The Senate released its proposed 2024 budget Sunday evening, Feb. 18, and the House released its proposed 2024 budget Monday, Feb. 19 at noon. Over the next couple of weeks, the two chambers will work together to craft a final budget. The legislative session adjourns March 7.
This year is a supplemental budget, which means it provides updates to the 2023-25 biennial budget passed last session. We saw unprecedented investments in important areas for hospital and health care last year, such as the hospital Safety Net Assessment Program and investments to help with complex discharge patients. Given the supplemental session and the previous historic funding, we expected to have a much smaller budget this year. That said, WSHA is disappointed some of our important priorities were not funded in these budgets.
WSHA’s 2024 budget priorities. WSHA priorities this year included: complex discharge funding; support for rural labor and delivery sustainability; funding to support reproductive access in public hospital districts; funding for Medicaid coverage for partial hospitalization/intensive outpatient mental health treatment programs for adults; and increasing Medicaid payments for professional services.
We are disappointed that neither budget included funding for long-term care slots for complex discharge patients who are undocumented, rural labor and delivery sustainability, or Medicaid coverage of partial hospitalization/intensive outpatient treatment programs for adults.
We are pleased that both budgets funded the Washington Reproductive Access Alliance for public hospital districts and a new residential treatment facility for children/youth with developmental disabilities and complex behaviors, and the House provides some funding for distressed hospital grants.
Revenue forecast. Forecasted state revenues increased by more than $3 billion since the 2023-25 budget was passed last year, exceeding increased maintenance level costs of $2 billion. State economists are now projecting a healthy balance of $2.7 billion at the end of 2023-25, with total reserves projected at $4 billion. This leaves some room for the Legislature to make new investments in this proposed 2024 supplemental budget. However, budget writers are concerned about three potential ballot initiatives that could substantially reduce state revenues if passed in November (repeal of the long-term care tax, capital gains tax and climate protection act funding), so they were cautious in their spending.
You can read WSHA’s full budget comparison table here.
Senate budget highlights
WSHA identified the following Senate budget items that are of interest to our members. Items in blue are only funded in the Senate budget and were not funded in the House budget.
Hospital Funding
- $412,000 GFS/total for UW to develop and implement the Washington Reproductive Access Alliance, so public hospital districts can provide substantially equivalent services under the Reproductive Privacy Act.
- $300,000 total to fund the Surgical Smoke Evacuation System Reimbursement Account directed by SHB 1779 (2022). Certain hospitals qualify for a reimbursement of $1,000 per operating room to install surgical smoke evacuation systems.
- $3.2 million GFS ($11 million total) to increase Medicaid payment rates to hospitals for the Substance Using Pregnant Person (SUPP) Program.
Complex Discharge Investments
- $2.1 million GFS to fund Office of Public Guardianship pilot program for eligible individuals in hospitals who are ready to discharge. Also funds legal decision maker/guardianship navigator and specialized guardianship training.
- Governor’s Complex Discharge Taskforce budget language amended to allow for expanded pilot participation.
- $12.32 million GFS ($15.25 million total) to provide operational funding for a residential treatment facility at Lake Burien to support youth with developmental disabilities and behavioral challenges, requiring tailored care and structured support environments.
- $1.28 million GFS ($2.75 million total) to increase the specialty dementia care rate add-on from $43.48 per client per day to $50. WSHA has long supported the specialty dementia care rate add-on for long term care providers.
- $2.8 million GFS ($7.0 million total) to increase Medicaid payments to non-emergent medical transportation providers for return trips longer than 25 miles.
Behavioral Health Investments
- $14.33 million GFS ($24.41 million total) is provided to enhance two reimbursement rates paid to 90- and 180-day involuntary civil commitment bed providers. The first is a rate enhancement of $500 per day for involuntary services for complex, difficult-to-place individuals with extensive needs.
- $136 million GFS/total to support operations at Olympic Heritage Behavioral Health (formerly Cascade Hospital) and add 72 inpatient psychiatric beds for civil conversion patients currently at Western State Hospital.
- $20 million GFS/total to fund the UW Behavioral Health Teaching Facility operation of 75 long-term behavioral health beds.
- $1.5 million GFS ($1.9 million total) is provided to increase support of youth stabilization teams in the state’s crisis system. Support is also included for rural crisis stabilization and withdrawal management facilities.
Workforce Investments
- $12.8 million total for the creation of a family medicine graduate medical education directed payment program through the Family Medicine Residency Network to supplement family medicine provider graduate medical education.
- $3.17 million GFS/total for project management teams to implement improvements to reduce the amount of time it takes to complete the health care licensing process.
- $426,000 GFS/total to help recruit and train a health care professional work force in rural and urban underserved areas.
Other Health Care Investments
- $50,000 GFS/total to align the implementation plan for the creation of a real-time hospital bed tracking tool for hospitals that meet WaTech requirements to begin in 2025.
- $48.3 million GFS/Total related to non-citizen Apple Health (Medicaid look-alike) coverage expansion beginning July 1, 2025.
