Transcript Highlights:

• So 0 to 5 population is about 40% of the children in out-of-home care, and 81% of our foster homes will
• So 0 to 5 population is about 40% of the children in out of home care and 81% of our foster homes will
• care that every one of those parents, or a majority... ...placements and out-of-home care that every
• care placement and the criteria and the rules that DCS is supposed to follow for out-of-home care placement
• Just out-of-home care is $360 million annually.

Committees: House Government , House House Government Committee of Reference

Transcript Highlights:

• So 0 to 5 population is about 40% of the children in out-of-home care, and 81% of our foster homes will
• So 0 to 5 population is about 40% of the children in out of home care and 81% of our foster homes will
• care placement and the criteria and the rules that DCS is supposed to follow for out-of-home care placement
• It's directed by 41, 25. ...follow for out-of-home care placement.
• Just out-of-home care is $360 million annually.

Committee: House House Government Committee of Reference

Summary: The Committee on Government met for a presentation-only hearing focused on the Arizona Department of Child Safety (DCS) and related child welfare system issues; no bills were heard or voted on. Chair Blackman opened by stressing that the hearing was for fact-finding and data, not personal attacks, and Director Catherine Patak then presented DCS data on hotline volume, investigations, reunifications, adoptions, guardianships, extended foster care, and placement patterns. She said DCS investigated more than 43,000 cases in 2025, kept the out-of-home population relatively steady, and emphasized that Arizona places a high share of children with kin. She also highlighted a mismatch between the age of children entering care and the availability of foster homes willing to take older youth, and said behavioral health capacity, not DCS alone, is a major constraint. Patak discussed kinship supports, foster care reimbursement increases, the Family First Prevention Services Act, missing youth, congregate care reduction, and the department’s procurement process for group home beds. Members asked about kinship caregiver support, behavioral health access, reunification services, parental-rights terminations, Auditor General findings on notices and documentation, licensing and reimbursement rates, and why some relatives are not approved as placements. Patak said DCS is working on policy guidance, supervisor training, and improved supports, but that provider capacity and other system partners limit what DCS can do. Representative Gillette then gave a lengthy presentation focused on system design, procurement, funding flows, and congregate care. He argued that DCS, DES, and Access are structurally intertwined, that DCS’s procurement carve-out and capitated funding model create incentives tied to bed space and volume, and that fragmented oversight diffuses accountability. He cited budget figures, contract amendments, and audit concerns to argue that the system is overreliant on congregate care and that decision-making, medical referrals, and placement processes are too vague or too centralized in ways that can harm children and families. Gillette said his findings were based on contracts, interviews, and public records, and he indicated some material would be referred to special counsel. He also raised concerns about placement decisions, due process, and demographic disparities in congregate care outcomes. The chair cut off further questioning of Gillette for time and announced the committee would move on to the next presenter, Vice Chair Fink, with attorneys and other speakers to follow.

Transcript Highlights:

• There's mention of care in the home throughout the state.
• And care into somebody's home.
• Home and community-based services are the largest payer of home care across the country.
• , community-based palliative care in the home.
• Do you have unlicensed home care? Do you have unlicensed home care providers in your organization?

Committee: House Legislative Health & Human Services Committee

Transcript Highlights:

• Would that have an impact on their care if the parent is taking care of them, if that home health that
• Next up, we have Denise Belleville from the Home Care Association of Florida. Ms.
• My first experience into home care was taking home a ventilator child.
• That was my first introduction into home care.
• As home care agents, I...

