Inside Olympia: House, Senate release proposed supplemental budgets

February 22, 2022

The House and Senate on Monday, Feb. 21, released their proposed supplemental budgets for the remainder of the 2021-2023 biennium. Since the adoption of the 2021-23 budget a year ago, state revenue collections have continued to grow. Each of the last four revenue forecasts have been revised upwards. Relative to the enacted budget, projected revenues for the 2021-23 biennium have increased by almost $4.7 billion. Over 5 years (FY2021 – FY2025), projected revenues exceed the estimates made a year ago by $10.1 billion. Costs for this biennium have declined by $1.2 billion compared to last year’s projections. The budget surplus comes from increased tax revenue, remaining federal pandemic relief funds, and savings from money not spent on policy changes last year, such as lower enrollment in K-12. Overall, the two budgets added significant new funding in transportation, K-12 education, rental assistance, and homelessness initiatives, as well as substantial investments in health care.

The final budget, representing the compromise reached by both chambers regarding the state’s spending priorities over the remainder of this biennium, will be released following negotiations between the chambers by March 10.

Good news for health care. WSHA is pleased that between the Senate and House budgets, WSHA’s priorities are nearly all funded in the budget. Due to WSHA’s sustained and strong advocacy over many years, both the House and Senate budgets provide significant funding to address long-term care, difficult to discharge and hospital throughput issues. Combined funding for WSHA’s four budget priorities include $456 million state funds and $883 million total funds in the House, and $396 million state funds and $659 million total funds in the Senate.

Our top budget priorities for this supplemental budget include (note funding amounts are derived from WSHA’s more detailed budget analysis):

  • Health care workforce education and pipeline — The main differences are that the House funds $5 million in nursing education slots at University of Washington ($1.2 million) and in community colleges ($3.8 million), as well as two mobile simulation training vans, whereas the Senate funds $6.2 for development of a Bachelor’s of Nursing program at Eastern Washington University. The House funds additional simulation labs at $13 million, and the Senate funds them at $15.2 million. House: $30 million state, $33 total funds. Senate: $31 million state, $33 million total funds.
  • Difficult to discharge – Investing in the long-term care system to ensure patients who are ready to discharge have an appropriate place to receive long-term services and supports during the pandemic and beyond. Both budgets fund each of our difficult to discharge priorities in some form. This was greatly enhanced by the governor’s Hospital Staffing Initiative. House: $285 million state, $588 million total funds. Senate: $193 million state and $398 million total funds.
  • Behavioral health – Improving the behavioral health system of care across the continuum. Both budgets make significant investments in behavioral health, including WSHA’s top priorities. The main difference is the House did not fund the partial hospitalization/intensive outpatient treatment program pilot expansion. House: $141 million state and $262 million total funds. Senate: $172 million state and $228 million total funds.
  • Washington Medical Coordinating Center (WMCC) – Sustaining the WMCC through the biennium so it is ready to level-load patients across the state during an emergency, such as another COVID-19 surge. Both budgets fully fund the WMCC for the remainder of the biennium. $1.3 million state funds.

Read WSHA’s detailed budget comparison document to see how the Governor’s, House, and Senate proposed budgets compare.

House Proposed Budget

Health care workforce

  • $5 million state for nursing education, to increase the number of nursing slots and graduates at UW ($1.3 million) and in community colleges and to purchase two simulation mobile vans ($3.8 million) state funds.
  • $113,000 state ($433,000 total) for the registered nurse to Bachelor of Science in nursing program at Western Washington University to increase enrollments and align program tuition rates with other state supported undergraduate degrees.
  • $461,000 state funds for development of a Master of Science in nursing program at Western Washington University.
  • $13 million state funds (workforce education investment account) to administer grants for nursing programs to purchase and upgrade simulation lab equipment to help expand capacity and serve more nursing students.
  • $6 million state for a preceptor grant program for nurses willing to supervise nursing students in health care settings.
  • $0 state ($2 million total) for 10 full-time equivalents to process nurse licensure applications in seven days or less.
  • $2.5 million state for one-time funding for DOH to process additional applications for provider credentials and address delays caused by the pandemic. The stated aim of this funding is to issue credentials within seven calendar days of receiving a complete application.
  • $3 million state for implementation of HB 2007 on graduate nursing student loan repayment for nurse educators.
  • $244,000 state funds for increased sexual assault nurse examiner (SANE) training (HB 1622).

