support system.

Bills: SB629 , SB1015 , SB2501 , SB2933

Committee: Senate Jurisprudence

Transcript Highlights:

• Line 506 reflects directed payments for hospitals, House File 2057.
• This is linked to the directed dispensing payment for pharmacies in that the directed payment is intended
• We believe this step is significant towards maintaining an adequate rural EMS system—a system that is
• But in the meantime, looking out for the health care system.
• The concern that I have in our health care system, it's a fragile system.

Bills: HF2435

Committee: House Health Finance and Policy

Transcript Highlights:

• > to</c> directed payments and dish payments to directed payments and dish payments to um<01:31:01.199
• </c><01:35:18.760><c> system</c> perspective payment system perspective payment system hospitals<01:35
• The prospective payment system hospital and the federal government reimburses differently from those
• The prospective payment system hospital and the federal government reimburses differently from those
• . payments. payments.

Summary: The Ways and Means Committee held a public hearing on Senate Bill 291, which would update religious land-use and property tax exemption rules for church-owned parsonages, parish houses, and similar properties. Senator Tim Lang, speaking for the sponsor, said the bill was intended to address situations where former parsonages are no longer occupied by clergy and are instead used for church-related purposes such as housing staff, religious education, or congregate living tied to ministry, including addiction recovery. He emphasized that the bill was not meant to create commercial rental housing and that it also preserves reasonable zoning and environmental regulations. Committee members pressed the sponsor on how the bill would be applied, especially the meaning of “religious purposes,” the six-unit limit, the “same lot” language, and whether churches could use the exemption to rent units for revenue. The sponsor said the six-unit cap was added to prevent large-scale commercial rental use, that congregate housing would be limited and defined, and that the bill was meant to cover uses like substance abuse recovery, homes for unwed mothers, and religious education, but not apartments converted for ordinary rental. He also said churches would still file annual exemption paperwork and towns could challenge claims they believed were commercial. Questions also raised concerns about whether the bill treated religious and nonreligious housing trusts differently; the sponsor responded that the bill was aimed at church-owned property used in pursuit of a religious mission. Several witnesses testified in support. Representative Mark Pearson, an active clergyman, said the bill would not remove additional property from the tax rolls because clergy housing allowances typically lead clergy to buy taxable homes elsewhere, while the church-owned parsonage remains exempt. Nick Taylor of Housing Action New Hampshire supported the bill as a modest expansion that could help create more attainable housing by allowing better use of existing religious land and structures, though he noted his organization would support even broader use. The hearing ended without a vote or final action, and the chair closed questions after the testimony.

Transcript Highlights:

• </c> payment withholds. payment withholds.
• The last recovering overp payments.
• </c> stopped payment on? That would be great. stopped payment on? That would be great.
• We have a very complex system.
• </c> benefits and provider payment. benefits and provider payment.

Committee: House Fraud Prevention and State Agency Oversight Policy

Transcript Highlights:

• We also have measures in place within our payment tracking system that trigger us to look deeper, and
• Yes, because when we put the information in the payment system, it directly ties back, and it's even
• we changed to this payment system in the first place was there were questions around testing. actually
• when we changed to this payment system in the first place was there was questions around testing.
• This payment system in the first place was there were questions around testing.