Summary: The subcommittee held its first meeting of the 2025-2026 term, took attendance, confirmed a quorum, and heard introductory remarks from members and staff. Chair Anderson outlined the subcommittee’s jurisdiction over access and affordability issues, including health facility regulation, insurance, Medicaid, CHIP, and state employee health coverage. The main agenda item was an update on implementation of HB 391, which created a family home health aide program for medically fragile children. Representative Tramont, the bill sponsor, explained that the law was intended to let trained family caregivers be paid through Medicaid to care for their children, reduce reliance on private duty nursing, and relieve families. He and several members expressed frustration that implementation had taken nearly two years and that families still faced barriers. Deputy Secretary Brian Meyer of AHCA and Bridget Royce of DCF said the program was implemented October 1, 2024, with billing available, but no home health agencies had yet launched the required 80-hour training program and no claims had been paid. They described the program’s requirements, including agency employment, background screening, training, a $25-per-hour Medicaid rate paid to the agency, and an annual assessment report. A major issue discussed was that income earned by family caregivers counts toward Medicaid eligibility and could cause families to lose coverage. AHCA and DCF outlined two possible fixes that would require CMS approval: disregarding the income for eligibility purposes or treating the child as a family of one. Members and public witnesses strongly urged changes to avoid forcing families to choose between income and coverage. Several providers said they had begun preparing training programs, but asked for clearer approval processes and more patient-specific training requirements. The committee then heard extensive public testimony from parents and caregivers of medically fragile children, who described the financial, emotional, and logistical strain of caring for children with severe disabilities and argued that the bill should be expanded to include Florida KidCare families and others in the coverage gap. They also raised concerns about the eight-hour-per-day limit, low pay, and the need for simpler rules and direct support. Home health providers and associations supported the concept but asked for modifications, including more targeted training and clearer implementation guidance. The meeting then shifted to a second agenda item on the Andrew John Anderson Rapid Whole Genome Sequencing Program, which was funded in the 2023 budget. Deputy Secretary Meyer said the program has been implemented since January 1, 2024, but utilization has been lower than expected, with only about 60 claims paid and many denials occurring through managed care. Public testimony from a lab, a hospital, and a pediatric rare disease expert said the program is clinically valuable and cost-saving, but managed care billing barriers, prior authorization issues, and DRG-related denials are limiting access; they urged direct billing to Medicaid and possible expansion to all newborns.

Transcript Highlights:

• We also call them home care aides in our state, as well as home health aides.
• nurses who provide care in long-term care settings, which include people's own homes.
• And I'll just tell a very quick story of my daughter, who was a home care aide with a home care agency
• in retaining newly hired home care workers?
• in retaining newly hired home care workers?

Committee: Senate Health & Long-Term Care

Summary: The committee held a work session on the long-term care workforce, hearing first from DSHS Assistant Secretary B. Rector and then from representatives of Washington Health Care Association, SEIU 775, and Behavioral Health Solutions. Presenters described rapid growth in the 85-and-older population, increasing demand for home- and community-based services, and persistent shortages in direct care, nursing, and behavioral health staff. They cited low wages, unstable hours, benefits, certification and testing delays, immigration-related workforce concerns, and burnout as major barriers to recruitment and retention. DSHS highlighted recruitment and retention initiatives funded with federal dollars, including high school training programs, a retention toolkit, transportation support, workforce navigators, tribal partnerships, and remote caregiving pilots. Industry and labor witnesses urged higher reimbursement and compensation, better training pathways, and more worker voice; they also noted that Washington ranks highly nationally on some workforce measures but still faces shortages and turnover. Behavioral Health Solutions added that credentialing delays and mental health staffing gaps are affecting nursing home behavioral care, and that its programs aim to reduce hospital transfers and improve resident outcomes. No votes were taken. The committee then received an overview from the Office of the Insurance Commissioner on the palliative care benefit work group created by 2024 legislation. OIC explained that the work group, with actuarial analysis from Milliman and input from multiple stakeholder organizations, studied a proposed palliative care benefit for commercial plans, Medicaid, PEBB, and SEBB. The report concluded that a new benefit would likely increase costs, estimating about 28 cents per member per month overall and roughly $2.6 million to $4.5 million in annual state Medicaid costs if implemented in 2027. OIC said the evidence was insufficient to conclude that palliative care would produce offsetting savings, though several provider members disagreed and submitted response letters. Members asked about other states, Medicare, health homes, and whether more research could clarify cost savings; OIC said the issue remains unsettled and that additional data may emerge as other states implement similar benefits. Finally, the Health Care Authority provided a broad overview of health care price transparency tools in Washington and federally. Staff described federal hospital and health plan transparency rules, the state all-payer claims database, consumer-facing price and quality tools, prescription drug price transparency reporting, the Health Care Cost Transparency Board, and the Prescription Drug Affordability Board. They emphasized that these tools provide useful but incomplete information because of data lags, proprietary restrictions, limited self-insured employer participation, and the complexity of machine-readable files. The committee also discussed the role of AI in making transparency data more usable and the limits of current tools in helping consumers afford care. No formal action or vote was taken on any item.

