Health equity highlights from the 2021 legislative session

November 11, 2021

Health equity is a top priority for Washington State hospitals. WSHA’s advocacy contributed to passage of several health policy bills and budget items that expand access to care for communities most likely to experience inequities during the 2021 legislative session:

Extend Medicaid coverage for post-partum individuals from 60 days to one year.

In Washington, Medicaid provides coverage to pregnant individuals with income at or below 193% of the federal poverty level (FPL), regardless of immigration status (known as “Apple Health for Pregnant Individuals”). Prior to Senate Bill 5068 and the current public health emergency (see below for details), coverage extended through the end of the month following the 60th day after pregnancy.

For several years, maternal health advocates urged that evidence-based practices demonstrate that access to post-partum care should be extended through the first year after the end of pregnancy. This would ensure access to both medical and behavioral health needs for individuals.

Senate Bill 5068 works to achieve this goal. It requires the State to provide one year of post-partum coverage in two phases.

  • Phase 1: For individuals receiving Medicaid under this program either during or after the expiration of the federal public health emergency due to the COVID-19 pandemic, coverage must be extended from 60 days to one-year post-partum. As a result of the Families First Coronavirus Response Act, the state receives a 6.2% enhanced federal match for Medicaid during the federal public health emergency. However, the State must provide continuous eligibility for individuals who are enrolled in Medicaid during the federal public health emergency – this includes those who are enrolled in the Apple Health for Pregnant Individuals program. The current federal public health emergency determination was renewed on July 20, 2021.
  • Phase 2: By June 1, 2022, pregnant individuals with income under 193% of FPL, who are residents of Washington, are not otherwise eligible for Medicaid or the Children’s Health Insurance Program (CHIP), and are newly eligible for Medicaid, must be provided with one year of post pregnancy coverage, regardless of any change in income.
  • Under the American Rescue Plan Act, states are now allowed a five-year option to expand post-partum Medicaid coverage to one year. This makes it much easier for Washington to make this Medicaid policy change (only requires submission of the state plan amendment).

Going forward, the Health Care Authority (HCA) will work with the Health Benefit Exchange to establish education and outreach campaigns to facilitate enrollment in coverage. This will include ensuring that information is culturally and linguistically accessible.

Prevent insurance companies from discriminating against persons who are prescribed gender affirming procedures

Section 1557 of the Affordable Care Act prohibits discrimination based on race, color, national origin, sex, age, or disabilities in health programs that receive federal funding, administered by the federal government, or qualified health plans that are offered on a health benefit exchange (in Washington, this would include qualified health plans available on Washington Healthplanfinder).

However, in 2020, the US Department of Health and Human Services issued final regulations pertaining to Section 1557. It removes gender identity and sex stereotyping from the definition of prohibited sex-based discrimination and eliminates the provision that prohibits a health plan from categorically or automatically excluding or limiting coverage for health services related to gender transition.

Senate Bill 5313 addresses this by establishing that health carriers and the HCA may not deny coverage for medically necessary gender affirming treatment or apply blanket exclusions to gender affirming treatment. It also requires health carriers and the HCA to ensure access to medically necessary gender affirming treatment. For commercial carriers, this applies to health plans that are issued or renewed on or after January 1, 2022. For Medicaid plans, this is effective as of January 1, 2022.

Increase funding to provide health care for uninsured and underinsured individuals, regardless of immigration status

The 2021-23 operating budget includes $35 million in federal funds to provide health care for uninsured and underinsured individuals, regardless of immigration status. These funds are available as grants to rural health clinics and public hospital districts, along with community health centers, free clinics and BH-ASOs. The grants will be administered by the HCA, which will issue more information shortly.

Grants must be used for direct care (can be on-site or off-site through telemedicine) and related to,

  • Testing, assessment, or treatment of COVID-19 (includes facility and provider fees)
  • Primary and preventive care
  • Behavioral health services
  • Dental care
  • Assessment, treatment, and management of acute or chronic conditions (can include costs of laboratory services, prescription medication, specialty care, therapies, radiology and other diagnostic costs)
  • Outreach and education

Study whether medical and psychiatric respite should be a Medicaid benefit

Respite care provides important post-acute care for people who are experiencing homelessness and are too ill or frail to recover without appropriate living conditions. For these individuals who no longer need hospital-level care, respite programs provide short-term residential services along with access to support services.

Today, there are 10 respite programs across the state, including in partnership with hospitals in Seattle, Spokane, Tacoma, Vancouver, Kitsap and Snohomish counties. While these services are essential in connecting hard-to-reach individuals with much needed preventive and behavioral health care, they are not statewide Medicaid benefits.

The 2021-23 operating budget includes $50,000 for the HCA to analyze the cost-effectiveness of adding respite care as a statewide Medicaid benefit. It will also allow the HCA to establish an implementation plan, which will include reimbursement structures, any administrative changes, and provider outreach. The HCA is to report its findings to the legislature, the Governor’s office, and the office of financial management by January 15, 2022.


We expect to support additional legislation to expand access to care in the 2022 legislative session, which convenes in January.


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Washington State Hospital Association
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Seattle, WA 98104

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