Committee: House Budget

Summary: The committee first heard the Office of the Governor’s FY 2027 budget request from Adam Gresham. He explained the office’s staffing and noted a $500,000 core reduction, along with a reallocation of three positions and about $168,000 from the governor’s office to the mansion operating fund to better reflect where those employees work. Members asked about the National Guard emergency line, which Gresham said had already spent about $63,457 in FY 2026 and could be used again for disaster activations, though he did not expect to use the full $4 million. He also said the agricultural resiliency transfer fund had not been used and had no current transfer plans. Several members commented on the size of the governor’s cut and whether the judiciary and other offices were also being asked to reduce budgets. No votes were taken. The committee then moved to the Department of Elementary and Secondary Education’s Office of Childhood and early childhood-related budget items. DESE staff described funding for the Office of Childhood, MoQPK child care provider grants, LEA pre-K grants, early childhood special education, Parents as Teachers, First Steps, preschool coordination, after-school programs, and child care subsidy. Members asked extensively about the MoQPK grants, including why Head Start providers were eligible, how curriculum approval works, and what safeguards exist against fraud or improper payments. DESE said it conducts physical inspections, desk reviews, payment-system checks, and investigations as needed, and that it had not had findings in this area. Some members questioned whether DESE or DSS was the right home for early childhood programs, while others defended the partnership and the role of early educators in identifying child needs. A major portion of the discussion focused on early childhood special education and the child care subsidy program. DESE explained that First Steps serves children birth to age three, while early childhood special education covers ages three to five and is driven by IEP eligibility; members asked for more data on diagnoses, trends, and how many children come off IEPs. The committee also discussed the child care subsidy budget and the governor’s proposed shift to paying providers based on authorization and at the beginning of the month. DESE said the change is being piloted, that a wait list is expected to begin around March 1, and that a May rollout is being considered, but only if software testing and fiscal projections show the system is sustainable. Members expressed frustration that promised changes had been delayed and that providers had been told different timelines, while DESE said the delay was driven by software issues, fiscal caution, and the need to avoid repeating prior payment problems. The hearing ended with the committee in recess before later resuming discussion of the subsidy program; no final votes or actions were taken in the portion provided.

Transcript Highlights:

• </c> reviewing their um their their systems reviewing their um their their systems early<00:48:08.119
• </c><00:50:24.880><c> so</c> the transparency Minnesota system so the transparency Minnesota system so
• </c> at least one visit before final payment at least one visit before final payment on<01:06:28.279>
• </c> for payment for payment um<01:08:56.560><c> checking</c><01:08:56.880><c> out</c><01:08:57.040><
• </c> grantees must submit their final payment grantees must submit their final payment request<01:09:

Committee: House Fraud Prevention and State Agency Oversight Policy

Transcript Highlights:

• and our public health system.
• It restricts state-directed payments from exceeding Medicare payment rates.
• There are no new state-directed payments that can exceed the Medicare payment levels, and it requires
• existing state-directed payments... ...the Medicare payment levels.
• Doula Hub and referral system.

Committee: Senate Health & Long-Term Care

Summary: The committee opened with an extensive update on the expected effects of federal HR1 on Washington’s health care system, especially Medicaid and the individual market. Governor’s office and Health Care Authority staff said the bill is likely to cause immediate coverage losses in the exchange beginning in January, followed by larger Medicaid impacts over the next several years. They highlighted likely premium increases, administrative burdens from more frequent eligibility checks and work requirements, reduced retroactive coverage, limits on state-directed payments and provider taxes, and possible effects on rural hospitals and safety-net providers. They also noted separate CMS rules already being implemented in Washington on prior authorization, managed care access, home- and community-based services, and eligibility/enrollment, and explained how those rules interact with HR1’s new requirements and timelines. Members asked about Planned Parenthood funding, work requirements, rural health grants, provider impacts, and how the state will use existing systems and a forthcoming timeline to prepare for implementation. The committee then received an update on the International Medical Graduate Work Group and Washington’s efforts to create pathways for internationally trained physicians. Presenters described the state’s clinical experience license, the clinical evaluation tool used to assess readiness, a grant program for career guidance and clinical training, and a 2025 law adding a hardship waiver process. National presenters from World Education Services and the Federation of State Medical Boards said many states have adopted similar pathways because of physician shortages, but approaches vary widely. They recommended clear guardrails, employment offers before application, ECFMG certification, supervised provisional practice, data collection, and protections against exploitation. Committee members asked about portability across states, retention of IMGs, and whether Washington should pursue additional options such as dedicated residency slots, preceptorships, or practice-ready assessment models. The final topic was an update on the Apple Health doula benefit and the statewide doula hub and referral system. Senator T’wina Nobles praised the state’s work, noting Washington’s high Medicaid reimbursement rate for doulas and the importance of building infrastructure to support equitable maternal care. Health Care Authority staff said the benefit launched on January 1, 2025, and covers prenatal intake, labor and delivery, postpartum visits, and telehealth-supported services. They reported 336 state-certified doulas, 134 enrolled with Apple Health, 287 clients served, and 641 claims paid so far, while also acknowledging barriers such as provider enrollment, claims submission, client matching, and language access. Doulas for All described the hub as part of a broader effort to expand access, support community-based birth workers, and reduce maternal and infant mortality disparities, especially for Black and Indigenous families.