Transcript Highlights:

• These are care homes who we serve.
• Um, personal care homes are of care.
• for</c><00:09:47.040><c> the</c> personal care homes that cared for the personal care homes that cared
• </c> personal care homes save is significant. personal care homes save is significant.
• </c> care homes and a lease on the fourth. care homes and a lease on the fourth.

Summary: The Budget Review Subcommittee on Health and Family Services heard a presentation on Kentucky personal care homes from representatives of the Kentucky Association of Healthcare Facilities, Management Systems of Kentucky, and Elder Care Partners. Witnesses described personal care homes as a lower-cost, 24/7 residential option for adults with serious mental illness who do not qualify for nursing home care but need structured support, medication assistance, meals, housekeeping, transportation, and supervision. They said the homes are regulated by the Cabinet for Health and Family Services, are not Medicaid-funded, and rely on a state supplementation rate of about $50.70 per day, which they argued no longer covers operating costs because of rising food, labor, insurance, and maintenance expenses. The presenters said the sector has shrunk significantly over time, citing a drop from 64 homes in 2002 to 34 today among the homes serving this population, with 30 closures over 23 years and two more closures since August. They argued that the closures have contributed to homelessness, hospital overcrowding, and longer stays in psychiatric hospitals, and they gave examples of residents who had spent many months in hospitals before stabilizing in a personal care home. One provider also described spending more than $800,000 on capital improvements after acquiring Kentucky facilities and said reimbursement is too low to sustain safe operations. They asked for an incremental reimbursement increase over two years and said they have also proposed an assisted-living model for people with mental illness. Members asked about staffing, reimbursement, and the number of people still needing placement. The presenters said there is no requirement for licensed or certified staff in these facilities, though some homes use medication technicians and occasional LPNs. They estimated they are currently serving about 2,000 residents and said they receive roughly 30 referrals for every one person admitted, with many referrals involving people whose needs exceed the personal care home level. Senator Meredith and Representative Fleming said any funding request would need documentation of savings and corresponding budget offsets, while Representative Duval expressed support and asked about possible staffing and program improvements. The witnesses also compared Kentucky’s flat-rate reimbursement to a more individualized reimbursement model in Minnesota, saying a needs-based system would better match staffing and reduce hospitalizations.

Transcript Highlights:

• <c> two</c><00:01:29.200><c> small</c> Home Care Association offers two small Home Care Association offers
• This home care services in Minnesota.
• </c><00:02:55.360><c> align</c><00:02:55.680><c> with</c> home care fine dollars to align with home care
• home care dollars go assisted living and home care dollars go into<00:07:08.720><c> um</c><00:07:09.199
• </c><00:07:29.520><c> is</c><00:07:29.840><c> a</c> home care and assisted living is a home care and

Transcript Highlights:

• Um, personal care homes are of care.
• Our Kentucky personal care homes homes.
• for</c><00:09:42.640><c> the</c> personal care homes that cared for the personal care homes that cared
• </c> care homes and a lease on the fourth. care homes and a lease on the fourth.
• homes. 2013 you had 81 uh, personal care homes.

