Inside Olympia: Legislature releases final 2024 supplemental budget

March 6, 2024

The Washington State Legislature released its final 2024 supplemental budget March 6. This is a supplemental budget year, which means this budget provides updates to the 2023-2025 biennial budget passed last session.

Last year, we saw unprecedented investments in important policy areas, such as the hospital Safety Net Assessment Program and investments to help with complex discharge patients. Given this is a supplemental budget session and last year’s historic funding levels, we expected to have a smaller budget this year.

WSHA’s 2024 budget priorities: WSHA advocated for the following priorities during the legislative session: complex discharge funding; support for rural labor and delivery sustainability; funding to support reproductive care 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 pleased that both budgets funded the Washington Reproductive Access Alliance, a new residential treatment facility for children/youth with developmental disabilities and complex behaviors, and expanded funding for distressed hospital grants, which includes funding for hospitals at risk of reducing labor and delivery services.

We are disappointed the budget did not include funding for long-term care slots for complex discharge patients who are undocumented, Medicaid coverage of partial hospitalization/intensive outpatient treatment programs for adults or Medicaid payment increases for specialty providers.

Revenue forecast: Forecasted state revenues increased by more than $3 billion since the 2023-2025 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 2023-2025, with total reserves projected at $4 billion. This left some room for the Legislature to make new investments in this proposed 2024 supplemental budget. However, budget writers remain concerned about three ballot initiatives that could substantially reduce state revenues if passed in November (repeal of the long-term care tax, capital gains tax and climate commitment act funding), so they were cautious in their spending.

You can read WSHA’s full budget comparison table here.

Final budget highlights

Hospital Specific Budget Items

  • $2.9 million GFS/total for bridge grants to distressed hospitals, including those at risk of reducing labor and delivery services. $1.36 million is for designated hospitals and $1.6 million is for low-volume birthing hospitals in danger of closing labor and delivery units.
  • $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.
  • $1.6 million GFS ($5.5 million total) to increase Medicaid payment rates to hospitals for the Substance Using Pregnant Person (SUPP) Program.
  • $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.
  • $274,000 GFS/total for an OFM study of pregnancy-related health care services.
  • $350,000 total for an OFM study of costs to the state related to tax breaks for non-profit health care providers and a report to the legislature and Governor’s Office by Oct. 1, 2024.
  • $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.

Complex Discharge Investments

  • $2.1 million GFS/total 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.
  • $2.85 million GFS ($7.1 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) 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.
  • $1.65 million GFS ($1.9 million total) 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 workforce in rural and urban underserved areas.

Other Health Care Investments

  • $71.04 million GFS/total for non-citizen Apple Health (Medicaid look-alike) coverage expansion beginning July 1, 2024. This is estimated to cover up to 15,000 of the over 100,000 eligible adults.
  • $2.4 million GFS ($5.3 million total) to align eligibility requirements for pregnant people and children at 210% of the federal poverty level, update maternity support services and create a post-delivery transitional care program for people with substance use disorder.


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