HB 1392 creates a new Medicaid Access Program in Washington to increase payment rates for certain health care services and expand access to care. The bill establishes a dedicated program structure within the Washington State Health Care Authority and the Office of the Insurance Commissioner, defines key terms such as covered lives, health carriers, and Medicaid managed care organizations, and sets up a financing mechanism based on annual assessments on health carriers and Medicaid managed care organizations.
The bill directs the state to seek any necessary federal approvals, including state plan amendments or waivers, and makes implementation contingent on those approvals and on sufficient appropriations. Once operational, the program would use assessment revenue to fund increased Medicaid professional service rates for specified categories of care, including anesthesia, diagnostics, emergency room services, surgery, inpatient and outpatient visits, behavioral health, maternity, office visits, and other physician services. It also authorizes use of program funds for administrative costs, provider payments, nonfederal Medicaid capitation share, refunds of excess payments, and a school-based Medicaid access component.
HB 1392 amends Washington law to create a new Medicaid Access Program account in the state treasury and to route assessment revenue, interest, and penalties into that account. It also authorizes the Health Care Authority and the Insurance Commissioner to adopt rules, collect reports, set payment schedules, and enforce assessment obligations. The bill includes provisions limiting liability for the program, its officials, and employees when acting in good faith, and it contains a severability clause, an emergency clause for immediate effect of some sections, and an expiration mechanism if federal approval is not obtained by a specified date.
The general sentiment around the bill appears to have been favorable enough to advance through both chambers, but not without significant opposition. It passed the House Appropriations Committee 19-12, the House floor 56-39, the Senate Ways & Means Committee 15-3, the Senate floor 31-18, and the House final concurrence vote 57-38, indicating majority support with a substantial minority opposed. The vote pattern suggests the bill was viewed as a meaningful Medicaid financing and access measure, while also drawing concern about its funding structure and fiscal effects.
The main points of contention likely centered on the new assessments imposed on health carriers and Medicaid managed care organizations, the use of those funds to increase Medicaid rates, and the bill’s dependence on federal approval and future appropriations. Opponents may have questioned the cost burden on insurers and managed care plans, the administrative complexity of the program, and whether the assessment-based financing model would be sustainable or consistent with federal requirements. Supporters, by contrast, appear to have emphasized improved provider reimbursement and expanded access to Medicaid services, including school-based care.
The bill would add a new chapter to Title 74 RCW and amend related statutes to establish the Medicaid Access Program, a new state financing and rate-setting mechanism for Medicaid services. It creates a dedicated treasury account, authorizes annual assessments on health carriers and Medicaid managed care organizations, and directs the resulting funds to higher Medicaid professional service rates, administrative costs, and related program expenses. It also gives the Health Care Authority and the Insurance Commissioner new rulemaking, reporting, collection, and enforcement authority tied to the program, while conditioning implementation on federal approval and appropriations.
The bill appears to have had mixed but ultimately sufficient support. It advanced through committee and both chambers with clear majority votes, but the margins were not overwhelming, especially on the House floor and final concurrence vote. That pattern suggests broad interest in improving Medicaid access and provider payment rates, alongside notable reservations about the financing approach and implementation risks.
The principal controversy was the assessment-based funding model, which requires health carriers and Medicaid managed care organizations to pay annual charges that finance higher Medicaid payments. Critics likely focused on the cost to insurers, the possibility of premium or market impacts, and whether the program could operate as intended without federal approval. There was also likely concern about the bill’s fiscal dependence on future appropriations, its administrative complexity, and the possibility that the program could expire if CMS approval was not secured. Supporters were presumably focused on increasing access to care, especially by raising reimbursement rates for Medicaid services and supporting school-based health services.