Summary: The Health and Family Services committee heard an informational presentation on Kentucky personal care homes from representatives of the Kentucky Association of Healthcare Facilities, Management Systems of Kentucky, and Elder Care Partners. Witnesses described personal care homes as a lower-cost, 24/7 residential option for adults, often with serious mental illness, who do not meet nursing home criteria but need structured supervision, medication assistance, meals, and daily support. They said the homes are regulated by the Cabinet for Health and Family Services, are not Medicaid-funded, and are supported largely through state supplementation payments and residents’ SSI income. The presenters argued that the current reimbursement rate of about $50.70 per day is no longer sufficient to cover staffing, food, insurance, utilities, maintenance, and other costs, and said the sector has shrunk significantly over time. They cited figures showing a decline from 64 to 34 homes serving the seriously mentally ill since 2002, with 30 closures over 23 years, and said the loss of beds contributes to homelessness, hospital overcrowding, and longer psychiatric stays. They also gave examples of residents who had spent many months in hospitals before being successfully placed in personal care homes, which they said can prevent more costly institutional care. Committee members asked about staffing credentials, fraud controls, referral processes, and how reimbursement works in other states. The presenters said Kentucky does not require licensed or certified staff in these facilities, though some homes use certified medication technicians or an LPN, and they described a county case-manager-based assessment process used to set individualized rates in other states such as Minnesota. Members expressed support for the work but emphasized the need for documentation of savings and budget offsets. The presenters said they are seeking an incremental reimbursement increase over two years, roughly 25% to 50% in the first year and another 50% after that, and urged the committee to support the homes to prevent further closures.

Transcript Highlights:

• , such as paid in-home personal care, residential settings, and nursing homes.
• Long-term care ombuds are the boots on the ground visitors who spend time with residents in care homes
• Long-term care homes have been using tech for many years.
• residents who are evicted from care homes.
• In home care, we know that home care is the preferred setting for clients.

Committee: Joint Joint Legislative Executive Committee on Planning for Aging and Disability Issues

Summary: The committee met for what was described as its final meeting, with members and staff reflecting on the work of the Joint Legislative Executive Committee on Aging and Long-Term Care and noting that future work would likely shift to standing health and wellness committees. The meeting began with introductions and then moved into updates on major initiatives that originated from the committee, including Washington Cares, the Dementia Action Collaborative, and Medicaid long-term care programs. Presenters emphasized that these efforts were developed through long-term legislative-executive collaboration and were intended to help Washington prepare for the state’s aging population. On Washington Cares, DSHS described the program’s development from a 2014 research effort to its 2019 enactment, premium collection beginning in 2023, portability improvements in 2024, and 2025 changes including a grandfathered opt-out fix and a framework for supplemental private long-term care insurance. The agency said benefits are expected to go fully live next summer, with a pilot of up to 400 applicants planned for next January. On dementia policy, the Dementia Action Collaborative reported on the state dementia plan, Project ECHO training for providers, and pilot dementia-capable community programs at area agencies on aging, citing preliminary results that about 85% of family caregivers said services helped people remain at home. DSHS also reviewed Medicaid Transformation Project initiatives, including Medicaid Alternative Care, Tailored Supports for Older Adults, presumptive eligibility, and health-related social needs benefits such as rental assistance, nutrition support, and home modifications. The committee then heard an emerging issues panel from ombuds and disability advocates. Patricia Hunter of the long-term care ombuds program raised concerns about staffing shortages, resident rights, surveillance technology, private equity ownership of facilities, and illegal discharges or evictions. Betty Sweeterman of the Developmental Disabilities Ombuds discussed people stuck in hospitals without medical need, gaps in behavioral health services for people with developmental disabilities, and the need for better workforce training. Todd Carlyle of Disability Rights Washington urged expansion and bundling of community supports such as PACT, GOSH, and peer bridgers to reduce repeated institutionalization and support discharge from inpatient psychiatric settings. Provider and labor panels followed, with nursing home, assisted living, supported living, and union representatives all emphasizing workforce shortages, low wages, Medicaid rate inadequacy, case management bottlenecks, behavioral health complexity, and the need for more flexible care models and stronger accountability for rate increases. No formal votes were taken; the meeting ended with public comment on manufactured housing and closing remarks thanking staff and participants for the committee’s work.

Transcript Highlights:

• A registered home is a child care center that operates out of an individual's home and cares for a smaller
• Can the foster care parent sign up and become the relative neighbor home care provider? Mr. Chair.”
• the care for their grandchildren, become a registered home or a licensed home?”
• the care for their grandchildren become a registered home or a licensed home?
• Because we're both registered home care providers, and we both need care for employment. Mr.

