Welcome to the Advocacy Exchange, where action, information, and community collide. Featuring opportunities for powerful action, behind-the-scenes updates from the WHCA staff, and inspiring stories from your colleagues in long-term care, this is your destination for advocacy.

Action

Secure Improved AL Medicaid Rates

In Olympia, the current focus is on one thing: the state operating budget. The House and Senate proposals have dropped, and everyone is scrambling to get their priorities secured in the final conference budget (more on that process in the Information section).

You can see a detailed breakdown of the competing proposals here – but the short of it is that the House budget proposal is far and away the best for assisted living providers. It boosts Medicaid rates for labor and specialized dementia care and lowers the threshold to qualify for the high-occupancy bridge rate. As budget negotiations heat up this week, it is essential that legislators understand the need to carry this funding into the final budget. This is where your action matters.

On the skilled nursing side of things, both proposals maintain a critically important rates rebase, and we are working internally with key legislators on implementation of the patient driven payment model. If and when it’s time to call in the cavalry, we’ll flex our grassroots muscle to support this effort– stay tuned.

Information

A Look Inside the Conference Budget Process

It’s easy to say, “the Governor, House, and Senate proposals are negotiated into a final conference budget”. But that hardly does justice to the process. Each proposal, underpinned by hundreds of hours of analysis, must be consolidated into one 70-billion-dollar operating budget that’s both financially and politically feasible. One mistake or overlooked appropriation could destabilize entire industries and jeopardize key portions of our social safety net.

This process of winnowing is surprisingly informal, largely dependent on the personalities and preferences of several legislative budget leaders. The key decision-makers in the House are Representatives Ormsby (D-03), Berquist (D-11), and Corry (R-14). Their Senatorial counterparts are Senators Robinson (D-38), Mullet (D-05), and Lynda Wilson (R-17). Because Sen. Robinson (Chair of Senate Ways & Means) previously served as Vice Chair under House Appropriations Chair Rep. Ormsby, they have a close working relationship and coordinate to a greater degree than past budget committee Chairs.

These leaders follow a general top-down process. They usually start with the big picture, determining what total spending will be and how much reserve funds will be used. Then they determine the “boxes”: how much will be spent for DSHS, DoH, K-12, etc. Next come further breakdowns – for example, appropriations to ALTSA within the DSHS box, and within that, funding for SNF, AL, ESF, and AFH. Typically, the last items negotiated are provisos – funding packages for specific projects.

Formality returns with the appointment of a Conference Committee, probably comprised of the above group of lawmakers. They will gather, review proposals line-by-line, finalize a conference report detailing the negotiated budget, and place this final budget request before the House or Senate. Once both chambers pass the negotiated budget bill, the Governor can veto any portion (or all) of the budget before signing it into law.

Connection

Committee Testimony, Media Engagement, and Growing Relationships

WHCA members have been advocating in a big way this session. Here are some highlights:

1. HB 1859 Testimony

• This bill would have endangered AL/ESF staff and residents. But opposed by the compelling testimony of WHCA members and allied stakeholders (and the 1,710 people who registered opposition), the bill failed to advance.

2. Media Placements

• Zack Wester Op-Ed | The Spokesman Review - Noble Healthcare co-owner and WHCA Board member Zack Wester published this powerful op-ed with perfect timing, just before budget negotiations and in the hometown paper of key budget leaders. He persuasively connected assisted living rate underfunding to the ongoing homelessness crisis in the Spokane area.
• Linzi Michel LTE | The Columbia Basin Herald - Another WHCA Board member, Linzi Michel is the Administrator at The Cambridge Assisted Living in Quincy. Published around the same time as Zack, she also warned against low Medicaid rates – with a distinctly local spin.
• In-Progress - From pitching a potent op-ed rejection of CMS’ skilled nursing staffing mandate, to several additional AL Medicaid-focused letters to the editor, we are working with experts to amplify your voice in the public square.

3. Relationship-building

Advocacy isn’t so different from farming – you plant seeds, nurture their growth, and when the time is right, harvest the fruits of your labor while keeping the ground fertile. This analogy springs to life with Mindy and Brian Kleine, whose advocacy journey we brought you along in the inaugural Advocacy Exchange. A few weeks ago, Congresswoman Gluesenkamp-Perez visited their facility, showing that the seed of advocacy they planted last summer has grown into a fine young tree indeed.

Congresswoman Gluesenkamp-Perez having some fun during her facility visit.

Each of these efforts create momentum—and together we can generate results. Thank you for being part of this community of advocates. Your work is making a difference.

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