Yesterday afternoon, the House and Senate released their final supplemental budget for the remainder of the 2021-2023 biennium. The Legislature is set to adjourn today – March 10. Since the adoption of the 2021-23 budget, actual and estimated future 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 (fiscal year 2021 through fiscal year 2025), projected revenues exceed the estimates made a year ago by $10.1 billion. Relative to the enacted budget, the cost of continuing programs for the 2021-23 biennium has declined by a net of $1.1 billion. 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 (the largest contributor to the savings).
Overall, the final supplemental budget added significant new funding in transportation, K-12 education, rental assistance, and homelessness initiatives, as well as substantial investments in health care.
Great news for health care. WSHA is pleased that all of WSHA’s budget priorities are funded in the final budget. Combined funding for WSHA’s four budget priorities includes $525.2 million state and $861.2 million total funds.
WSHA is particularly pleased with the funding for the Department of Social Health Services (DSHS) Long Term Care, DSHS Developmental Disability Administration, and Health Care Authority to address barriers related to difficult-to-discharge and long-length-of-stay patients. This unprecedented funding is a direct result of strong advocacy by WSHA, hospitals and our partners.
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 final budget funds $5 million for 180 nursing education slots at the University of Washington ($1.2 million) and in community colleges ($3.8 million), and $6.2 million for development of a Bachelor of Nursing program at Eastern Washington University that will create 40 nursing education slots. The budget also funds additional simulation labs at $15.2 million. $47.8 million state, $49.8 million total funds.
- Difficult to discharge and long length of stay – 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. The budget funds virtually all of our difficult-to-discharge priorities in some form. This was greatly enhanced by the governor’s Hospital Staffing Initiative. $269.3 million state, $548.7 million total funds.
- Behavioral health – Improving the behavioral health system of care across the continuum. The budget makes significant investments in behavioral health, including WSHA’s top priorities. $206.8 million state and $261.4 million total funds.
- Washington Medical Coordinating Center – 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. The budget fully funds the WMCC for the remainder of the biennium. $1.3 million state funds.
Final Budget Highlights
Health care workforce
- $5 million state for nursing education to increase the number of nursing slots (180 slots in 2023) and graduates at UW ($1.2 million) and in community colleges ($3.8 million). The community college funding also includes resources to purchase two simulation mobile vans.
- $6.2 million state to establish a Bachelor of Science in nursing program at Eastern Washington University (40 slots).
- $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.
- $461,000 state for development of a Master of Science in nursing program at Western Washington University.
- $15.2 million state 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 supervising nursing students in health care settings.
- $8 million state to expand the Opportunity Grant program to provide health care workforce grants for students.
- $3 million state for implementation of HB 2007 on graduate nursing student loan repayment for nurse educators.
- $1 million state to establish a joint labor-management CNA apprenticeship program.
- $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.
Difficult to discharge and long length of stay
- $10.5 million state ($21 million total) for DSHS for incentive payments to long-term care facilities to take Medicaid clients discharged from hospitals.
- $2.2 million state for HCA incentive payments to skilled nursing facilities to take Medicaid clients discharged from hospitals.
- $8.9 million total funds 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 low-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, 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:
- $1.7 million state ($2.1 million total) for Agencies on Aging (AAA) care coordinators stationed in acute care hospitals.
- $3 million state ($6 million total) for incentive payments to home- and community-based service providers who 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.
- $12 million state ($26.3 million total) to establish 242 nursing home beds to serve patients discharging from acute care hospitals.
- $688,000 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.
- $1.2 million ($1.5 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)
- $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.
- $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.
- $2.9 million state to expand the partial hospitalization and intensive outpatient pilot programs to an additional site beginning in FY 2023.
- $6 million ($8 million total) for no-barrier or low-barrier, housing-first model.
- $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 ($49.9 million total) to increase Medicaid reimbursement rates by 7% for community behavioral health providers contracted through managed care organizations.
- $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 million 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 million total) for assisted outpatient treatment.
- $20 million state funds for non-Medicaid funding to increase Behavioral Health-Administrative Service Organization and Managed Care Organization wraparound service contracts and implement a 7% rate to address services needs that cannot be paid for with Medicaid funds.
- $1.5 million state funds for reopening evaluation and treatment facilities, increasing staff capacity and expanding outpatient services for adults ages 18-24 in Clark and Spokane counties.
Washington Medical Coordinating Center (WMCC)
- $1.3 million state to contract with WMCC to provide services that connect all health care facilities, ensure clinical coordination and equitably distribute patients.
Other health care investments
- $1 million for training nurses to perform sexual assault examinations as well as funding to start programs in hospitals that do not currently have the service.
- $244,000 state funds for increased sexual assault nurse examiner (SANE) training (HB 1622)
Save the Date: Legislative Summary Webcast from 12-1 p.m. Wednesday, March 23
Please save the date to join us for the Legislative Summary Webcast from 12-1 p.m. Wednesday, March 23. This important members-only webinar will provide you with important information from this legislative session, including action you will need to take to comply with newly adopted state law. Register now!