Summary: The committee heard first from LFC staff on a brief about New Mexico’s universal child care expansion. Staff said child care assistance has clear benefits for parents and families, but LFC has not found evidence in New Mexico that it improves children’s educational outcomes; they argued pre-K is the better tool for that goal. The brief highlighted four concerns with universal access: an estimated annual cost of about $849.7 million, a sharp decline in registered homes, possible crowding out of lower-income families, and reduced access for children under age two. Staff also suggested possible mitigations such as prioritizing slots for low-income and at-risk families, reinstating sliding-scale co-pays, and tying quality improvements to workforce wages. Members raised questions about the cost estimate, funding sources, provider quality, and whether the data showed actual crowding out. Several lawmakers expressed support for child care generally but concern about the fiscal impact and whether universal access would divert resources from the families most in need. Others emphasized the importance of child care for workforce participation, rural communities, and family stability, and questioned how registered homes are counted and regulated. LFC staff clarified that the cost estimate was for child care assistance only, not the entire ECECD budget, and that the data showed declines in the share of lowest-income children and infants/toddlers served, though not causation. The ECECD secretary then presented the department’s response, saying universal child care is intended to complete a cradle-to-career system and that the department has already seen strong uptake, increased capacity, and rising workforce participation. She said 6,206 families were found eligible in the first month, the share of infants and toddlers served rose, and new provider applications and licensed slots increased after the November rollout. The department also emphasized wage increases, quality improvements, and a new wage scale/career lattice, while projecting a lower near-term cost than LFC’s estimate and requesting additional funding for child care, early pre-K, home visiting, workforce systems, and capacity-building. No votes or formal actions were taken in the portion provided; the discussion was informational and focused on questions and testimony.

Transcript Highlights:

• We also call them home care aides in our state, as well as home health aides.
• nurses who provide care in long-term care settings, which include people's own homes.
• And I'll just tell a very quick story of my daughter, who was a home care aide with a home care agency
• in retaining newly hired home care workers?
• Home care rates, Just one example here, home care rates in particular are, you know, run and developed

Summary: The committee began with an extended work session on the long-term care workforce. DSHS Assistant Secretary B. Rector described the new Home and Community Living Administration and outlined major workforce pressures: Washington had about 126,000 long-term care workers in 2022, with demand expected to outpace supply as the 85-plus population and dementia prevalence rise sharply. She emphasized that direct care workers are largely women, people of color, and immigrants, and that family caregivers are also a major part of the system. She highlighted recruitment and retention efforts funded through federal Money Follows the Person dollars, including high school training partnerships, a retention toolkit, transportation support, caregiver newsletters, tribal workforce navigators, and a remote caregiving pilot. Committee members asked about career pathways, technology use, and turnover drivers; Rector said wages, benefits, unstable hours, and workplace support are key issues and promised follow-up data. Aidan Swain of the Washington Health Care Association said skilled nursing and assisted living facilities face acute RN vacancies, wage pressures, and Medicaid reimbursement that does not cover costs, and urged modernization of training, better reimbursement, and continued support for facility-based care. Maddie Fouch of SEIU 775, representing about 55,000 caregivers, said low wages, weak benefits, lack of voice, and certification delays are driving turnover and shortages, and argued for higher compensation, better worker protections, and more transparent reimbursement. Catherine Smith of Behavioral Health Solutions described growing behavioral health needs in nursing homes, the role of expanded behavioral supports programs, and credentialing delays that slow hiring. No votes were taken; the panel was informational only. The second agenda item was an overview of the palliative care benefit work group report required by 2024 legislation. Nico Jansen of the Office of the Insurance Commissioner explained that the work group, convened with the Health Care Authority, studied a potential palliative care benefit for fully insured commercial plans and also Medicaid, PEBB, and SEBB. He said palliative care is a philosophy of care focused on symptom management, coordination, and support for serious illness, and is distinct from hospice because it can be provided alongside curative treatment. The actuarial analysis concluded that creating a new benefit would likely increase costs, estimating about a 28-cent per member per month increase overall and roughly $2.6 million to $4.5 million in annual state Medicaid costs if implemented in 2027. Jansen said the consultants did not find sufficient evidence to assume savings from avoided hospitalizations or long-term care, though several work group members disagreed and submitted response letters. Senators asked about other states, Medicare, health homes, and whether more research could clarify cost savings; OIC said some states, including Hawaii, are moving ahead with Medicaid palliative care benefits, Medicare covers some related services but not in the same way, and further evidence may emerge over time. OIC did not take a position on whether the Legislature should create the benefit. The final presentation covered health care price transparency tools in Washington and federally. Evan Klein and HCA Chief Data Officer Vishal Chaudry reviewed federal hospital and health plan transparency rules, the state all-payer claims database, prescription drug price transparency, the Health Care Cost Transparency Board, the Prescription Drug Affordability Board, and other reporting systems. They explained that the APCD contains claims from fully insured commercial plans, Medicaid, and public employee programs, but not self-insured employer data except for limited voluntary submissions. They also described how machine-readable files, consumer price tools, and aggregated dashboards are used, and noted that data limitations, delays, and complexity remain significant. Senators asked about voluntary self-insured participation, the role of AI in making data more usable, and whether transparency can really help consumers given access barriers and medical debt. HCA said AI is increasingly used by private entities to mine large transparency datasets, but state agencies still face limits in data access and analytic capacity. The committee did not take action; the session was informational and ended with a discussion of how transparency data might better inform policy and purchasing decisions in the future.