Difficult to Discharge

  • $10.5 million state ($21 million total) for Department of Social Health Services (DSHS) for incentive payments to long-term care facilities to take Medicaid clients discharged from inpatient care.
  • $2.2 million state funds for Health Care Authority (HCA) incentive payments to skilled nursing facilities to take Medicaid clients discharged from inpatient care.
  • $8.9 million total funds to renew two WSHA priority components of Initiative #2 of the state’s 5-year Medicaid Transformation Project Waiver.
    • $900,000 for Office of Public Guardianship slots for long-income people in need of guardians.
    • $8 million for Medicaid presumptive eligibility for patients discharging from acute care hospitals.
  • $3.3 million state ($6.5 million total) to reduce case load for case managers serving DSHS clients with significant behavioral health needs and increase placement in significant behavioral health needs.
  • $8.2 million state ($17 million total) to reduce caseloads for hospital discharge planners, Agencies on Aging (AAA) case managers and case managers for clients in residential settings.
  • Funding related to Gov. Inslee’s Hospital Staffing Initiative to address acute care hospital capacity:
    • $1 million state ($1.4 million total) for AAA care coordinators stationed in acute care hospitals.
    • $3 million state ($6 million total) for incentive payments to home- and community-based service providers that accept clients ready to discharge to a lower-level setting from acute care hospitals and nursing homes. Additionally, ongoing funding for a daily rate add-on for 36 Specialized Dementia Care clients.
    • $18 million state ($36 million total) to establish 242 nursing home beds to serve patients discharging from acute care hospitals.
    • $2.9 million state for Assistant Attorney General staff dedicated to guardianship issues to help create and maintain bed capacity at acute care hospitals by facilitating the transition of patients to the community after their medical needs have been met.
    • $2.1 million ($2.9 million total) for DSHS staff to assist patients facing guardianship barriers to discharging from hospitals.
  • $10.7 million state ($22.3 million total) for a new contract at the Transitional Care Center of Seattle (DSHS-owned nursing home).
  • $4.8 million state ($8.5 million total) to help developmentally disabled patients transition care settings.
  • $640,000 state ($1.3 million total) in HCA and $1.1 million state ($2.3 million total) in DSHS to increase private duty nursing rates.
  • $1.4 million state ($2.5 million total) to address the Developmental Disabilities Administration (DDA) financial eligibility process delays.

Behavioral Health

  • $563,000 state to help facilitate the Children and Youth Behavioral Health Workgroup and develop a strategic plan for behavioral health services for children and youth.
  • $6.3 million state ($12.6 million total) to increase the number of community-contracted Children’s Long-Term Inpatient Program (CLIP) beds.
  • $2.1 million state ($2.6 total) toward youth inpatient navigators to help support families and children that need, but are unable to find, long-term inpatient beds.
  • $17.4 million state ($51 million total) to increase Medicaid reimbursement rates by 7% for community behavioral health providers contracted through managed care organizations.
  • $42 million state ($100 million total) one-time funds to assist behavioral health providers that serve Medicaid and state-funded clients and experienced revenue losses or increased expenses due to the COVID-19 epidemic.
  • $48,000 state ($97,000 total) to establish a 32-bed, short-term Residential Crisis Stabilization Program for youth with severe behavioral health diagnoses.
  • $2.2 million state funds ($3.1 total) to manage and contract for 16 beds at the residential treatment facility in Vancouver and 16 beds planned for the residential treatment facility in Snohomish County.
  • $4.4 million state funds ($5.3 total) for assisted outpatient treatment.
  • $3.9 million state funds for non-Medicaid funding to increase BH-ASO and MCO wraparound service contract and implement a 7% rate to address services needs that cannot be paid for with Medicaid funds.
  • $1.5 million state funds for reopening E&Ts, increasing staff capacity, and expanding outpatient services for young adults ages 18-24 in Clark and Spokane counties.

Washington Medical Coordinating Center

  • $1.3 million state to contract with WMCC to provide services that connect all health care facilities, ensure clinical coordination and equitably distribute patients.

Senate Proposed Budget

Health Care Workforce

  • $6.2 million to establish a Bachelor’s in Nursing program at Eastern Washington University.
  • $461,000 state to establish a Master’s in Nursing program at Western Washington University.
  • $433,000 state for the registered nurse to Bachelor of Science in Nursing (RN-to-BSN) program at Western Washington University to increase enrollments and align program tuition rates with other state-supported undergraduate degrees.
  • $15.2 million state (workforce education investment account) to administer grants for nursing programs to purchase and upgrade simulation lab equipment to help expand capacity and serve more nursing students.
  • $6 million state for a preceptor grant program for nurses willing to supervise nursing students in health care settings.
  • $0 state ($2 million total) for 10 FTEs to process nurse licensure applications within seven days.
  • $2.5 million state for one-time funding for DOH to process additional applications for provider credentials and address delays caused by the pandemic. The stated aim of this funding is to issue credentials within seven calendar days of receiving a complete application

Difficult to Discharge

  • $9 million state ($21 million total) for DSHS and $66,000 total for DDA for incentive payments to long-term care facilities to take Medicaid clients discharged from inpatient care.
  • $2.2 million state ($4.5 million total) for HCA incentive payments to skilled nursing facilities to take Medicaid clients discharged from inpatient care.
  • $0 state ($8.9 million total) to renew two WSHA priority components of Initiative #2 of the state’s five-year Medicaid Transformation Project waiver.
    • $900,000 for Office of Public Guardianship slots for long-income people in need of guardians.
    • $8 million for Medicaid presumptive eligibility for patients discharging from hospitals.
  • $20 million state ($40 million total) governor’s Hospital Staffing Initiative to reduce the numbers of individuals in acute care hospital settings who no longer need that level of care by increasing the capability to transition them to other home- and community-based settings.
  • $4.2 million state for AAA care coordinators stationed in acute care hospitals.
  • $10.7 million state ($22.3 million total) for a new contract at the Transitional Care Center of Seattle (DSHS-owned nursing home)
  • $2.2 million state ($3.8 million total) to help developmentally disabled patients transition care settings.
  • $640,000 state ($1.3 million total) in HCA and $1.1 million state ($2.3 million total) in DSHS to increase private duty nursing rates.
  • $1.4 million state ($2.5 million total) to address DDA financial eligibility process delays.