Transcript Highlights:

• With the exception of the University of Texas system and the Texas A&M system, they have their own health
• JRS2, Judicial Retirement System 1, I mean. It closed back in 1986.
• And the legislature put that on a payment plan with a legacy payment, which is $5 billion.
• to provide an overview of our system and what we do.
• As a system...

Committee: House Pensions, Investments & Financial Services

Transcript Highlights:

• </c> payments. on-time payments. payments. on-time payments.
• </c> to the credit reporting system itself? to the credit reporting system itself?
• and post payments in place.
• and post payments in place.
• the financial system.

Bills: HF4207 , HF3639 , HF3981 , HF3064 , HF2123

Committee: House Housing Finance and Policy

Transcript Highlights:

• I should note there were claims edits in the system MMIS, our claims processing system, ahead of this
• Um, we are is a payment withhold.
• </c> notifications through our minute system. notifications through our minute system.
• Claims for payment.
• </c> system. So that's that's the concern. system. So that's that's the concern.

Bills: HF3378

Committee: House Human Services Finance and Policy

Keywords: human services, Optum reports, data privacy, transparency, legislative oversight

Transcript Highlights:

• In addition, prospective and enrollment-based payments are eliminated.
• make some changes in the administrative systems associated with the bill.
• make some changes in the administrative systems associated with the bill.
• Prospective payment system hospitals are reimbursed based on a set fee or a broader diagnosis-based grouper
• Prospective payment system hospitals are reimbursed based on a set fee or a broader diagnosis-based grouper

Summary: The House Appropriations Committee held a public hearing on a series of bills, beginning with House Bill 2689 on Working Connections Child Care. Staff explained that the proposed substitute would keep eligibility at 60% of state median income, eliminate scheduled expansions to 75% and 85%, reduce future subsidy rates from the 85th to the 75th percentile of market, end enhanced regional rates, and change reimbursement rules from prospective enrollment-based payments back to attendance-based payments with a reduced monthly payment after 11 absent days. Child care advocates thanked the committee for removing the proposed cap on the program but opposed the cuts to provider rates and eligibility expansions, warning of harm to families and providers. The committee then heard Engrossed Substitute Senate Bill 5124 on Medicaid network adequacy for post-acute care, with staff noting administrative costs and indeterminate fiscal effects; hospitals supported the bill as a way to reduce discharge delays and reliance on single-case agreements. Senate Bill 5832, which would raise the new motor vehicle arbitration fee from $3 to $6 to support the Lemon Law arbitration program, drew support from the Attorney General’s Office and auto dealers, who said the fee had not been updated since 1995 and the program was underfunded. The committee also heard Substitute Senate Bill 5862, providing a one-time 3% COLA for certain PERS 1 and TRS 1 retirees, with retirees testifying in favor and local government representatives warning about added employer costs. The committee next heard Senate Bill 5922, allowing school districts to transfer money from the Transportation Vehicle Fund to other funds if they reduce their fleet and receive OSPI approval; staff said the bill would mainly add administrative work for OSPI, and no one testified. Substitute Senate Bill 5923 would allow a hospital on an island in Skagit County to qualify as a critical access hospital if federally certified; Island Health testified that the designation would help sustain rural services, and a committee member asked about bed count and Medicaid/charity-care pressures. Senate Bill 5944 would require language access providers to bargain over compensation for missed or canceled appointments and clarify that statutes prevail over conflicting contract terms; WFSE supported the bill, saying it would equalize bargaining rights across agencies. Substitute Senate Bill 5972 would extend interest arbitration rights to correctional employees in city and county jails regardless of population size; labor supported the bill as a retention tool, while cities and counties opposed it, arguing it would raise costs and should include ability-to-pay protections. The committee also heard Senate Bill 5988, authorizing the Department of Health to continue accrediting opioid treatment programs and charge accreditation fees, which DOH said was needed to avoid winding down the program. Later, the committee heard Senate Bill 6151, which would move Ecology fee revenues for landfill methane emissions and laboratory accreditation into dedicated accounts; Ecology supported the bill as improving transparency and reinvesting fees into the programs, and staff said the lab fee shift would be offset by a related budget action. Engrossed Substitute Senate Bill 6194 would pay a rural hospital on a federally recognized Indian reservation, specifically Astria Toppenish, at 150% of the Medicaid fee-for-service rate beginning in 2027; hospital leaders and community members testified that the hospital serves a high-Medicaid, rural, and tribal population and faces persistent losses. Finally, Engrossed Substitute Senate Bill 6302 would direct L&I to investigate possible misclassification of independent contractors on public works projects involving multiple workers doing the same finishing work; labor and business representatives both described it as a negotiated compromise to address underground economy abuses. The committee took no final votes during the hearing and ended by reiterating amendment deadlines for bills scheduled for executive session.