Transcript Highlights:

• I'm very supportive of nursing homes.
• I'm very supportive of nursing homes.
• </c> today on behalf of the long-term care today on behalf of the long-term care imp<00:08:49.399><c>
• </c><00:09:07.160><c> care</c><00:09:07.279><c> in</c> hurt access to nursing home care in hurt access
• to nursing home care in Minnesota<00:09:08.040><c> as</c><00:09:08.160><c> you</c><00:09:08.279><c>

Bills: HF1419 , HF500

Committee: House Human Services Finance and Policy

Summary: The committee took up House File 500, which would require the legislature to fund the Nursing Home Workforce Standards Board’s standards before they could take effect. An author’s DE2 amendment was adopted first; the amendment was described as pausing the board’s standards unless the legislature estimates and fully pays the cost for each nursing home. The bill author argued that mandates without money create serious consequences for seniors and providers, and said the measure would keep budget authority with the legislature rather than an appointed board. Supporters, including nursing home operators and the Long-Term Care Imperative, said the board’s holiday pay and minimum wage standards would create large unfunded costs, citing estimates ranging from hundreds of thousands to millions of dollars for individual facilities and more than $200 million statewide. They argued that some facilities could face debt, reserve depletion, or reduced access to care if the standards are not funded. Opponents, including SEIU workers and union leaders, said the board has improved staffing, recruitment, morale, and worker safety, and that caregivers deserve higher wages and holiday pay. They argued the bill would weaken the board’s ability to address chronic understaffing and would shift focus away from worker protections. Members also debated whether nursing home reimbursement rates have already risen enough to cover wages and whether the problem lies with how funds are used by providers. After public testimony closed, several members spoke in opposition and support. A roll call was requested, and the committee voted 9-7 to re-refer House File 500, as amended, to the Committee on Labor and Workforce and Economic Development Finance and Policy.

Transcript Highlights:

• mandate on home care nursing services.
• Care mandate on home care nursing services that has been law since 2010.
• The commercial plan is responsible for covering home care nursing services. >> Home care nursing is continuous
• </c> home care nursing. home care nursing.
• </c><00:25:48.080><c> While</c> home care nursing services. While home care nursing services.

Transcript Highlights:

• Medicare does not cover most long-term care services, such as custodial care provided in nursing homes
• care per day for individuals... ...$50,000 translates to roughly four hours of home care per day for
• Yet many do need that long-term care, home care, adult day health care, and assisted living at some point
• The IHSS program allows me to care for her at home, keep her happy and...
• The IHSS program allows me to care for her at home, keep her happy and healthier.