- 2.4 million GFS ($5.3 million total) to align eligibility requirements for pregnant people and children at 210% FPL, update maternity support services and create a post-delivery transitional care program for people with SUD.
House budget highlights
WSHA identified the following House budget items that are of interest to our members. Items in blue were only funded in the House budget and were not funded in the Senate budget.
Hospital Funding
- $4 million GFS for bridge grants to distressed hospitals. $1.36 million is for designated hospitals, with the remaining $2.64 million available to other qualifying hospitals.
- $412,000 GFS/total for UW to develop and implement the Washington Reproductive Access Alliance, so public hospital districts can provide substantially equivalent services under the Reproductive Privacy Act.
- $300,000 total to fund the Surgical Smoke Evacuation System Reimbursement Account directed by SHB 1779 (2022). Certain hospitals qualify for a reimbursement of $1,000 per operating room to install surgical smoke evacuation systems.
- $350,000 GFS/total for OFM to study costs to the state related to non-profit health care providers and insurers.
Complex Discharge Investments
- Governor’s Complex Discharge Taskforce budget language amended to allow for expanded pilot participation and pilot funding shifted between fiscal years to fund the pilot.
- $12.32 million GFS ($15.25 million total) to provide operational funding for a residential treatment facility at Lake Burien to support youth with developmental disabilities and behavioral challenges, requiring tailored care and structured support environments.
- $2.26 million GFS ($4.85 million total) to increase the specialty dementia care rate add-on from $43.48 per client per day to $55. WSHA has long supported the specialty dementia care rate add-on for long term care providers.
- $4.1 million GFS ($10.4 million total) to increase Medicaid payments to non-emergent medical transportation providers for return trips longer than 25 miles.
Behavioral Health Investments
- $14.33 million GFS ($24.41 million total) is provided to enhance two reimbursement rates paid to 90- and 180-day involuntary civil commitment bed providers. The first is a rate enhancement of $500 per day for involuntary services for complex, difficult-to-place individuals with extensive needs.
- $135 million GFS/total to support operations at Olympic Heritage Behavioral Health (formerly Cascade Hospital) and add 72 inpatient psychiatric beds for civil conversion patients currently at Western State Hospital.
- $20 million GFS/total to fund the UW Behavioral Health Teaching Facility operation of 75 long-term behavioral health beds.
- $1.4 million GFS ($1.9 million total) is provided to increase support of youth stabilization teams in the state’s crisis system. Support is also included for rural crisis stabilization and withdrawal management facilities.
- $2 million GFS/total is provided for a pilot program to provide rapid methadone induction services to clients in hospitals electing to provide these services on an inpatient basis.
Workforce Investments
- $12.8 million total for the creation of a family medicine graduate medical education directed payment program through the Family Medicine Residency Network to supplement family medicine provider graduate medical education.
- $3.17 million GFS/total for project management teams to implement improvements to reduce the amount of time it takes to complete the health care licensing process.
- $426,000 GFS/total to help recruit and train a health care professional work force in rural and urban underserved areas.
Other Health Care Investments
- $50,000 GFS/total to align the implementation plan for the creation of a real-time hospital bed tracking tool for hospitals that meet WaTech requirements to begin in 2025.
- $71.1 million GFS/Total related to non-citizen Apple Health (Medicaid look-alike) coverage expansion beginning July 1, 2025.
- $2.38 million to fund non-hospital birth center grants to support new centers in areas lacking access.
WSHA weighing in: Feb. 19-23
WSHA is weighing in on the following bills this week:
Monday, Feb. 19
- House Community Safety, Justice & Reentry
- E2SSB 5937: Supporting crime victims and witnesses by promoting victim-centered, trauma-informed responses. (Jessica Symank)
Tuesday, Feb. 20
- House Civil Rights & Judiciary
- 2SSB 5825: Concerning guardianship and conservatorship. (Zosia Stanley)
- House Health Care & Wellness
- E2SSB 5213: Concerning health care benefit managers. (Andrew Busz)
- SB 5811: Expanding the definition of family member for individual providers. (Katerina LaMarche)
- House Human Services, Youth & Early Learning
- E2SSB 5853: Extending the crisis relief center model to provide behavioral health crisis services for minors. (Cara Helmer)
- Senate Health & Long Term Care
- Providing for health home services for medicaid-eligible children with medically complex conditions. (Katerina LaMarche)
Thank you for testifying!
Thank you to everyone who testified in support of WSHA’s legislative efforts last week:
- Colton Myers, Policy and Legislative Analyst, Ferry County Public Hospital District
Save the date for WSHA’s Legislative Summary Webcast March 26
Please save the date to join us for our 2024 Legislative Summary Webcast from 12-1 p.m. Tuesday, March 26! The Government Affairs Team will provide you with important information from this legislative session, including action you will need to take to comply with newly adopted state law. Please contact Tim Pfarr at timp@wsha.org with questions about the webcast.