Transcript Highlights:

• upper payment limit, which is the supplemental payment in the fee-for-service realm, to the supplemental
• payment in the managed... ...supplemental payment in the fee-for-service realm to the supplemental payment
• in the managed care realm, which is called a state-directed payment.
• There are a couple of big system changes that are required.
• We had a value-based payment arrangement. We had primary care case management.

Committee: Senate Health and Welfare

Transcript Highlights:

• In front of you is Senate Bill 6139, an act relating to partial rental payments and rental payment methods
• A landlord must first apply any payment made by a tenant toward rent before applying any payment toward
• the tenant any means of payment agreed upon in the rental agreement and any means of payment previously
• Payment portals are not neutral tools. Once they are open, payments are automatically accepted.
• Will you accept a partial payment?'

Summary: The Senate Housing Committee held public hearings on three bills. SB 6237 would require landlords to disclose flooding history and flood risk to new tenants, along with notices that renters’ insurance and flood insurance may be needed and that county or local government sources have hazard information. The sponsor said the bill was a simple disclosure modeled on other states’ laws after recent flooding in Washington. Testimony was generally supportive, with an environmental nonprofit urging a broader jurisdiction-based disclosure instead of only county government, and housing industry groups saying they were neutral or concerned about added lease disclosures and asking for clearer language about what flooding information must be disclosed. No vote was taken on the bill. The committee then heard SB 6214, which would authorize public corporations, housing authorities, and certain nonprofits to operate as land bank authorities for affordable housing, with requirements for affordability covenants, annual reports, priority access to tax-foreclosed properties, and tax exemptions for qualifying land bank property and transfers. Supporters from Spokane, counties, housing authorities, affordable housing groups, and developers said land banking would help lower land costs, speed development, and expand affordable housing production. One member of the public opposed the bill, arguing it could remove land from the market and affect rural land supply. Department of Revenue staff flagged a technical issue, saying the bill needs a clearer definition of a qualifying land bank authority so the exemption can be administered, and confirmed the proposal would shift property off the tax rolls. The committee also asked whether the bill would allow non-housing uses such as parks or green space; staff said the bill requires affordable housing use, though the other half of land bank activity is not specified. The committee also heard SB 6139, which would require landlords to keep accepting previously used payment methods and continue to accept partial rent payments during an unlawful detainer process, while making clear that partial payments do not reinstate a lease or stop an eviction unless the parties agree in writing. The sponsor said the bill was intended to address cases where tenants can make partial payments but landlords shut off payment portals and refuse them, forcing judges to issue case-by-case standstill orders. Tenant advocates opposed the bill, arguing it would encourage evictions, remove judicial discretion, and could trap tenants by inviting partial payments that do not protect their housing. Landlord and property management groups were concerned about requiring continued access to payment portals and about ambiguity over whether accepting partial payments would waive eviction rights, though they said the bill was a good starting point and suggested clearer receipts and statutory protections. The public hearing was closed without action on SB 6139. In executive session, the committee adopted a proposed substitute for SB 6091, which limits broker marketing restrictions without requiring open access to homes and removes a Washington Law Against Discrimination provision, then voted the bill do pass to Rules. The committee also voted to recommend confirmation of gubernatorial appointments 9278, Pedro Espinoza, and 9279, Diana H. Perez, to the Housing Finance Commission.