Summary: The Assembly Budget Subcommittees held a joint hearing on older adults and long-term care supports and services, with members and witnesses focusing on the growing “forgotten/overlooked middle” of Californians who are too wealthy for Medi-Cal but unable to afford long-term services and supports (LTSS). Administration witnesses from DHCS and the Department of Aging described Medicare’s limited long-term care coverage, Medi-Cal’s role for low-income residents, and ongoing state work on LTSS financing, including a 2024 financing initiative and a final report due in 2026. Testimony emphasized rising costs, caregiver shortages, homelessness among older adults, and the need to preserve home- and community-based services to avoid more expensive institutional care. Several advocates urged immediate action, especially Medi-Cal share-of-cost reform, housing supports, and protection of HCBS funding. Members asked for the most urgent budget priorities and were told to focus on share-of-cost reform and assisted-living rate protections, along with broader system navigation and caregiver support. The committee also heard testimony on the Community-Based Adult Services (CBAS) program. CDA reported that CBAS serves about 42,000 participants through 304 centers, with demand generally stable but geographic gaps in some regions and staffing challenges after the pandemic. DHCS explained a rate-setting issue: a 10% CBAS rate increase had been mistakenly posted on the Medi-Cal fee schedule in 2024, and while Proposition 35 later made the targeted SB 159 rate increase inoperative, DHCS said any repayment by managed care plans would depend on contract terms and the department would not require clawbacks. CBAS providers and advocates warned that the program is in a financial crisis, with six center closures since June 2024, and requested $74.8 million ongoing General Fund to close about half the gap between current reimbursement and costs. Members expressed concern that clawbacks could accelerate closures and noted the program’s role in preventing institutionalization and supporting family caregivers. In the final panel, CDSS presented on In-Home Supportive Services (IHSS) provider recruitment and retention and on the AB 102 statewide bargaining report. CDSS said the IHSS Career Pathways program has concluded successfully, with more than 59,000 providers completing training, and that the AB 102 report—based on workgroup meetings and consultant analysis—will be sent to the Legislature shortly. The department said the workgroup viewed statewide bargaining as more viable than regional bargaining, but identified major issues around consumer participation, county fiscal impacts, administrative responsibilities, and the need to define bargaining scope in statute. CDSS estimated that each $1 per hour statewide wage increase would cost at least $1.3 billion to $1.5 billion annually. Provider unions supported statewide bargaining, arguing it would improve wages, benefits, and workforce stability, while county representatives said any statewide model should preserve consumer focus, protect county finances and realignment funds, and keep core administrative functions with local public authorities. The hearing concluded without votes, with members requesting additional follow-up information and urging continued engagement ahead of the May revise.

Transcript Highlights:

• PACE is an integrated system of care for older adults who are eligible for nursing home care but who
• PACE is an integrated system of care for older adults who are eligible for nursing home care but who
• PACE is an integrated system of care for older adults who are eligible for nursing home care but who
• care at home for and continue providing care at home for as<01:08:44.239><c> long</c><01:08:44.400><
• </c> who are caring for loved ones at home who are caring for loved ones at home have<01:15:14.480><c

Bills: HF1937 , HF2407 , HF1678 , HF1477 , HF2040 , HF1840 , HF257

Committee: House Human Services Finance and Policy

Transcript Highlights:

• Home care aides support people who need extended care due to age or disability in many different settings
• Home care aides support people who need extended care due to age or disability in many different settings
• While home care aides often provide care in clients' homes, they also work in adult family homes and
• I-1163 established a home care aide certification.
• However, only for home care aides...

