Gov. Jay Inslee released his proposed $62 billion supplemental budget this week. This year, the governor released the budget in four distinct parts, highlighting three major priority budget areas: climate, salmon recovery and homelessness. The fourth part, released today, rounded out the remainder of the 2022 supplemental budget. In addition to maintenance level funding adjustments, the budget released today targets new investments in poverty reduction, transportation and public health. Overall, education is the largest area of spending ($28.3 billion), followed by social and health services ($7.5 billion) and the Health Care Authority ($6.8 billion). We appreciate the governor’s investment in WSHA’s priority areas outlined below. However, new health care spending in this budget is largely focused on transitioning out of federal pandemic programs.
In a 60-day legislative session, the supplemental budget makes spending adjustments to the 2021-2023 biennial budget that was passed last year. Supplemental budgets typically do not include new large spending increases — referred to as policy-level changes. This supplemental budget does not fit that pattern. The governor proposes $4.2 billion in new spending.
The budget exercise, however, is not over. The Legislature will convene on Jan. 10, 2022. The House and Senate will also release their versions of the budget during the legislative session (in February) before working together to craft a final budget. Revenue forecasts released along the way will inform the process. The last day of the regular session is Thursday, March 10.
WSHA has outlined highlights related to WSHA’s budget priorities below and will send a more detailed analysis of the governor’s supplemental budget tomorrow.
WSHA’s Budget Priorities
The Proposed 2022 Supplemental Budget and Policy Highlights document, which outlines the governor’s priorities, highlights investments in each of WSHA’s four priority budget areas.
Health Care Workforce Investments
The governor proposed a package of investments titled “Addressing Washington’s Nurse Shortage.” While the proposal does not include all the elements WSHA and other stakeholders have been pursuing, it does highlight the governor’s commitment to address the nursing workforce shortage. WSHA and key stakeholders will continue to advocate for additional investment. The package includes the following proposed investments:
- $6 million state to establish a nurse preceptor grant program for nurses who are willing to supervise nursing students in health care settings.
- $8 million state to administer grants to incentivize students to enter the health workforce. This includes up to one year of college and access to tutoring, career advising, emergency childcare and more .
- $3.6 million state + $3.6 million state + $5.8 million state ($13 million total) to administer grants for nursing programs to purchase and upgrade simulation lab equipment to help expand capacity and serve more nursing students.
- $7.8 million state for Nurse Staffing Crisis for Long Term Care (LTC) funding to conduct health workforce survey of LTC workers and pilot grant funded program to improve retention and “job quality” in LTC facilities.
In addition to this package, the proposed budget includes investments in the following administrative processes to facilitate health care workforce entry.
- $2.5 million state to improve health care credentialing performance.
- $0 state ($2 million total) to fund 10 additional FTE licensing staff for faster processing for nurse licenses.
- $0 state ($761,000 total) NQAC will expand nursing assistant training to reduce the time an individual needs to complete the nurse certification exam and create an apprenticeship pathway for nurse assistants and LPNs.
Difficult to Discharge
We are pleased the governor’s budget makes investments to address barriers that are keeping non-acute patients stuck in hospitals, leading to high hospital capacity and delays in timely care for patients who really need acute care. The governor’s budget includes important funding to address difficult-to-place patients, but more substantial, sustained investments are needed. Several of WSHA’s priorities are not fully funded in the proposal, including increased DSHS home and community services assessor staffing. The proposed budget includes funding for the following:
- $0 state ($3.4 million total) for COVID-positive units in nursing homes.
- $0 state ($3.24 million total) in incentive payments to long-term care settings to accept non-acute patients from acute care hospitals.
- $0 state ($840,000 total) for incentive payments to skilled nursing facilities to take Medicaid clients discharged from inpatient care.
- $39.8 million in local match and federal funds to renew Initiative 2 (long-term supports for older adults) for 5 additional years under the state’s Medicaid Transformation Project, subject to federal approval. This proposal includes funding for two WSHA priorities: guardianships for low-income people through the Office of Public Guardian and LTSS funding to implement presumptive eligibility for patients discharging from acute care hospitals.
WSHA’s priorities for behavioral health include a call for a comprehensive plan to improve the behavioral health system of care, expanded access to intensive outpatient treatment/partial hospitalization program benefits and additional funding for the Children’s Long-term Inpatient Program (CLIP). The governor’s proposed budget includes several measures designed to improve behavioral health services across the continuum of care. Relevant highlights include:
- $300,000 state funds for the prenatal-to-25-year-old behavioral health facilitation to help facilitate the Children and Youth Behavioral Health Workgroup and develop a strategic plan for behavioral health services for children and youth ages prenatal to 25 years. WSHA hopes to increase this funding to support a comprehensive statewide strategic plan for behavioral health services for all ages.
- $15 million state ($30 million total) to increase the number of community-contracted Children’s Long-Term Inpatient Program (CLIP) beds.
- $4.6 million state ($5.5 million total funds) for youth inpatient navigators to help support families and children that need, but are unable to find, long-term inpatient beds.
- $10.7 million state funds ($30.46 million total funds) for a 4.5-percent increase in Medicaid reimbursement rates for community behavioral health providers contracted through managed care organizations. This is in addition to the 2-percent increase provided in the current 2021-2023 budget. The Children and Youth Behavioral Health Work Group and Behavioral Health Workforce Advisory Committee both recommended a 7-percent increase.
- $50 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 the COVID-19 epidemic.
COVID-19 Response and Health Care
One of WSHA’s top priorities is to ensure funding for the Washington Medical Coordination Center, which was put in place during the pandemic to level-load hospital capacity across the state during capacity surges. The pandemic has taught us that we should be prepared with this type of resource in the event of any unexpected capacity surge. The governor’s budget proposed to fund the WMCC at $1.3 million for the remainder of the biennium.
The budget proposal also includes significant investments in COVID-19 response:
- $173.2 million state ($198.4 million total) for COVID-19 Contain the Spread. Funds to continue supporting statewide efforts for diagnostic testing, case investigation and contact tracing, care coordination, outbreak response, disease surveillance, public communications and other necessary operational support.
- $99.9 million state to expand COVID-19 vaccinations.
Join us for our Legislative Session Kickoff webinar Jan. 11
Please join us at noon Tuesday, Jan. 11 for our annual Legislative Session Kickoff webinar for members. The webinar will cover what to expect during the 2022 legislative session and give an overview of WSHA’s legislative priorities and hot topics. It will also include an opportunity to ask questions of WSHA’s Government Affairs leaders. We will record the webinar for our members to watch at their convenience. Register now.
Join us for Hospital Advocacy Days Jan. 24-28
WSHA will host our annual Hospital Advocacy Days Jan. 24-28, 2022. The event activities and meetings will be virtual once again, and attendees will partner with WSHA staff to meet with state lawmakers to advocate for health care priorities and to tell the hospital story. This is your chance to be a voice for your hospital patients and community. We ask that you register as soon as possible — and hold the time on your calendar — so our team can schedule meetings with legislators. Register online at wsha.org/advocacydays and contact Joanna Castellanos at email@example.com with questions.