Behavioral Health

  • $300,000 state to help facilitate the Children and Youth Behavioral Health Workgroup and develop a strategic plan for behavioral health services for children and youth.
  • $2.6 million state ($5.3 million total) to increase the number of community-contracted Children’s Long-Term Inpatient Program (CLIP) beds.
  • $2.9 million state to expand the Partial Hospitalization and Intensive Outpatient pilot programs to an additional site beginning in FY 2023.
  • $18.1 million state ($53.2 million total) to increase Medicaid reimbursement rates by 7% for community behavioral health providers contracted through managed care organizations.
  • $100 million one-time state funds to assist behavioral health providers that serve Medicaid and state-funded clients and experienced revenue losses or increased expenses due to COVID-19.
  • $48,000 state ($97,000 total) to establish a 32-bed, short-term Residential Crisis Stabilization Program for youth with severe behavioral health diagnoses.
  • $8.5 million state funds to supply Naloxone kits distributed by hospitals and providers and expand Naloxone distribution programs.
  • $2.8 million state funds ($4 total) to manage and contract for 16 beds at the residential treatment facility in Vancouver and 16 beds planned for the residential treatment facility in Snohomish County.

Washington Medical Coordinating Center

  • $1.3 million state to contract with WMCC to coordinate and distribute COVID-19 patients based on available capacity.

WSHA weighing in: Feb. 21-25

WSHA is weighing in on the following bills this week:

Monday, Feb. 21

  • House Health Care & Wellness
    • E2SSB 5702: Requiring coverage for donor human milk. (Ed Phippen)
    • SSB 5900: Creating a provisional certification for emergency medical services providers under chapters 18.71 and 18.73 RCW. (Cara Helmer)
  • Senate Health & Long Term Care
    • SHB 1866: Assisting persons receiving community support services through medical assistance programs to receive supportive housing. (Cara Helmer)
    • SHB 1893: Allowing emergency medical technicians to provide medical evaluation, testing, and vaccines outside of an emergency in response to a public health agency request. (Cara Helmer)
    • ESHB 1821: Concerning the definition of established relationship for purposes of audio-only telemedicine. (David Streeter)
    • HB 1739: Modernizing hospital policies related to pathogens of epidemiological concern. (David Streeter)
  • Senate Labor, Commerce & Tribal Affairs
    • E2SHB 1868: Improving worker safety and patient care in health care facilities by addressing staffing needs, overtime, meal and rest breaks, and enforcement. (Ashlen Strong)

Tuesday, Feb. 22

  • House Appropriations
    • 2SSB 5736: Concerning partial hospitalizations and intensive outpatient treatment services for minors. (Ashlen Strong)
  • Senate Higher Education & Workforce Development
    • E2SHB 1659: Making higher education more affordable and accessible for students by bridging the gap between cost and need to reduce barriers, improve opportunity, and advance economic security. (Ed Phippen)
    • HB 2007: Establishing a nurse educator loan repayment program under the Washington health corps. (Ashlen Strong)
  • Senate Ways & Means
    • SHB 1789: Establishing a property tax exemption for adult family homes that serve people with intellectual or developmental disabilities and are owned by a nonprofit. (Zosia Stanley)

Wednesday, Feb. 23

  • Senate Labor, Commerce & Tribal Affairs
    • EHB 1837: Restoring the state’s ability to address work-related musculoskeletal injuries. (David Streeter)

Friday, Feb. 25

  • Washington State Building Code Council

Thank you for testifying!

Thank you to everyone who testified in support of WSHA’s legislative efforts over the last week:

  • Shane McGuire, CEO, Columbia County Health System
  • Dianne Aroh, SVP/Chief Nursing Officer, Virginia Mason Franciscan Health
  • Ramona Hicks, CEO/Chief Nursing Officer, Coulee Medical Center
  • Rachael Seekins, Registered Nurse, Coulee Medical Center
  • Scott Eiselberger, Assistant Vice President, Pulse Heart Institute MultiCare
  • Mike Martinoli, Chief Nursing Officer, Ferry County Memorial Hospital
  • Karyn Mirante, Registered Nurse, Harbor Regional Health Community Hospital

Affiliates

Contact Us

Washington State Hospital Association
999 Third Avenue
Suite 1400
Seattle, WA 98104

Map / Directions

206.281.7211 phone
206.283.6122 fax

info@wsha.org

Staff List