Summary: The Joint Legislative Audit and Review Committee held a public hearing on the State Auditor’s Office performance audit of Washington’s Restoring Quality Home Care Initiative (I-1163). Auditors said the initiative’s background checks and 75-hour training requirement are widely viewed as safety measures, but the state lacks pre-2011 data to directly measure safety outcomes. They also found Washington’s long-term care workforce is still short, though the state ranks better than many others in workers per disabled person, and that some groups and regions have larger gaps between authorized and actually used Medicaid care hours, suggesting access problems for certain clients. The audit focused heavily on the certification process for home care aides. Auditors reported that many applicants never finish certification, that the process often exceeds the 200-day legal deadline, and that delays can cause lost income, job loss, and in some cases repeated employer changes that allow aides to keep working without becoming certified. They recommended that the Department of Health accept applications only after training and testing are completed, move testing into training programs more broadly, and eliminate redundant DOH verification of FBI background checks. Committee members asked about testing contract incentives, language access, and the role of immigration in workforce shortages; auditors said they found no financial performance standards in the Prometric contract, did not specifically study immigration status, and did not focus on language barriers in this audit. Department of Health and Department of Social and Health Services officials largely agreed with the audit’s findings and recommendations. They said they have already made improvements, including expanded in-program testing, more staffing, and rule changes, and that testing has been integrated into more than 110 training programs. DSHS noted testing is offered in 13 languages. Both agencies said they support further streamlining and expect continued collaboration, including possible budget or legislative requests. No public testimony was offered, and the committee adjourned without taking any vote or formal action on the audit.

Transcript Highlights:

• You can bring in a BNA or some other home care agency to provide your care. It's totally up to you.
• Yeah, and just rest home level of care is long-term care level.
• So rest home. Rest-home level of care, and then rest-home level of care.
• So rest home, many of these licensed nursing homes associated with a CCRC have both skilled level care
• and rest-home level care.

Summary: The Special Commission on Continuing Care Retirement Communities met for its third meeting, focused on regulations, oversight, and enforcement. Staff and agency presenters reviewed the current framework: the Executive Office of Aging and Independence explained that assisted living regulations generally do not apply to CCRCs unless an assisted living component markets itself separately, and that CCRCs must submit marketing materials, contracts, and disclosure statements for public posting. The Attorney General’s office described Chapter 93A consumer protection standards and noted it is working on draft assisted living-specific regulations. DPH outlined its oversight of licensed nursing facilities associated with some CCRCs, including routine surveys, complaint investigations, and enforcement tools such as admissions freezes, fines, receivership, and license actions, along with federal CMS sanctions for certified facilities. Commission members and presenters then discussed gaps and ambiguities in how CCRCs are defined and regulated, especially whether communities without on-site skilled nursing should still be treated as CCRCs, how assisted living-like services within CCRCs are classified, and whether residents have enough clarity about the services they are buying. A major theme was disclosure: members raised concerns about entrance fees, refund timing and conditions, whether skilled nursing is on-site or provided by contract, and how residents can compare communities. Several participants suggested more standardized disclosure and possibly broader consumer protection rules, while others cautioned that overly rigid requirements could affect community finances and development. The commission also explored enforcement and resident protections. Some members argued that independent living residents are already covered by landlord-tenant law and that existing complaint systems and community education may be sufficient, while others said residents in supported or assisted settings within CCRCs should have clearer access to ombudsman services and oversight. The discussion turned to closure and ownership transfer, with members citing recent national examples of sales and bankruptcies that changed resident terms. DPH explained its closure process for licensed nursing facilities, and members noted that Chapter 197 of 2024 adds oversight for facility transfers and financial disclosures. The meeting ended with logistics for the next session at Brookhaven at Lexington on June 2, a public hearing on June 16, and a request to circulate the hearing notice broadly to residents and stakeholder organizations.

Transcript Highlights:

• I could not take care of him, and he was placed in a group home.
• The care he receives now at the group home is much less expensive for Medicaid than the care he received
• We need to pay caregivers more, whether it's the care provided in a nursing home or a group home. home
• In some health care fields, direct care workers are making $12 an hour when most nursing homes are making
• I'm representing the Association for Home Care and Hospice.

Bills: SB1 , SB 1

Committee: Senate Finance

Transcript Highlights:

• A registered home is a childcare center that operates out of an individual's home and cares for a smaller
• We aren't just providing any care, any kind of home visiting or early intervention.
• Can the foster care parents sign up and become the relative neighbor home care provider? Mr.
• the care for their grandchildren, they can become a registered home or a licensed home?
• Because we're both registered home care providers and we both need care for employment. Mr.

Transcript Highlights:

• They will refer back to CYFD for in-home services such as safe care that are more intensive services.
• From the home or whether in-home services are appropriate.
• home.
• The child will stay with the foster care home, and they'll have a hearing within 10 days.
• home.