Yesterday, the Legislature adjourned after the 105-day regular session. Thank you for your advocacy work throughout the session—it is incredibly important that legislators understand that you are interested and engaged. We are committed to continued support in the interim and look forward to working with you to connect more powerfully.
Final Budget Passes
The Legislature passed the final operating budget plan for 2023-25 on Sunday. The bill now travels to the Governor’s Office for final consideration. The Legislature’s state operating budget allocates $70 billion in state spending for the two-year cycle. Here is a three-way budget comparison.
For assisted living, the budget drives $170 million in additional funding, including a 15% increase in base Medicaid rates. The plan includes a FY25 rebase in base rates that equates to an increase of about $7/day as well. Specialized dementia care rates are converted to a flat rate add-on of $43.48 per resident day. “Bridge funding” of $20.99 per day is provided for ARC, EARC and AL contracts for care centers where there is a Medicaid census of 90% or greater. The plan also includes a 5% increase for enhanced community services contracted rates. We are working to review the rates models—the House, the Senate, and the Governor each used different base models so we are looking to DSHS to provide final rate impact. We will provide that information as soon as we have it.
For enhanced services facilities, the final budget provides a rate increase from $459/day to $596.10/day, and provides $30 million in operating funds for new ESFs and specialized dementia care beds through the Behavioral Health Community Capacity Grants funded in the 2021-23 capital budget. This includes a phase in of 64 ESF beds, and phase-in of 107 additional specialized dementia beds. The budget also requires DSHS to develop a standard process for acute care hospital referrals for difficult to discharge behavior clients to go to ESFs and EARCs with specialty behavioral health contracts. DSHS is required to allow the referrals to go to these providers regardless of whether the individual being referred has involuntary treatment history.
For skilled nursing facilities, the Conference budget drove a total of $406.1 million in additional Medicaid funding, including money for a one-time annual rebase for FY24 and for the statutory FY25 rebase. The current budget dial is $319.82. That moves to $341.41 for FY24, and $364.67 for FY25. The plan includes an inflation adjustment for each year of the biennium (FY24 = 4.7%; FY25 = 5%). Minimum occupancy is established at 80% for FY24 & FY25. The direct care cap was also subject to adjustment (FY24 = 153%; FY25 = 142%). The budget provides that a rate add-on will be allocated to ensure the budget dial from FY25 is carried into the base for the 2025-27 biennium. This means the dollars are built into the four-year Outlook Budget even though the one-time policies will be sunset in two years. Finally, the proposal also includes funding for SNF specialty rates including vent and trach care.
Policy Wrap-Up
There was much positive momentum on workforce issues this session. Additionally, we were successful in our work to ensure that independent senior meals are exempt from taxes, and we helped shape legislation related to nursing pool reporting and transparency. Here are details on the policy bills we’ve been engaged in this session. Some of these initiatives will require rule promulgation—WHCA will be fully engaged in these efforts.
Where do we go from here?
While the Legislature adjourned on Sunday, I recognize that our work is far from over. I believe that we have gained traction with legislative leaders but, in truth, I am not fully satisfied with this budget, particularly for assisted living Medicaid funding. We clearly have more education to do with policymakers for all our provider types. In June we will begin working on my traditional and comprehensive data book that we will use next session and we will look to our providers to help us determine what data sets to include. At a minimum, we will once again be highlighting workforce shortages and wages. In the immediate future, our team is working on a grassroots advocacy plan designed to ensure legislators can tour member care centers, meet the individuals who deliver care and services, and most importantly, meet the patients and residents who rely on long term care support. We will count on your assistance with these initiatives.
Plan to Attend the WHCA Annual Convention in Tacoma, May 22-24, 2023
Please join your long term care peers from across the state at the WHCA Convention coming up in May. We are providing a legislative wrap up and honoring key advocates. We have also invited DSHS rates division to present on both SNF and AL rates. We will be starting our strategic work anew. We will welcome and appreciate your input, engagement, and presence. I do hope to see you there. Learn more.
